Posted on 06/22/2012 7:54:17 AM PDT by DBCJR
How do I know when a prescription becomes an addiction? This is a critical question.
Many Oklahomans have a legitimate need for prescription painkillers for the relief of pain from surgery or an injury. Unfortunately, even legitimate reliance on medication can easily and unintentionally turn into physical dependence.
That can be confusing, as the medications ARE prescribed by a doctor, so doesn’t that mean that they are needed and safe to use? Alarmingly, the most commonly prescribed drugs including OxyContin, Vicodin, hydrocodne, hydrocodone, Darvocet, Lortab, Lorcet and Percocet can cause one to start "needing" the drugs in order to feel normal, or keep from getting sick, at the same time they offer relief from pain.
That is called addiction, whether prescribed or not. Addiction is an obsessive compulsive behavior:
They become obsessed meaning it controls their thinking and focus. It becomes compulsive, meaning they MUST get the drug regardless of what it costs in terms of money, time, and relationships.
Addiction is progressive, meaning it is hard to distinguish from legitimate need at first, then gradually builds in its intensity and control of one’s life. At the same time the denial , associated with addiction, is developing making it hard for the addict to see, and often for those who love them as well. By the time addiction reveals itself it often has the addict firmly in its clutches. Early detection and intervention lessens the progression of the addiction and the damage it causes.
Here are some symptoms to consider if you think someone you know may be experiencing a dependency on these drugs.
1. Usage Increase - Over time, it is common for individuals taking prescription medications to have increased tolerance to the effects of their prescribed medication dose. That means it takes more and more of the drug to produce the same effect. Increased tolerance indicates the person will also have increased withdrawal symptoms when they quit the medication. That is physical addiction to the drug. This symptom can be seen by the following signs:
badgering the doctor to continue their medication past the prescribed period, taking more medication or at a rate quicker than prescribed, pressuring their doctor for higher and higher doses, or going to more than one doctor to get more of the drug.
2. Change in Personality – While there may be other explanations, changes in a person's normal behavior can be a sign of dependency. Energy level, mood, and concentration changes may may signal every day responsibilities become secondary to the need for the relief the prescription provides and the psychological escape it offers. Opiate drugs affect the brain in a way that heightens one’s perception of pain, both physical and emotional. They may become less tolerant of the stress of everyday life and neglect schoolwork, parenting, or job responsibilities.
3. Social Withdrawal – Withdrawal from family, friends and other social interaction may result as they become more focused upon their drug, obtaining it, and avoiding negative feedback about it and/or the stress of social interaction. Initially, they may tend to hang out with people who share their growing obsession with the drug. The commonality that forms the basis of their relationship may be sharing contacts for doctor-shopping or street drugs. As the addiction progresses, the obsession with securing a supply of the drug and finding sources narrows their social circle to those people who use at the level they use and know how to get that quantity of drugs. By the time you detect this pattern of behavior they are likely using a far greater amount than you are aware.
4. Ongoing Use – Wanting refills after a medical condition has improved can be a sign of a forming addiction. They may say they are "still feeling pain" and need just a little longer on the medication in order to get well. Frequent complaints about doctors who refuse to write the prescription, looking for other doctors, or being fired or referred by a doctor could be signs. The addict may actually be experiencing pain as opiates numb pain receptors and chronic use can create a chronic hypersensitivity, meaning they have an enhanced perception of pain. Many opiate addicts, who had no chronic pain problem before, develop one during their addiction because of the effects of opiates on the brain.
5. Time/Effort Spent on Maintaining Supply – An addict will spend large amounts of time searching, driving great distances, and visiting multiple doctors to obtain the drugs. This is a result of a preoccupation with securing their needed supply of the drug, demonstrating that the drug has become their top priority.
6. Decline in Appearance and Hygiene – As the addiction becomes their focus less attention is placed on other things that previously were considered important, like appearance and self-care. The opiate, a central nervous system depressant, bombards the brain daily also causing a chemically induced depressive state that lowers motivation. Pupils may be constricted, smaller. They may itch and scratch frequently.
7. Decline in Health – Sleeping habits may change as a result of a lack of energy and tiredness. They may nod a lot, fighting sleep. Eating habits may also change as opiates often affect one’s gastrointestinal system. While using, the addict will tend toward constipation. During the ascending high they may become nauseated. In withdrawals they may tend toward diarrhea. and a person may have a constant cough, runny nose and red, glazed eyes.
8. Neglects Responsibilities - A dependent person may call in sick to work more often, and neglect household chores and bills.
9. Increased Sensitivity - Normal sights, sounds and emotions might become overly stimulating to the person. Hallucinations, although perhaps difficult to monitor, may occur as well.
10. Blackouts and Forgetfulness – A definite sign of dependence is when the person regularly forgets events that have taken place and appears to be suffering blackouts.
11. Defensiveness - When the addict feels their addiction is being threatened, even subcosciously, they can become very defensive. Just being discovered is considered a threat as, if they acknowledge the addiction, they may feel like they will be pressured to do something about it. So, a type of defensiveness called denial develops. Subconsciously, they head off awareness by minimizing, blame-shifting, etc. They might even react to simple requests or questions by lashing out.
Prescriptions to painkiller medication can be safe when taken as prescribed and are carefully monitored. However, it is important to recognize that, even when prescribed, opiates can be dangerous. Addiction is a disease that can develop even in the most cautious person. Therefore, anyone who is prescribed pain medications should take extra precautions to avoid the developing a dependency. Watch for these symptoms.
If you see a few of the above symptoms come by http://ascs-okc.com to find out more or call 405-672-3033.
Much here is very good - when obtaining the drug becomes a preoccupation or interferes with normal functioning, it is a problem. However, on the other hand, it is also a problem when people cannot function due to crippling pain. Certainly a physical addiction develops - but while the author attributes personality change, obsession, etc with opiate addiction, he ignores the fact that people in constant pain also undergo massive personality changes, obsessions about their pain, doctor shopping to try any means (surgery, electronic stimulators, accupuncture, physical therapy, "miracle" diets, hypnosis, etc) to deal with the pain.
But certainly, if you or a loved one take perscription painkillers, you should be on the lookout for side-effects and discuss strategies for not developing a tolerance that requires ever-increasing doses.
Not sure what agenda you think you are seeing here. It appears that you read the article through a certain lens. But, perhaps, I can clarify some of your concerns about the article.
The author often used “may” and suggested there might be other causes for such observations. Chronic pain affects personality, which is well documented, but in different ways than addiction affects personality. Where they are similar is the pain-avoidant behavior parallels medication-seeking behavior, to which you referred. Where it is different, however, is when alternative means are suggested but the patient is obsessed ONLY with the drug.
One is focused on pain avoidance, the other, as the author makes clear, is focused upon obtaining the drug. While those can, at times, appear similarly they are distinguishable.
I have been a hospital nurse for over 30 years and have had a ringside seat at the burgeoning narcotic problem that has emerged in this country. Narcotic dependence was something you used to see in innercity neighborhoods. Now, entire hospital units are filled with patients of all ages and backgrounds who are consuming quantities of narcotic pain medications such as I have never seen. And it’s ruining their lives. Plus it’s making the lives of healthcare workers and their families a nightmare.
Where it is different, however, is when alternative means are suggested but the patient is obsessed ONLY with the drug.
****
That is precisely where it is not different.
I would become angry very quickly if some quack tried to take away painkillers that were controlling my pain very well in favour of deep breathing exercises and a couple sessions in a hot tub.
Luckily I’m a DO so I can get what I need, when I need it, despite the NHS.
We don’t become hysterical when people are “dependent” on beta-blockers, SSRI’s, or any number of drugs the sudden withdrawal of which can cause nasty rebound syndromes.
Its only painkillers because, my god, they might make people feel good as well as controlling their pain, and we just can’t have that.
Short acting benzo’s are viewed this way by the NHS.
So what if ativan actually works for people with chronic panic disorder, let’s put ‘em on SSRI’s or beta-blockers (drugs that can have many difficult to live with side effects than and are less effective) because someone, somewhere, might be getting doped up on ‘em.
What is most pathetic about all this is the fact that most of the “life destroying” side effects that accompany opiate dependence can be traced directly to the practice of making the drugs difficult to obtain rather than the dependence itself.
As for all this talk of obsessions, the obsession with denying that opiate based drugs are usually the most effective remedy for chronic pain is bizarre and unhealthy in itself.
Painkillers and doctors who prescribe them have become demonized by the nanny state.
A stash of vicodin is your friend! My doc prescribes it for me. I only get 60 tablets a year and I’m very careful with them. Usually, I cut them in half. I use it for pain that motrin can’t touch. That’s usually only one or two days month or if I get a back injury.
Before I got on thyroid meds I was in terrible pain everyday. I believe it’s much harder on a person’s body to be eating tylenol or motrin like candy trying to get rid of the pain than just taking one pill.
Of course, some people do abuse these meds. From what I’ve read, the amounts they ingest are staggering.
I hate to see people suffer due to the stupidity of a few.
Addiction is terrible, but so is labeling someone a potential addict just because they ask for something that works.
Living everyday in excruciating pain and suffering that indignity adds insult to injury.
As a physician you should know that the dependence on an SSRI is not the same type as that of an addiction. That is so blatantly a broad-brushed statement that, for a physician, it calls your motivations into question.
Good clinical practice is not to “make people feel good”, as you imply. Relieving acute pain with opiates or acute anxiety with benzos are legitimate treatment goals. When the disorders become chronic, the addictive quality of those medications countervail that indication.
“Addiction is terrible, but so is labeling someone a potential addict just because they ask for something that works.”
Who did that?
Addiction can LEAD to OC behavior, but addiction to opiate painkillers (in this example) is a physical fact. It is not a behavior; it is a biological fact clinically observable through the servere medical reaction which happens when these drugs are suddenly withdrawn from long time users. (Which is not to deny there CAN be a psychological addiction as well; but the physical fact of biological dependence is VERY real. If you don't believe me, visit a local de-tox facility. Those folks aren't shaking because they want to!)
Yes, of course I have a certain lens. I am a long term user of prescription painkillers - under the care of ONE doctor, a psychiatrist whose experience with drug addiction goes back to treatment programs during the Vietnam War. (Once it became apparent I might be on painkillers for a long time, I wanted to make sure someone was "in charge" who knew what he was doing.) There is no doubt that I am physically addicted to these painkillers - and obviously I have talked seriously with my doctor about them. When I asked him directly about this he said: "You're not a druggie; you don't take this stuff to get high; you take what you need to be functional". When I got a spinal stimulator implanted, I was able to halve the amount of painkillers I took (and was glad to, because the CNS depressive efffects of painkillers are NOT pleasant if you ARE trying to function. In my case, I must also take an anti-narcolepsy drug to counter these side effects.)
So I find the original author is painting with far too broad a brush. Certainly there is a problem with people who take these substances in greater quantity than needed or to address an inability to cope with life, or to experience a sense of exhiliration. But the author seems to pay scant attention to differentiate the two behavior sets.
I think the problem comes in trying to use the term addiction to refer to 2 very different things. There is a physical addiction which is a side effect of taking these medications for a period of time; there is a completely different problem with a psychological addiction and the progression from druge USE to drug ABUSE. The author is clearly focused on the second problem but, I find, is less careful than he should be in differentiating a physical addiction from a pattern of self-destructive and anti-social behavior which he refers to as "addiction" with no other qualifiers. Of course, the person in a self-destructive spiral ALSO has a physical addiction).
We have enough of a nanny state as it is - I am not interested in giving the government any more ammunition than it already has to interfere with medical decisions which should be between a patient and responsible doctor.
Addiction is in fact an obsessive compulsive behavioral pattern. That is most established in addiction research so I will not argue the point with you here.
The fact that there is a clear physical dependency does not negate such a psychologic phenomenon but rather supports it. Such dichotomous perspective would disintegrate a highly integrated biological/psychological system.
There is no need to be defensive. I was not posting the article AT YOU, nor was it written AT YOU. Your reaction, however, is very interesting.
Finally, the author never made any statements that could be construed as advocating a governmental policy of any kind. There was no need to bring in the “nanny state” comments. The article was written to help people realize if they have an addiction. If that is a sensitive subject for you, you might want to take a look at that. Perhaps it is because you have been wrongly accused in the past that you are so sensitive. But nothing has been written here that points the finger at you.
Your reaction is very interesting and says a lot about you.
I was thinking the same thing. You have to be living under a rock to not know that pain patients have been attacked and kept under a cloud of suspicion for decades. Good people are suffering because of a puritanical mindset that is beyond all logic and reason.
That sounds strange. I think I want a second opinion. ;-)
Otherwise doctors would be bartenders or prostitutes.
I posted an article on how you determine if someone who is on painkillers is addicted and you two take it personally. That is a bit suspect. Nothing about that is puritanical. The article was a guide for self-assessment.
It boogles my mind that some late stage terminal cancer patients or chronic severe pain sufferers are denied pain meds or given doses too low to be of any real help or made to feel like criminals for getting their Rx’s filled because of the “concern” they may become addicted.
Granted, there are bad doc’s – pill pushers and some very wiley addicts who make it hard for legitimate pain sufferers. But a good doctor who knows his patient is in extreme pain and should be able to help his patient get through it. And that same good doctor should be able to determine when the patient is no longer in physical pain and is now just looking to “feel good”. IMO, you treat and relieve the symptoms, work to eliminate the cause of the pain if possible, incorporate safer methods for dealing with the pain along with medications if chronic, and if in the event that addiction to the pain meds follows, treat that addiction and rationally and safely, slowly bringing the patient down from the use of pain killers as just the next step in the overall treatment plan. The worse thing is to deny the person their pain meds and make them feel like criminals as 1) they may legitimately need them and 2) even if they are addicted, forcing them to go underground, almost guarantees that they will be one.
There is no reason with our advancements in medicine and pharmaceuticals that anyone should unnecessarily suffer excruciating pain. And this is coming from someone who rarely even takes an aspirin.
The most “drugged up” I ever was, was after a back injury – the pain and the constant muscle spasms were unbearable and had been going on for days before I finally decided I couldn’t deal with it anymore. My niece drove me to the ER after it took me nearly an hour just to get out of bed and another ½ hour to literally crawl to the bathroom (and I ended up peeing on the floor as I was in so much pain and the spasms so bad, that I couldn’t pull myself off the floor to get on the toilet) an another ½ hour to make my way to a phone to call for help (all the time that commercial – “Help me. I’ve fallen and I can’t get up” was playing in my head and I wondered if it had finally come to that : ), ).
At the ER I was given a steroid injection, and injection of an anti-inflammatory pain reliever and was sent home with 3 Rx’s; a steroid to reduce the inflammation, a muscle relaxer for the spasms and Percocet for the pain. I took a muscle relaxer every 4 hours and a Percocet every 6 and the steroids for the next 14 days thank God for them! I spent the first 3 days on my living room recliner in quite a daze, channel surfing but having no idea or memory of what I was watching and alternating an ice pack and a heating pad and taking the drugs as proscribed until the pain and spasms finally subsided. That experience with Percocet made me realize that at least for me, it didn’t completely take away the pain per se, but it made me not care so much that I still had some pain although not quite nearly as bad as it was without it.
When I felt I no longer needed the drugs to deal with the pain, I flushed the unused pills down the toilet. The next week I followed up with an orthopedic who sent me to “back school”, i.e. physical therapy to work on reducing the inflammation and to strengthen my core muscles and to learn stretches and exercises so that I might not have this problem ever again and so far so good.
But if I’m ever in that kind of pain again, I sure hope I can get pain relievers. Seriously, if you are in so much pain like I was and lying on the bathroom floor, unable to get up off the floor to go to the bathroom and finally say “Oh Heck”. “I’ll just pee right here on the floor and just deal with it later”, that’s pain and that’s where drugs are a God send. My condition was temporary and treatable but I can’t imagine dealing with that sort of pain on a daily and long term basis.
This story may be of interest:
Aimee Copeland agrees to painkillers following skin graft surgery despite previous refusal
Most folks abhor the idea of some bureaucrat coming between doctor and patient. The DEA is full of such bureaucrats. Do any of them have any medical training?
As far as I am concerned, a person who is certain to die in the near future should have an unfettered right to determine what drugs he wants to take. At that point, the DEA should be escorted from the room.
That has been done to me by physicians I have seen. I travel a lot and I'm going to new physicians every two to four years. I could spend thousands of dollars and undergo all sorts of tests and "let's try this treatment first" and finally get the meds with every new doc. Or, I can curtail my activities and cope with chronic pain. That seems to be the only options to me.
Well, I don't have thousands of dollars to throw away every so often. The tests are the same and the results are the same: "yes, you have two ruptured disks and will eventually need surgery. Try to cope and if you still have pain in six months or so, I'll prescribe some meds. Try it this way first." I have perforce limited my activities to about two hours of travel in a car, sitting in church for an hour, or shopping for maybe half an hour. Everything else is done from a horizontal position.
But docs won't prescribe pain meds because they think I'm an addict since I want them. Sheesh!
Some doctors have tendency to put people in that category.
I suppose it’s because the government is on them so hard about writing prescriptions.
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