With chronic pain affecting up to 20% of Americans, pain is one of the most common reasons why people take medication. Severe pain can also result from injuries and some illnesses. Prescription painkillers can alleviate the burden of pain for many people, but its frequent use is also associated with abuse and addiction. Misusing painkillers is one of the most common forms of substance abuse and one of the hardest to treat.
How do painkillers work?
There are a variety of prescription drugs that work to alleviate pain. Most of these are depressants, meaning they depress or slow down the activity of the central nervous system including vital functions such as breathing and heart rate. This can also relieve muscle tension that causes pain or reduce neural pain signals to reduce the sensation of pain.
Opioids are the most commonly prescribed painkillers. They interact with opioid receptors in the brain to increase the amount of pleasure-related chemicals like dopamine and endorphins, while blocking pain signals. Both of these functions make painkillers especially easy to abuse or become addicted to. This is why the US Drug Enforcement Administration (DEA) classifies many prescription painkillers as Schedule II controlled substances.
Which painkillers are most commonly abused?
It’s no surprise that the most commonly prescribed painkillers are also the most commonly abused. This is because addiction tends to begin with a legal drug prescription, even if individuals progress to illicitly obtaining the drug either through friends or by doctor shopping for multiple prescriptions. The most commonly abused painkillers include Vicodin, Oxycontin, and Fentanyl. These drugs are at the heart of the opioid epidemic that has killed over half a million people over the last two decades. Other painkillers that may lead to addiction include Percocet, Demerol, Stadol, and Lorcet.
Behavioral signs of painkiller addiction may become noticeable to oneself and loved ones. Typically, more of these signs are evident when addiction is more severe. These include:
- Increased time spent obtaining, using, and recovering from painkiller use
- Neglect of personal or professional responsibilities due to painkiller use
- Intense cravings for painkillers
- Continued painkiller use despite detrimental effects it may have on physical or mental health
- Continued painkiller use despite detrimental effects it may have on interpersonal relationships
- Decreased interest in hobbies or other enjoyable activities in favor of painkiller use
- Using painkillers in dangerous situations like while driving
- Tolerance, requiring higher painkiller doses to achieve the same effects
- Withdrawal symptoms which begin if painkiller use is discontinued
All medications have potential side effects, and these are particularly evident when the drugs are abused. Painkiller addiction can include many physical and psychological symptoms depending on the type of painkiller being abused.
Physical symptoms include:
- Slurred speech
- Sedation
- Itchy skin
- Seizures
- Constipation
- Nausea
- Vomiting
- Constricted pupils
- Slowed respiration
- Coma
Psychological symptoms may include:
- Mood imbalances
- Anxiety
- Depression
- Psychosis
Withdrawal results from physical dependence to a drug. When the body is used to painkillers and the chemical effects they have on the brain, suddenly eliminating the drug requires the body to adjust to its normal baseline without the drug. During this stage, the body experiences a variety of unpleasant symptoms. These symptoms typically begin within several hours of the last dose and may persist for several days. Painkiller withdrawal symptoms tend to be worse when the addiction or physical dependence is more severe. Symptoms include:
- Loss of appetite
- Dilated pupils
- Tremors or shakes
- Insomnia
- Body aches
- Nausea or vomiting
- Diarrhea
- Irritability
- Restlessness
- Chills or shivering
- Increased heart rate
- Hypertension
Mixing painkillers with alcohol
Many individuals who abuse painkillers tend to also abuse other substances including alcohol. Painkillers are often abused concurrently with alcohol because alcohol is so readily available. This is an especially dangerous mix because both substances are nervous system depressants. When taken together, they may have a synergistic effect that is more powerful and dangerous than that of either one taken individually.
The effects may be unexpectedly more pronounced, so accidental overdose is more likely. Painkillers and alcohol may lead to dehydration, dramatic changes in blood sugar, seizure, and slowed heart rate and breathing, which can be life-threatening. At high doses, the combination of the two can result in loss of consciousness, coma, or death.
Treatment for painkiller addiction is tailored according to individual needs, which may also require treating co-occurring mental health disorders. A comprehensive treatment program includes several phases or interventions, beginning with medical detox and progressing to therapeutic intervention.
Medical detox
Medical detox is typically the first step in addiction treatment because in order to fully address psychological reasons for painkiller abuse, one must be fully sober. During medical detox, individuals are monitored round-the-clock to slowly reduce their painkiller use until it is fully eliminated from the body. During this process, doctors can treat distressing symptoms of withdrawal to make it safer and more comfortable.
Replacement medications
Painkiller addiction can be difficult to treat because the underlying pain disorder that they were prescribed to treat must still be managed. In some cases, replacement medications that are safer may be prescribed to treat the pain. These may include longer-acting opioids which don’t create the same “high” of fast-acting opioids but can still effectively treat pain. Some replacement medications include buprenorphine, naltrexone, and methadone. Since they have a milder effect on the nervous system, there is a lower risk of addiction.
Therapeutic interventions
Following detox, individuals in addiction treatment usually begin the psychological work of treating addiction. This includes individual therapy, peer support groups, and psychoeducation. Therapy aims to uncover underlying issues and triggers that stimulate painkiller abuse. This can also be modified to treat co-occurring mental health problems like depression or anxiety. Another key aspect of therapeutic intervention is skill building to help individuals better cope with stress and develop techniques to prevent relapse.
Painkiller addiction FAQs
Can I become addicted to painkillers even if I only take it as prescribed?
Yes. It’s possible to become addicted to a substance even if it is taken according to a doctor’s recommendations. This is in part because physical dependence is possible with long-term use of any drug. If you suspect you are becoming addicted to painkillers, talk to your doctor to change your prescription.
Can I overdose on painkillers?
Overdose on painkillers is possible when taken at very high doses. Overdose is more likely when prescription painkillers are taken in conjunction with other drugs that may exacerbate its effects.
How can I prevent an accidental overdose?
To avoid accidentally overdosing on painkillers, you should always take them exactly as prescribed and avoid contraindications such as alcohol or other medications that can interact dangerously with the drug.
