What Increases the Risk of Drug Addiction and Abuse?
The risks of drug addiction and abuse don't seem to be the same for everyone.
"It's not the pills alone that make an addiction," Miotto says. She points out that addiction develops from a number of physiological, psychological, genetic, and social factors. A personal history of substance abuse also seems to increase the risk.
Mixing drugs also increases the risk of problems. "If you're taking your pain medicine along with other prescription drugs, you ratchet up the risk of addiction enormously," says Miotto.
Webster says that pain itself is a risk factor: the greater the severity of the pain, the higher the risk of drug abuse and addiction. "After years of living with severe chronic pain, people will do anything to get rid of it," he tells WebMD.
The Effects of Addiction and Abuse
Miotto says that drug addiction may seem to start innocently. A person might just occasionally call in a prescription early, or take a spouse's medication as well as their own. "These behaviors can creep up on people slowly and then, all of a sudden, they have a physical dependency," says Miotto.
The problem is that people who have a prescription drug addiction don't realize it. "Addiction is a disease of denial," Miotto says. "It can take years before people realize what's happening to them." It pushes people to horrible extremes. Miotto knows one patient who eventually admitted that she pushed for surgery solely because she wanted the opioid painkillers she knew she'd get afterward.
There's also another dimension to prescription drug abuse you should consider. Even if you don't abuse the opioid pills you've been prescribed, someone else could.
"A lot of the opioids that get used illicitly -- especially by adolescents -- come from the medicine cabinets of people who were prescribed the drug for legitimate pain," says Webster. "People need to understand the potential harm that they can do to communities if these medications aren't properly secured."
Doctor vs. Patient
In part because of the stigma of prescription drug addiction, chronic back pain can sour even the best doctor-patient relationships. The patient can become frustrated by the doctor's inability to cure his or her pain. Meanwhile, the doctor may become suspicious of someone who's always demanding refills of powerful opioids.
"Doctors are getting sued from both ends," says Miotto. Some have been sued for providing opioid painkillers that lead to addiction; others get sued for not prescribing them to relieve debilitating pain.
People with a past history of addiction face the most skepticism from their doctors.
"I hate to say it, but when people walk in to the doctor and mention an addiction history, they may not be able to get these painkillers," says Miotto. "The doctor may just not trust them."