Some people do become addicted, and the results can be devastating. But there are ways to limit your risk.
Candy Pitcher of Cary, N.C., knows all about the fear of addiction. One summer day in 2003, a tree cutter working at Pitcher's home started to topple from his ladder. "If he hits the ground, he'll break his back. I have to catch him!" she thought.
Pitcher broke the man's fall, which crushed a vertebra in her upper back. Ever since then, she's had chronic pain. To manage it, she's had a prescription for a drug that's widely feared and often misunderstood: morphine.
"I've never been 'high' from morphine," she says, nor has she ever been tempted to take more than the prescribed amount. But she says she's wary of becoming addicted.
She's not the only one with that fear. "Addiction" is a widely used word. But many people don't use it accurately.
What Addiction Is ... and Isn't
Addiction is far more than a craving. It also means there are troubling consequences that can often disrupt someone's personal life or job.
"Addiction means the individual has lost control over the use of the drug. They're using it compulsively, there are consequences to using the drug, and they continue to use it anyway," says Gary Reisfield, MD. He's a chronic pain and addiction specialist at the University of Florida.
Tolerance and dependence are not the same as addiction.
Tolerance is common in people using opioids (such as hydrocodone, oxycodone, and morphine) for chronic pain. It means the body has become used to the drug, and it has less effect at a given dose, Reisfield says.
Dependence means that there are unpleasant withdrawal symptoms if a person abruptly stops taking a drug.
People who aren't addicted can develop drug tolerance or dependence. And both can be absent in people who are addicted to certain drugs.
Potential for Addiction
Opioid pain medications are some of the most commonly abused prescription drugs. However, the risk that well-screened people will become addicted to opioid drugs when they're taking them for chronic pain is actually low, Reisfield says.
A 2008 study that compiled previous research found that about 3% of people with chronic non-cancer pain using opioid drugs abused them or became addicted. The risk was less than 1% in people who had never abused drugs or been addicted.
Other common drugs with the potential for addiction are benzodiazepines, especially when they're prescribed along with opioids, Reisfield tells WebMD. Some benzodiazepines include Ativan, Klonopin, Valium, and Xanax.
Risk of Uncontrolled Pain
Some people don't want to use pain medicines because they fear becoming addicted. That can lead to a different set of problems that stem from poorly controlled pain.
"If pain is inadequately treated, we see poor functional level, a diminished quality of life, we often see mood disorders such as depression, and we see an increased risk of suicide," Reisfield says.
These six steps can help ensure that you use pain-relieving drugs properly:
1. Weigh Your Risk Factors
Before he prescribes opioid drugs for chronic pain, Reisfield talks to patients about issues that could make them more likely to become addicted. These include:
- A history of addiction to prescription medicine or illicit drugs.
- Addiction to alcohol or tobacco.
- Family history of addiction.
- A history of mood disorders (such as depression or bipolar disorder), anxiety disorders (including PTSD), thought disorders (such as schizophrenia), and personality disorders (such as borderline personality disorder).
2. Look at Other Options
People with a higher risk of addiction may want to try other pain control strategies first, Reisfield says. These can include:
- Physical therapy.
- Working with a psychologist to learn how to change your pain-related thoughts and behaviors.
- Alternative approaches such as acupuncture and tai chi.
Those methods aren't just for people who are at high risk for addiction. They're part of an overall pain management strategy that may include, but is not limited to, medications.
3. Use the Medication for Its Proper Purpose
"People need to be vigilant that the medication doesn't become a coping mechanism for other issues," says Karen Miotto, MD, an addiction psychiatrist at UCLA.
If your doctor writes you a prescription that makes your pain more tolerable, and you're using it as directed, that's OK. But if you're using it for some other reason that your doctor doesn't know about, that's a red flag. For example, if you hate your job and you're taking the drug because you find it takes the edge off, that's a sign that you could develop a problem, Miotto says.
4. Watch for Early Signs of Trouble
Here are four warning signs that you may be misusing your prescription painkiller:
- You're not taking the drug as prescribed.
- You're taking the medicine for reasons other than why the doctor prescribed it.
- Your use of the drug has made you miss work or school, neglect your children, or suffer other harmful consequences.
- You haven't been honest (with your doctor, loved ones, or yourself) about your use of the drug.
Your doctor should work with you to limit addiction risk. They may ask you about how you're doing, give you a urine test to check for medication, and ask you to bring in all your medications so they can check how many are left and where the prescriptions came from.
5. Ask for Help
If you feel like you're losing control over your pain medicine use, or if you have questions about whether you're becoming addicted to it, you may want to consult a doctor who specializes in pain medicine. They should listen to your concerns without judgment and take a reasoned approach.
For instance, if they think you need to get off a certain drug, they might look into switching you to another drug with less potential for misuse. If your doctor isn't comfortable handling your situation, consider getting a second opinion from a psychiatrist or addiction specialist, Miotto says.
6. Take Precautions
Pain-relieving drugs can lead to problems other than addiction, Miotto says. Keep opiates locked away so kids, teens, and others in your home can't take them.
And be extra-cautious using other prescription and over-the-counter drugs along with opiates. Certain combinations could cause you to become unconscious, stop breathing, and even die.
When Candy Pitcher, now 56, makes her monthly visits to the pain clinic, the staff gives her random drug tests and counts her morphine pills. She doesn't mind the attention. "Because of the benefits the opioid has given me, I'm willing to do it," she says.