Per the National Institute on Drug Abuse (NIDA), abuse of prescription medications is a serious issue in the United States. Sources estimate that over 20 percent of adult Americans report they have misused prescription medications at least once.
A great deal of prescription medication misuse and abuse involves medications designed to control pain.
Chronic pain is a major medical issue in the United States. The American Association of Pain Medication reports that over 100 million Americans suffer from chronic pain. The primary form of treatment for these individuals is use of some type of pain-relieving medication, commonly known as painkillers.
Pain is a complex physical and psychological experience, and there is no objective way to measure any individual’s level of pain. Physicians have been trained to focus on their patient’s self-report of pain since the 1980s, and patients are often asked to rate their current level of pain.
Different types of pain will often be best addressed by different types of medication. There are a number of different medications that can be used to assist an individual in dealing with pain, including:
The majority of over-the-counter products are not significant drugs of abuse. Even some prescription medications, such as antidepressants, anticonvulsant medications, sedative and tranquilizers, and even muscle relaxants, are not primarily designed to control pain and therefore would not be categorized as “painkillers.”
The primary painkillers of abuse belong to the opiate or narcotic medication class. These medications are tightly controlled by the United States Drug Enforcement Administration and listed as controlled substances because they have a significant potential for abuse and the development of physical dependence. This class of medications has received quite a bit of publicity regarding their potential for abuse and overdose. Thus, while any of the above groups of medications can be abused, opiate drugs are the primary painkillers that are abused in the US.
The term addiction is often used in a number of different contexts and therefore is no longer considered a formal diagnostic term or category. Instead, the current diagnostic scheme used by most professional organizations, including the American Psychiatric Association (APA), prefers the use of the term substance use disorder over more generalized and ethereal terms like addiction, substance abuse, substance dependence, etc.
When speaking of a substance use disorder, it is important to understand that being diagnosed with this type of disorder does not necessarily mean that the individual has developed physical dependence on a substance, although the development of physical dependence can serve as a diagnostic indicator that one may have a substance use disorder. Physical dependence (developing both tolerance and withdrawal symptoms to a drug) is neither a necessary nor sufficient condition for an individual to be diagnosed with a substance use disorder. For example, individuals using pain medications for chronic pain under the supervision of their physician and according to the prescribed instructions will often develop some level of physical dependence on these medications; however, they would not be classified as having a substance use disorder because they are not misusing or abusing the drug. In fact, the majority of people with a prescription for these medications do not develop substance use disorders to them.
The formal definition of a substance use disorder requires that the individual uses the drug for nonmedicinal reasons and develops significant impairment or distress as a result of this use. This article will focus on this interpretation of the notion of addiction as it is the most appropriate way to conceptualize the issue.
Although not everyone who develops a substance use disorder to pain medications will demonstrate the following signs, these characteristics are often associated with individuals who abuse these substances. Individuals need not demonstrate all of the following characteristics but typically will demonstrate at least some of them. According to APA and NIDA, these characteristics include:
With the above specifications in effect, there are a number of signs that an individual has developed a substance use disorder to painkillers. If one honestly answers “yes” to two or more of the following questions, the person should be concerned that they might have a substance use disorder:
The more “yes” answers one gives to the above questions, the more likely it is that they have a substance use disorder to painkillers. In addition, there is a positive relationship between the above signs and the severity of the problem, such that the more positive responses one gives, the more severe the potential problem may actually be. The only way to definitively determine the severity of one’s substance abuse issues it to be formally assessed by a licensed mental health professional.
The above checklist consists of both formal diagnostic symptoms and other signs that an individual has developed a substance use disorder. It should be noted that the formal diagnosis of a substance use disorder can only be made by a licensed mental health clinician based on the actual diagnostic criteria for these disorders. Even though an individual may recognize some of the symptoms, a formal evaluation is required. Therefore, any person who honestly answers “yes” to two or more of the above questions should seek a professional consultation regarding their use of pain medications. This includes individuals who have a prescription for these medications.
Recognizing that one has a problem is only the first step in recovery. Individuals who have substance use disorders or abuse issues with pain medications will inevitably require professional help and assistance from family and friends to recover from this problem. The development of a substance use disorder to painkillers is a serious psychological disorder. In order to recover from it, a person requires professional intervention, understanding, and patience. The vast majority of individuals who attempt to address their substance use disorder without some form of professional help are doomed to fail.