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:
- Over-the-counter pain medications, such as nonsteroidal anti-inflammatory pain medications (NSAIDs)
- Prescription medications, such as:
- Prescription NSAIDs, such as Celebrex (celecoxib)
- Muscle relaxants, including Flexeril
- Antidepressant medications, including tricyclic antidepressants and selective serotonin reuptake inhibitors
- Anticonvulsant medications for certain types of neuropathic pain
- Sedative and tranquilizers, such as benzodiazepines or barbiturates, to reduce pain associated with muscle rigidity or muscle tension
- Opiate or narcotic medications, such as OxyContin, Vicodin, Lortab, etc.
- Over-the-counter herbal and other remedies, including herbal teas, amino acids, and other products
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.
What Is an Addiction?
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.
Characteristics of Individuals with Substance Use Disorders
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:
- Suffering from some other psychological condition, such as depression, an issue with anxiety, an eating disorder, stress, abuse or trauma, etc.
- Issues developing stable relationships and friendships, or feeling like one doesn’t “fit in” with others
- Issues coping with stress
- Using pain medications along with other drugs, such as alcohol, cannabis, stimulants, other pain medications, etc.
- Falling between the ages of 16 and 30 (though a substance use disorder can occur at any age)
- Having family members who have some form of substance use issue
- Using drugs to cope with life’s stressors or as a form of recreation
Signs of a Substance Use Disorder to Painkillers
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:
- Do I use prescription pain medications without having a prescription for them?
- Do I use pain medications for reasons other than controlling pain?
- Do I have frequent desires or urges to use pain medications?
- Do I use pain medications in conjunction with other drugs or alcohol?
- Do I use pain medications to relax, to escape, or to deal with stress?
- Do I often use more pain medication that I had originally intended to use?
- Am I spending more time using pain medications that I used to?
- Do I sometimes miss work after I have used pain medications?
- Has anyone close to me expressed concern about my use of pain medications?
- Have I sometimes not fulfilled an important responsibility as a result of my use of pain medications?
- Has my productivity at work or school suffered as a result of my use of pain medications?
- Have I gotten into arguments with family members or friends regarding my use of pain medications?
- Have I ever stolen pain medications from someone else?
- Do I find that I need more of the medication to get the effects that I once got from a smaller amount?
- After I have not used pain medications for a day or more, do I find that I become irritable or mildly ill?
- Do I ever use pain medications to deal with the irritability or ill effects that occur after I have not used them for a while?
- Can I identify any physical issues that have occurred as a result of my use of pain medications?
- Do I find that most of the people that I associate with also abuse pain medications?
- Do I plan to use pain medications on specific days or at specific times?
- Have I ever attempted to hide my use of pain medications from anyone?
- Do I sometimes neglect my personal hygiene, such as not bathing, changing clothes, cleaning up, etc., after I have used pain medications?
- Do I frequently use pain medications in situations where a person should not use them, such as while driving, using machinery, caring for children, or at work?
- Has my use of pain medications led me to engage in risky behaviors, such as having unprotected sex, sharing needles, gambling, etc.?
- Have I become more isolated from friends or family since I began using pain medications?
- Do I have any legal issues associated with my use of pain medications?
- Does it take me longer to recover from my use of pain medications than it used to?
- Do I no longer have interest in things that I used to be interested in?
- Am I spending a significant amount of money on pain medications even though I do not use them for pain?
- Am I beginning to spend more time trying to get pain medications, using them, or recovering from using them?
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.