Opioid medication and addictionWritten by: Joanne Zeis

Reviewed by: Kevin L. Zacharoff, MD, October 2015

Learning Goals

➢This lesson will help you learn:❖What the terms addiction, tolerance, dependence, and withdrawal mean.

❖How many people have been prescribed opioids to treat pain, and what percent of them become addicted to the opioid?

❖Can a person with a history of addiction, or a person at high risk of addiction, use opioids safely to treat pain?

❖How can health care providers help prevent addiction?

❖What are some warning signs of addiction to opioids?

Definitions

➢Addiction:❖The overwhelming urge or need to use a drug or other substance❖Using a drug often in spite of its bad health effects❖Not being able to control how much or how often a drug is used

➢Tolerance:❖Getting used to a drug over time, so that it's less effective

➢Dependence:❖When someone becomes so used to taking a drug that withdrawal happens when the drug is

stopped

➢Withdrawal:❖Uncomfortable or painful symptoms when someone dependent on a drug suddenly stops

taking it❖Symptoms can include nausea, vomiting, and increased pain❖Symptoms can be prevented by following your doctor’s instructions

The Facts About Opioid Use and Addiction➢Some patients need to use opioid medications for a long time to help ease their

chronic pain.

➢Experts agree that most chronic pain patients do not become addicted to the opioid medications that are prescribed for them.

➢When opioids are used for the treatment of chronic non-cancer pain in people with no history of substance addiction or abuse they have a relatively small risk of developing addiction or abuse. Unfortunately, although there have been many studies on the topic of how many people become addicted, there is no single percentage risk that all experts agree upon. Therefore, the National Institute of Drug Abuse recommends advising that the overall risk estimate of opioid addiction or abuse ranges somewhere between 3-20 percent.

➢Even though more and more people in the U.S. abuse prescription drugs every year, this should not keep people who get relief from these medications from having them prescribed.

The Facts About Opioid Use and Addiction➢Most people who take opioid medications for pain use them correctly, and

don’t become addicted. These people may still be sick, but their pain medication helps them to function much better on a day-to-day basis. ❖In 2004, 82% of adults in the US took at least one prescription, over-the-counter, or

herbal/natural medication in any given week.

❖Even though the U.S. population only rose by 13% between 1992 and 2002, the number of prescriptions written for opioid drugs increased by more than 150%. ❖This increase is almost 12 times higher than the rate of population growth.

❖ It is roughly three times the number of prescriptions written for other drugs during the same time period.

❖In 2004, $19 billion was spent on ALL types of pain relievers in the U.S.❖One-third of that money ($6.3 billion) was spent on filling 235 million opioid prescriptions.

❖Many episodes of drug abuse in the U.S. involve the use of opioid pain medications.

Can an Addict Ever Be Treated for Pain with Opioids?

➢People who have a history of drug or substance abuse can be a challenge to treat if they’re in pain. Health care providers can use opioid medications with many of these patients, but any opioids need to be prescribed very carefully.

Health care personnel who are treating a drug abuser or recovering addict for pain should keep in close contact with pain management or addiction specialists for guidance.

More research needs to take place so that substance abusers and those in recovery can still be guaranteed pain relief when it’s needed.

How Health Care Providers Prevent Addiction➢Health care providers want to make sure that their patients are not in pain and might prescribe

opioid medication if that’s the best option for pain relief. At the same time, they need to know that these drugs will be used correctly.Questions you will be asked before getting an opioid prescription:

➢What is your experience with addictive substances like tobacco, alcohol, and mind-altering drugs?

➢Have family members or friends ever worried that you might have a problem with drug or alcohol abuse?

➢Does anyone in your family have a history of addiction?

➢Have you ever been arrested, or do you have a history of legal problems?

➢ If you are a recovering addict:❖Where is your treatment program located?❖How long have you been in recovery?

➢Health care providers might ask you to give a urine sample at an appointment.❖ This urine sample will be checked for the presence of legal and illegal substances.❖ This is done in an effort to keep you safe, and to make sure that you keep getting the medication that you

need.

What Is a Patient-Provider Opioid Agreement?

➢If you are given an opioid prescription for pain relief, your health care provider will probably ask you to sign an opioid agreement. This is an agreement between you and your health care provider who is prescribing the opioid. You may be asked to agree to do a number of things:❖Get your prescription from only one health care provider❖Have your prescription filled at only one pharmacy❖Return to your provider regularly for office visits❖Have your urine screened for substances without any advance warning❖Have your pills counted during office visits❖Not make any changes in the use of your medication without speaking to your health

care provider first❖Not ask for any early refills of your medication

What Can I Do to Avoid Addiction?

➢Learn the warning signs of addictive behavior.

➢Be honest with your health care providers about your use of drugs or other addictive substances.

➢Learn as much about your medications as you can, so that you’re an “informed consumer.”

➢Keep the lines of communication open between you and the people in charge of your medical care.

➢Learn other ways to manage your pain in addition to medication.

➢Get support from family and friends.

Self Check

➢What is the likelihood that someone who takes a prescribed opioid medication for treatment of pain will become addicted to the opioid?❖Always (100 of the time patients will likely become addicted)

❖Frequently (approximately 50% of the time patients will likely become addicted)

❖Infrequently (approximately 3% to 20% of the time patients will likely become addicted)

❖Never (0% of the time patients will likely become addicted)

Answer

➢Infrequently (approximately 3% to 20% of the time patients will likely become addicted). Although it happens infrequently, a patient may get addicted to an opioid that has been prescribed by a health care provider. A lot of research has looked at the number of patients with non-cancer pain, with no history of substance abuse or addiction, who have become addicted to their legally-prescribed opioids. Even though these studies have had different results, their numbers are usually s small. Since there is no one single percentage risk that all experts agree upon, the National Institute of Drug abuse recommends advising that the overall risk estimate of opioid addiction or abuse ranges somewhere between 3% and 20%. This is one reason why providers ask their patients a lot of questions in advance about their drug use, and follow these patients closely after prescribing an opioid medication.

➢Addiction is the overwhelming, out-of-control urge to use a drug or other substance; this is often done in spite of the drug’s bad health effects. An addicted user is not able to control how much, or how often, the drug is used.

Self Check

➢All of the following are symptoms of being addicted to an opioid pain medication except: ❖The overwhelming urge or need to use the medication

❖The need to increase the dose of the opioid pain medication in order to get the same level of pain relief

❖The use of the medication often in spite of its bad health effects

❖The inability to have control over how much or how often the medication is used

Answer

➢The need to increase the dose of the opioid pain medication in order to get the same level of pain relief. The need to increase the dose of opioid pain medication to get the same level of pain relief is not a symptom of addiction. People who take opioid medications may become physically tolerant to the drugs: They may need to have their doses increased. Physical tolerance of a medication is not the same thing as addiction.

Additional Resources:

➢American Pain Foundation. Treatment options: a guide for people living with pain. (Click "Publications" on the left-hand menu), http://www.painfoundation.org

➢Bruce, B. & Hooten, W. (2008). Mayo Clinic Guide to Pain Relief. Rochester, MN: Mayo Clinic Health Solutions.

➢Feinberg, S. (2008) American Chronic Pain Association. Medication and chronic pain supplement 2008. (Search on “chronic pain supplement”), http://www.theacpa.org