Human beings are biologically wired to avoid pain, and seek pleasure. Our bodies naturally produce chemicals called endorphins that help us cope with the physical aspects of pain by reducing the intensity of nervous-system signals reaching the brain, and the emotional aspects by simultaneously promoting feelings of euphoria. Endorphins (literally “endogenous [produced from within] morphine”) act on the same part of the brain as opium and its derivatives (opioids), which include prescription painkillers.
When used as medically directed, prescription painkillers can make recovery from a serious accident or major surgery more tolerable, and they can improve the quality of life for individuals who suffer from chronic pain. However, when they are misused—deliberately or inadvertently— life-threatening physical dependence and addiction can occur.
What are Opioids?
Opioids are both natural by-products of the opium poppy (like codeine or morphine) and manmade (synthetic) drugs, produced by altering natural opium by-products. Like super-charged endorphins, they help minimize the perception of pain while inducing a “high.” Examples include:
- oxycodone (brand names include OxyContin and Percocet)
- hydrocodone (e.g., Vicodin) • meperidine (e.g., Demerol), and
- propoxyphene (e.g., Darvon).
Opioids are meant to be used in cases where over-the-counter pain relievers like acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs; e.g., ibuprofen or aspirin), and milder prescription medications that combine nonprescription pain relievers and opioids fail to work.
Physical Dependence and Addiction
Repeated use of prescription painkillers can result in physical dependence and addiction. Physical dependence occurs when a biologically based tolerance to the drug develops, requiring ever-increasing and more frequent doses to achieve the same effects, and the body grows dependent on the opioid for functioning. Consequently, withholding it causes a powerful physical and psychological response called “withdrawal syndrome” with symptoms like fever, chills, seizures, tremors, panic attacks and paranoia.
Addiction is a chronic brain disease characterized by uncontrolled, compulsive behavior (in this case, prescription drug abuse) that continues despite serious negative health, social, legal and other consequences because of chemical changes in the brain. It is not a lack of willpower—a common misconception that contributes to the stigma still attached to the disease.
Not everyone who uses opioids is destined to become addicted. There appear to be biologic and cognitive contributing factors, for example:
- Hereditary predisposition/family history of substance abuse. About 10% of the population is believed to have a biologic/genetic predisposition to addiction, be it legal or illegal drugs, alcohol or gambling.
- Psychological trauma such as history of abuse and attempts to cope with the aftermath
- Concurrent mood or behavioral disorders – e.g., depression, anxiety, eating disorders
- Another form of addiction – e.g., alcohol or gambling.
Prescription painkiller abuse and addiction are a growing problem, especially among older people who are developing the many aches, pains, and other conditions of advancing age. In most cases, they are not using opioids recreationally. Rather, age-related physiological changes that can affect their metabolism and response to opioids may make them more susceptible. It has been projected that the number of people age 50 and older misusing prescription drugs could increase 190 percent from 911,000 in 2001 to almost 2.7 million by 2020. Prescription painkiller abuse is also much more prevalent in women—affecting 44 percent of women versus 23 percent of men.
The Importance of Treatment
Opioid addiction is treatable, but it’s not a quick fix. The course of treatment depends on the specific needs of the individual and may involve several approaches:
- Detoxification to safely wean the body from physically needing the drug
- Individual and group psychological counseling to address underlying emotional issues and teach the individual to function without drugs, to resist cravings and situations that could lead to drug use, and to recover from a relapse
- The use of addiction medications
Addiction becomes more serious and more difficult to treat over time. Related physical and mental health problems also worsen and the likelihood of overdosing increases. Death is a very real possibility at that point because opioids reduce breathing rate, and too much can suppress breathing until it stops altogether.