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Chronic Pain and Drug Abuse

Chronic Pain and Drug Abuse

The Opioid Crisis

The United States has, over the past 25 years, experienced a dramatic increase in opioid overdose, abuse, and addiction, as well as other health issues related to abuse of, and addiction to, these substances. This can be directly traced to the increase in the number of prescriptions that have been written for narcotic medications to treat chronic pain. In fact, between 1999 to 2011, the annual number of fatalities from these prescription medications tripled. Even more concerning is that, while the number of annual fatalities from prescription medications remained somewhat stable between 2011 and 2015, overdose deaths from illicit opioids, such as heroin and fentanyl, nearly tripled during this time. The rise in overdose deaths from illicit drugs can be linked, at least in part, to the number of pain management patients who originally started using prescriptions for the drugs. We are now at the point where drug overdose is the leading cause of unintentional death in the United States, and almost all of these deaths involve a prescription or illicit narcotic.

As of 2015, 2 million Americans aged 12 and older had a drug abuse or addiction disorder involving these substances, with nearly 600,000 of them having an addiction to heroin. And the number of heroin users will continue to rise as doctors, once so quick to provide prescriptions to these highly addictive substances, begin cutting off their patients’ supply of legally obtained opiate medication. The problem is that the patient is already addicted and, therefore, will likely turn to illegal substances to alleviate the withdrawal syndrome associated with narcotic pain medication.

It comes as a surprise to many people when someone in their 40’s, 50’s, or beyond, become addicted to heroin or other illicit drugs. Most of us associate the age of first use of these drugs as in the teens or early 20’s. But the reality is that, due to the increasing number of chronic pain patients receiving prescriptions for narcotic pain medications, many of the patients presenting themselves to detox and rehab are significantly older. They have usually been injured or suffer from degenerative or other painful syndromes, and have been treated with the standard medication regimen.

Unfortunately, due to the ongoing scrutiny by the Federal Government of doctors’ prescription writing practices, a large number of these patients are simply “cut off” from their supply. Keeping in mind that with these medications, an increasingly higher dose is necessary to combat the patient’s tolerance (which develops quickly when taking them every day), by the time to doctor stops writing the prescriptions, the patient is physically addicted to these drugs. Withdrawal from any drug is painful, and it is likely that the patient is unfamiliar with the withdrawal syndrome. Becoming suddenly sick, with chills, diarrhea, cramps, sweating, and a host of other problems common to opioid withdrawal can be terribly frightening when one is not familiar with withdrawal and isn’t prepared.

And that is how many of these patients become addicted to heroin late in life. A “well-meaning” friend, co-worker, or family member will offer the patient relief from their illness. And while some would say that they should just “ride it out,” the reality is that for a patient who is already in chronic pain, the addition of withdrawal on top of the existing pain can be just too much to tolerate. They will do anything to alleviate their suffering. Hence, they wind up addicted to heroin or other illicit drugs, and their lives spiral completely out of control.

While the medical community struggles to find less lethal alternatives to these medications, chronic pain patients are faced with a very real dilemma. Pain is a complicated ailment; it’s very subjective, and, therefore, hard to measure and treat. That leaves chronic pain patients in a precarious situation. However, once the patient becomes addicted, it is usually advised that they go to detox and/or rehab to treat their drug addiction. Upon discharge, it then becomes imperative that they find non-narcotic alternatives to the medications they had previously been taking.

There are alternative treatments, and it is up to the patient to search them out. And there is help available for those suffering from drug abuse and drug addiction. Speaking to your doctor about treatment is an excellent place to start. At the very least, discussing slowly coming off the narcotic medications by means of a taper, or “replacement therapy,” is something that every pain management doctor should make a part of their practice. Most reputable physicians will work with their patients to ensure that they are as comfortable and safe as possible, and there is an array of drug treatment programs available for those who seek help.