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Understanding Why Painkiller Dependency Occurs

May 01, 2012 - 19 comments
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painkiller

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painkiller addiction

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prescription drugs

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dependence

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Addiction




We’ve treated thousands of patients for dependency to painkillers over the past 13 years, and one of the concerns I hear most frequently is how quickly and unexpectedly our patients found themselves unable to stop taking the medication.  Unfortunately, that physical dependnecy and craving leads people to feel unwarranted shame, and they’ll often put off seeking treatment for fear of telling their loved ones.  It’s important for anyone battling a painkiller dependency to understand it’s not their fault and anyone prescribed medication is susceptible.  Some important facts that people should know about painkiller dependency include:

o Dependency to prescription painkillers is often referred to as the fastest rising type of addiction in the country.  It has even surpassed cocaine and marijuana in some communities.
o Two million Americans use prescription opiates every year, making the chance for dependency significant in our population.
o Many prescription painkiller dependencies start with a prescription for traumatic, acute, or chronic pain.  It could be caused by a car accident, sports injury, migraines, arthritis, or a host of other pain sources.  Physical dependency can begin after as little as two weeks, and many people experiencing pain are prescribed medication for at least that long.
o We speak with many patients who felt their doctors overprescribed opiate painkillers to them, and that they weren’t warned properly of the risks.  Focused on eliminating pain, physicians can overlook the long-term consequences of dependency.   Sufferers of dependency then became afraid to alert medical professionals for fear they would be taken off the drugs they’ve now become reliant on.
o In addition to pain from the initial injury, patients start to experience the painful discomfort of withdrawal. The pain has not eased, but intensified. We’ve seen patients whose pain jumped to level 8 or 9 after a year of painkiller use.
o Over time the body becomes tolerant of opiates so higher doses are needed in order to achieve the same effect.  This can causes the dependency to worsen and spiral out of the control of the patient.
o Opiate dependency is a chemical imbalance that requires medical intervention.  It stems from prolonged use of painkillers, and is not a personality flaw.  

One of my goals has always been to erase the stigma associated with prescription drug dependency, and to help educate the public that opiate dependency is a medical condition that should be reversed in a hospital setting by trained physicians, combined with a customized aftercare program.   We need to empower people with the information and resources they need to get help, and spread the word that there is assistance available.


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by Tryin2BClean, May 07, 2012
This is a fantastic piece of writing on opiate dependency.  I now realize that my situation is a classic example of someone who is dependent rather than me being a "bad" or "weak" person.  In my case, I would have suffered through my pain if I had not needed higher functionality to he a good wife and mother.  Ironically, the very same thing that I turned to so I could have higher daily functionality, is the thing that now causes me to function at a lower level and has compromised, if not stolen, my ability to be a good wife and mother.  The part about being afraid to alert medical professionals is spot-on.  If not for my fear of being "red-flagged," stigmatized, judged, and God forbid told not to come back, has kept me from seeking my doctor's help for at least six months.  This article is so accurate that I'm forwarding it to my husband in hopes that he better understands what is and was happening to me.

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by CWKavinRAS, May 07, 2012
I am so glad this article has helped you. I truly believe that the understanding of the condition and the awareness of the issue, is the best way for patients to find healing. If physical healing is not fully possible at least the psychological and social is...Better treatment and less judgment should be the rule of medicine.

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by sockmonkey054, May 11, 2012
I fully understand this. I was prescribed vicodin after back to back surgeries for two seperate problems. One dr felt the other dr wasn't giving me enough pain medication and prescribed more. I became an addict with in weeks and all I had to do was call that dr and say I needed more he gave it to me. I spent two years addicted. I took the meds because he said I would need them and so I believed him.

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by 4candy, May 17, 2012
I have been using Oxycontin together with Norco for a long time. I used to get the Oxycontin from my doctor while getting the Vicodin online through websites like findrxonline where I was referred to 'understanding' doctors. For me the drug buprenorphine (buprex) has been a lifesaver. I don't think I would have ever gotten clean without it.

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by CWKavinRAS, May 17, 2012
There is no set rule for any form of treatment. There are human beings with specific and unique needs. What might be harmfull to one, might be life saving for others. In the end is all about improving quality of life.

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by 29sillygirl, May 19, 2012
Interesting.  I understand dependency, but at 76 with severe arthritis, it is necessary to take something for pain ....or retire to a wheelchair and assisted living. Physical therapy does just so much.  

Oxycontin got me through six weeks of radiation therapy for anal cancer.  Without this drug, I would be dead. Full stop.
The pain of  daily radiation would have been more than I could tolerate...thus ending my battle against a stage IIIb cancer.  The side and after effects of chemo and radiation far surpassed any dependency issue.  Kidney failure and Cdif were significant after effects of chemo, and almost ended my life.  Oxycontin?  Kept me going until I was out of hospital.
The damage radiation did to my body presents me with daily challenges.  Oxycontin?  No after effects...a gradual weaning was necessary, but I will be forever grateful to this drug for helping me through cancer treatment.

Occasionally I need Soma for back spasms.  For anyone who has suffered these as well as acute arthritis, and cannot tolerate aspirin based medicines, a muscle relaxant is lifesaving.  They are habit forming and not without side effects, but they relieve pain, so I can do the stretches recommended by my doctor.

At my stage of life, it is important to stay independent and enjoy a quality of life that would be impossible without aid from pain relieving medications.  Mother's day was a wonderful memory!  I walked with my daughter and neice and nephew with minimal pain as I had talken 1/2 a Soma the night before.

You are correct in saying there is no one rule for improving a person's quality of life by relieving pain.  I have tried many things....heat, ice, aspirin (which I can no longer tolerate without gastic distress), stretches, etc....the only meds that really get me out are, fortunately or unfortunately, depending on your outlook, are habit forming.

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by lizi173, May 23, 2012
Unfortunately, some of us dependent opiate pain medication users have no other option. I take pain medication for a rare congenital condition that has no cure or treatment. It progressive so has gradually deteriorated at a steadily increasing rate and now at 38 yrs old I am on a huge dose of pain medication.
I am frightened of how I will manage the pain of my condition for the remainder of my life as I am already on such a big dose. My specialist is looking into a spinal morphine pump for longer, management but I am told this does not work for every patient.
Some people don't have a choice about whether they take pain medication or not. It's not always a case of an injury that has resolved yet the medication is now the problem. For me it is the condition that dictates my use of pain medication. 
Stopping is not an option if I am to live my life and function in as normal a way as is possible - if I could change this I would, but I was born this way, I did not choose it.

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by marytartin, May 23, 2012
Years ago I had a shoulder surgery.  I was prescribed vicadin and after taking the perscribed dose, it would only give me 1/2 hour of pain relief.  It was horrible.  I didn't sleep literally for 3 days, paced in the evenings because I was beside myself with pain.  It was excruciating.  I could have eaten the vicadin like candy.  It just did not touch the pain.  I finally called my physician and he prescribed Percocet (oxycontin).  My doctor informed me that some pain relievers work on some people and some don't.  I wish I had have known that, for I would have placed a call to my doctor much sooner.  I was literally half crazed with pain and sleep deprivation!  The Percocet relieved my pain and allowed me to sleep.  I also suffer from fibromyalgia and moderate arthritis, especially spinal arthritis.  I am very careful about taking pain meds and usually opt for regular tylenol.  I cannot take any aspirin or ANSAIDS because of gastric problems.  In the evening, on nights that the tylenol does not work, I use tramadol. Otherwise, I would not sleep and the pain is only intensified with sleep deprivation.  I think that we as a society, need to realize that every body, health problem, and chemical and psychological make-up is entirely unique.  The occasional nights that I need to rely on pain meds is what keeps me going, exercising and living my life.  Without them I would be seriously sleep deprived and withdraw from social and physical exercise that makes me well and my life worth living.  I realize that addiction can be a problem with pain meds for some people, but lets look at the whole picture here before we as a society rule pain meds as a "bad" thing.  It very well has saved people's lives and allowed them to have a life worth living.

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by rayak, May 23, 2012
Sadly, we are not the best judge of our pain treatments. Although we know if something is working,- or not, we don't know if that "something" has become addictive, - or not! I have found  that in my case a Doctor is a good companion to take along the pain journey. Every couple of months we sit down and re-examine the drug regimen. There is always the temptation to NOT disclose all I'm doing, but recognising that threat is the step that sets me free. Varience of drugs seems to work in my case, giving my body a rest period where any dependance traits seem to fade. However, without my Doctor companion, I am aware that this path will soon become a very slippery slope. Sadly, it's all still a bit of a gamble, as to how much damage is being to the various body organs to ensure some sort of "Quality of Life"!  And I believe that quality of life is the key!

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by layla198, May 24, 2012
This was a helpful article. I am only 20 years old. I have a chronic pain condition and have had to use pain killers for the past five years of my life. Unfortunately I've tried every other option and have yet to feel a day pain free. As much as I hate the fact that I'm dependent on Vicodin, I can not have a life without it. I have tried going off of the pain-killers and the quality of my life suffers, I have wasted so much of my life in pain, the worst part being that the pain killers don't get rid of all the pain. I can't even remember what it's like to not have pain. I have also tried just about every medication my doctor can think of. And now he has "run out of options" for me. Basically telling me I will be stuck in this pain, indefinitely. For a long time, I have felt weak in myself for needed the pain killers. But this article was good to read. Thank you for seeing this problem from a patients point of view, and not putting the blame on them for a troubling problem.

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by CWKavinRAS, May 26, 2012
You are very welcome. It is my pleasure to help. Judgment should have no place on the treatment of patients.

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by SmokeyTheDog, Aug 20, 2012
Doctor Waismann, thank you for sharing your expertise. It is like putting together a puzzle... having to get bits and pieces of information from various forums. You should write more as you are very gifted in putting thoughts into words, THANKS AGAIN.

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by CWKavinRAS, Aug 20, 2012
Dear Smokey ,

I am not a doctor , I am a RAS. I do appreciate your kind words and will do my best to write a bit more . I believe sometimes less is more because the range of patients situation varies so much.
Again thank you for your thoughts.


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by lostinbenicia, Dec 13, 2012
Can't we sue the doctors who did not educatate us on the pain meds? they need to be more responsible. I asked and asked, and finally filed a complant with the hospital. But it happend over and over as I got worse. Even the ER docs never notified my doc at the same hosp when I came in with seizuers or strokes. My legs got so bad that I was admitted one nite with compression ballons on my legs. For five years I got sicker and sicker and they never admitted me. Never did my doctor ask about any ER visits. The seizures were caused from my doc not filling my Rx's on time. sometimes haing to go weeks with out my meds because she was off duty. There must be lawyers who are aware of this. This is hurting America. I was a functional working student, already had one degree,and a single mom. Lost my job,couldnt finish school,car was repo'd, lost family and friends. My daughter had to drop out of school to care for me. Thank you for what you are doing.

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by christyjo1028, Aug 26, 2013
I'm 41 years old & sadly have to admit that I'm addicted  to pain meds & never had any surgery's. Although I do have severe pain with my arms at times can not even pick something up without dropping it because of pain or numbness. I don't have ins even though it would be cheaper to go to dr. but I know once they do blood work they wouldn't help anyway. I just told my family cause I need help this is not a life I want to continue living but I'm scared of withdraws. I can't even take care of myself or my family. I know if continue this I'm going lose everybody that cares for me cause they can only take so much before giving up. I just don't know how to get though this without being able to take care of my family it's not like I can just lay down get though it when I have 6 other people that need me I have 2 elderly parents & mother in law with alzheimer's that depend on me. I just need to know is there somewhere I can go to get help without having ins  

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by mgill594, Oct 20, 2013
I have been suffering from back pain for over 25 years, I have tried numerous treatments for my back pain, none of them worked effectively.After taking pain killers for over 25 years, I tried a natural pain relief oil from Canada, called Dard Nashak -All Natural Muscle and Joint Pain Relieving Massage Oil. I was surprised at the effectiveness of pain relieving properties of this oil. I used it for 1 month, and I stopped taking pain killers, the results of pain relief was a bit better than pain killers, and pain relief was amazing.I feel good about not taking pain killers and this natural oil replaced them. I feel more refreshed now everyday. I hope this helps some in need of pain relief like me. There is something about natural products, as they have been used for over hundreds of years, with good results.

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by tino70s, Oct 21, 2013
What is the best way to deal with the with-drawls of Hydrocodone. Going through it now. I'm miserable and need some help fast. Cold chills and sweats, severe anxiety and flu like symptoms. What can I do? I have no more hydro so I cannot taper off. I'm in the middle of cold turkey here...day two.  Please advise quickly. Just want off and to be free!!!!! Thank you!

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by TwinsMommma, Nov 26, 2013
Where do I even start with most of u people...???...articles and some of the comments are the reason why I choose not to attend any local chronic pain groups that my doc will suggest every now and then...my doc is one of the top rated cutting edge pain docs in the world...he specializes in complicated cases like myself...he is the doc that other docs, nurses and their families go to...he is very strict with urine tests, pill counts- meaning u may get called in to make sure u r taking has prescribed not selling etc...patient contracts etc...and believe me he has his reasons why and I welcome it so that we can focus on health issues, options etc...I have also exhausted all options to treat 2 collapsed disks, osteoarthritis, facet arthrosis etc...I'm only 40 and chronic pain has been solid 15 yrs...my options are shots and meds or double fusion surgery which actually is a very, very bad option that u must put off unless u r using the bathroom on yourself...he is hoping the stem cell research would hurry past the political stage...anyways...I have gone thru several phases of meds or not...but once u educate yourself and u r only taking just enough to have a more REASONABLE quality of life and increase in function u will then not doubt yourself or your doc and trust that u and he or working for the best interest within reason...I have weaned off loratab and OxyContin each with different reasons...I went thru colon cancer and needed to wean off in order to figure out what was opiate induced constipation compared to scar tissue of colon...it's too complicated to explain...but my point is that if u r a legit ament pain sufferer that takes meds u and dr agree on than STOP OFFENDING us by using the word addiction...google the difference btw addiction and physical dependence...educated yourself then make comments...to those of u with your shady stories of running out of meds or doc blaming etc...then please comment on some substance abuse article and or educate yourself, ask your doctor questions which by the way welcomes my concerns on tolerance etc...it just proves to him even more that I am willing to try new solutions and not stuck on just one treatment....u gotta have a couple treatments...ie...injections help about 10% meds about 20% give or take which is too complicated to explain to people not educated...i am wife and mom of 6 yr old twins so to those of u who need treatments whether meds or whatever I do feel empathy for...I say be open and honest with yourself and doc to get the most effective guilt free help...to the person who was cured with herbal oil or had significant decrease in pain with an oil CAN NO way possible have a condition severe enough to consider long term opiate care...when your MRI matches up with pain complaints and your treatments make sense and u r not driven by money from disability, wanting opiates for depression or anxiety, or especially not from a mental addiction then u shouldn't need to worry too much on whether u may become tolerant or not but rather if u do have issues then have an exit plan or other options etc...to ease your mind...the 2 main problems r opiated induced constipation and tolerance stuff...u can't get greedy with always upping dosage...my doc says rule of thump try and take a middle of the road dose and dose that u can manage side effects...this kind of reasonable, disciplined thinking is better for the long road...now I'm talking from experience because trial and error is just part of what comes along with this often unforgiving and overwhelming condition(s)...at times i was on a higher dose which controlled pain better but higher doses tend to speed up tolerance and or can worsen constipation so its VERY patient specific and complex...THE BEST ADVICE  is having a honest conversion with doc helps take some burden off u, the patient, who can easily make desperate or  emotional decisions when dealing with pain...sometimes I would ask him if I were your daughter would u advise her to do this or that....especially when cancer thru a wrench in the mix...people with severe pain should expect to still have some pain no matter what treatments your on and if u do not have some pain then u r over-medicated...great docs know the cons of meds and have solutions to try more and more each year and they will try med rotation too if needed to combat tolerance...no patient taking opiates is free of side effects so if your not bringing the topic up a good doctor WILL ASK u and it will be suspicious if for some reason u evade the subject and actually IF YOU are prescribed long acting opiates and not prescribed or told to get OTC stool softener and miralax then your with the wrong doc....although some of the people commenting above obviously would probably avoid the kind of doc I have or getting it illegally....u know who u are...if u r still even reading this post u r rolling your eyes....but here some advice to u phonies why dontnu just get your fix off alcholol or weed and leave our meds alone....u will never be ok trying to chase the intial SIDE EFFECT of euphoria that goes away just like any other side effect like nausea or fatigue (constipation does not go away) some people can stay on same dose and manage side effects for 10 yrs some 6 months....that is where the care is specialized with u and a great doc weighing out your pros and cons...if u need to wean off med your doc will take it slow and do everything he can to avoid unpleasant symptoms...long acting is harder than short acting either way if your doc isn't involved than u deserve to suffer thru withdraws....u r not gonna die and it will get better...how do I know that u may ask because I tried to go off quicker than my doc recommended therefore choosing a rougher road but my cancer surgery was hurting more the withdrawals and at any time I could have asked doc to dose back up and go slower to avoid stuff and doc prescribed clonidine and Xanax for unpleasant symptoms that u will have a little bit of no matter what in regards to OxyContin but not so much loratab which is a walk in the park compared to OxyContin...oxy is effective med for pain control but difficult to wean off...sorry for bad news gotta take good with the bad...to person above complaining about loratab withdrawals is u just gotta white knuckle it...the half life is short and u will be alright just stop thinking their is some easier way out if u did not have an exit plan...which is taper off and ask for clonidine and some kind of Valium otherwise u gotta learn the hard way cuz u were misusing and learn from it!!!!!

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by beanswii, Nov 29, 2013
I was on a pain regiment of muliple pills for a back injury and for 3 years i took them as prescribed.  I became sleepy all the time and slept 3 years of my life away, became suicidal, and lonely. I was taken off my pain meds this year and best thing that could have happened,  i still have a lot of pain but the pain i felt in me while on the medicines was much worse.  My mind is clear and i try to get through the pain by staying busy by painting, scrapbooking, talking on the internet,  and crocheting.  Dont let pain win, fight.

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