Health

Opioids and the Slippery Slope of Addiction

Dr. Riddle Responds:

Dear Cindy:

What you are describing is consistent with what we call a substance use disorder. Individuals dealing with this disorder find that using substances causes significant problems in their lives. It sounds as if you have become both physically and psychologically dependent on these medications to make it through the day. In essence, you are on that slippery slope of addiction.

Opioids—like Percocet, Oxycontin, Dilaudid, Vicodin, and morphine—are powerful pain relievers. When the patient is suffering acute pain, such as directly after surgery, opioids can offer much-needed relief. However, in cases of chronic pain, using these medications for an extended period of time can lead to problems. Symptoms of an opioid use disorder include many of the features you describe, such as taking more opioids than you intend to, craving the drugs, being unable to cut down, spending excessive time obtaining and using the medications, signs of tolerance—like needing a higher dose to get the same effect—and having symptoms of withdrawal when you cut down. Although you say you are still able to go to work, you express concern that your job performance is suffering. A key part of this disorder is that it can lead to trouble in your work and personal life, to the point that you are unable to function as you would want to. It sounds as if you have not escalated to that point, but it is critical that you seek professional help now, before your symptoms worsen.

Unfortunately, your problem is all too common among those who are taking prescribed chronic opioids. Some studies have found the rates of substance abuse as high as 1 in 4 among those on long-term opioids

The consequences can be dire. Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. You mention that you also use Klonopin, a benzodiazepine, to help deal with anxiety. Taking benzodiazepines—Klonopin, Xanax, Valium, and Ativan are all popular—with opioids is a particularly deadly combination. Because both can be sedating and decrease your drive to breathe, overdoses can happen at significantly lower doses when they are used together. Of the deaths from opioids in 2011, 31 percent of those individuals had also taken benzodiazepines at the time of the overdose.

You owe it to yourself—and your family—to seek professional treatment for your drug use. Be aware that although it can be tempting to go “cold turkey” when quitting, stopping benzodiazepines suddenly can be dangerous—potentially fatal—and withdrawal should be done under medical guidance. While withdrawing from opioids does not have the same danger as withdrawing from benzodiazepines, the symptoms can be very uncomfortable. Thus, it is important to find a physician you trust to help you through this process, and inpatient detox may be an appropriate step, but is not necessary for everyone struggling with addiction.

You, like many suffering with issues of prescription opioid dependence, are continuing to have problems with chronic pain. Paradoxically, chronic opioid use can actually make you more sensitive to pain. As you come off of the opioids, it will be important to work closely with your doctor to determine and address your ongoing needs for pain relief. It may be possible to manage your pain using non-opioid medications; these include medications that treat inflammation, spasms, and neuropathic pain. Even certain antidepressants have been shown to offer pain relief, independent of their effects on mood. You can also benefit from complementary therapies, such as physical therapy and massage.

The road ahead of you is not an easy one, but you do not need to go it alone. I would encourage you to seek support in recovery. This network can include friends and family, along with health professionals and recovery groups. These are people who can help you navigate the darker times and celebrate your successes. With treatment, you can begin on the path to the healthier, more fulfilling life you deserve.

Megan Riddle, M.D./Ph.D.

 

 

References

Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning, and monitoring compliance. Pain Med. 2008;9(suppl S2):S145–S166.

Brown RL, Rounds, LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wisconsin Medical Journal. 1995:94(3) 135-140.

American Psychiatric Association (2013): Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.

National Institute of Neurological Disorders and Stroke (2003): Low Back Pain Fact Sheet.

Strain. E (2014): Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. http://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis In: Saxon AJ, editor.

Tompkins DA, Campbell CM (2011): Opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon? Current pain and headache reports. 15:129-136.

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. Jones, CM; McAninch, JK. “Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines.” Am J Prev Med 2015; 49 (4):493-501.

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