Opioid pain relievers are a group of potent narcotic medications designed for reduction or elimination of severe forms of pain that don’t respond to other treatment options.
Because of the way they work inside your body, these medications, when used regularly for extended periods of time, commonly result in a condition called physical dependence.
For this reason, as well as the influence of public perceptions about addiction risks, many doctors hesitate to write long-term opioid prescriptions for their patients. However, while the risks for addiction are real, the vast majority of legitimate, properly supervised patients never develop an addiction even when they develop a physical dependence on opioids’ pain-relieving effects.
The opioid family includes a wide variety of natural and synthetic substances based on the chemistry of opium, a psychoactive sedative produced by the plant papaver somniferum, commonly known as the opium poppy. Legally available, prescription opioid medications in the U.S. include oxycodone (OxyContin, Percocet), codeine, hydrocodone (Lorcet, Vicodin), methadone (Methadose, Dolophine), fentanyl (Fentora, Duragesic), meperidine (Demerol) and hydromorphone (Exalgo, Dilaudid). While the specific effects of these drugs vary to a certain degree, they all achieve their general effects by binding to specific areas of your brain cells and subsequently altering the way in which your brain receives pain signals from your body, as well as reducing your subjective experience of pain symptoms.
The difference between dependence and addiction
Physical dependence on a drug or medication occurs when your body becomes accustomed to its presence and starts to rely on it to maintain a sense of normality. In some cases, such as in the use of insulin in people with diabetes, this “normal” is an actual correction of deficiencies or abnormalities in the function of an organ or body system. In other cases, “normal” is simply an adjustment to a drug or medication’s effects and an attempt to maintain adequate function despite its presence. In physically dependent people, lack of a drug or medication produces symptoms of physical withdrawal that vary according to the substance in question.
For example, in diabetics, withdrawal from insulin simply triggers a return of the conditions associated with poor blood glucose control. In legitimate prescription opioid users, withdrawal symptoms can include insomnia, anxiety, sweating, diarrhea, abdominal cramps, sore muscles, dilated pupils, nausea and vomiting, as well as the unwanted return to a previous norm of severe or disabling pain.
While physically dependent people can develop drug addictions, addiction differs from dependence in certain fundamental respects, according to guidelines and definitions established by the American Pain Society and the American Academy of Pain Medicine. The hallmarks of addiction are the presence of an ongoing drug craving and involvement in forms of behavior that include compulsive drug seeking, compulsive drug use, and drug use that continues in the face of severely negative legal, social, personal, or work-related consequences. Generally speaking, physically dependent people retain their ability to participate in a meaningful, productive life, while addicts increasingly lose this ability.
Addiction in legitimate users
Very few legitimate, medically supervised users of prescription opioids develop problems with drug addiction, experts at the Cleveland Clinic Pain Management Department report. This is true even when opioid users develop a physical dependence on their medication and/or take their medications for extended periods of time. The same results also hold true for properly supervised patients who develop a tolerance to a given dose of opioid medication and require a dosage increase in order to receive adequate pain relief. In addition to receiving initial instructions from their doctors, well-supervised pain medication patients engage in a number of behaviors that reduce their addiction risks, including continuing to follow all dosing instructions, reporting any problems or medication side effects, and reviewing any potential drug interactions that can increase the chances for addiction. Well-supervised patients also share their drug and alcohol histories with the doctor who writes their opioid prescriptions.
Risks of unsupervised use
Doctors who issue prescriptions for opioids must do what they can to make sure their patients use their medications properly. Failure to do so can lead to prescription abuse and the onset of a serious or potentially fatal opioid addiction or opioid overdose. By definition, anyone who uses opioids without a proper prescription also engages in opioid abuse. Again, in these circumstances, lack of adequate oversight and supervision can greatly increase the chances for the onset of addiction or overdose. According to the National Institute on Drug Abuse, opioids are among the most commonly abused medications in the U.S., and in 2010 alone, over 2 million Americans started down the road of prescription painkiller abuse.
While there is a generally accepted consensus that properly supervised opioid users have low addiction risks, no one knows for sure exactly how many cases of addiction occur. In addition, specific risks for addiction can vary greatly in different population groups. For instance, researchers at the University of Texas Health Science Center in San Antonio explain, participants in programs at a typical pain clinic usually don’t develop opioid addiction problems. On the other hand, pain patients undergoing treatment for previous opioid addictions have re-addiction rates as high as 40 percent.