The patient sat in her chair, tears streaming down her face. She had tried everything. “Nothing can make the pain in my back go away,” she said, yelling, “except those pills!” She was sure she was not addicted.
As I handed her a Kleenex and waited for her to calm down, the attending physician prepared for the difficult task of telling her that he no longer would be willing to write her prescriptions for Vicodin. He had learned that she had been obtaining hundreds of pills from more than a dozen other physicians — she was hooked.
Every time I see patients in primary care settings, I’m taken aback by the number of patients — regardless of age, gender or financial status — who are addicted to opioid pain medications, such as Hydrocodone (including Vicodin), Oxycodone (including Percocet and Percodan) and Methadone (including Dolophine and Methadose).
The consequences of this addiction can be severe, including lost wages, unemployment, academic failure, broken relationships, legal trouble and even death.
Pain medications have clear medical uses, including for the treatment of post-operative pain and for the treatment of pain associated with cancer. However, many patients demand — and many physicians are willing to write — prescriptions for opioid pain medications in the management of a variety of other conditions that cause pain, both acute and chronic.
These pain medications — also called opioid analgesics — decrease the sensation of pain, cause a sense of euphoria and induce varying degrees of sedation through a variety of different chemical pathways. They also produce a psychological drive to increase their intake, which can lead to addiction.
Opioid addiction is one of the fastest growing public health problems we face in the United States.
One reason is because physicians prescribe opioid analgesics at higher rates than in the past, in theory because of an increased awareness of the pain and suffering of patients.
Between 1997 and 2005, the number of grams prescribed of Methadone increased 933 percent. In the same time period, the number of grams prescribed of Oxycodone and Hydrocodone increased 588 percent and 198 percent, respectively.
More American teenagers than ever before also report having used these drugs for recreational purposes, with 16 percent (4.3 million) and 10 percent (2.3 million) reporting the use of Vicodin and OxyContin, respectively.
Most research, however, indicates that the vast majority of people addicted to opioid analgesics are people who at one point were prescribed the medication for legitimate pain. They developed an addiction to the medication over time due to both an increased psychological drive for the medication and an increased tolerance to the medication, a phenomenon where relief of symptoms over time requires larger doses to get the same effect.
As a result, the number of emergency room visits due to opioid analgesic use has risen from 42,857 in 1995 to 160,363 in 2005.
Symptoms of withdrawal — what patients experience when they’ve gone a few hours without the drug — can be quite serious and include shivering, goose bumps, muscle aches and cramps, restlessness, insomnia, irritability, depression and anxiety.
Addiction to any substance can be crippling. Fortunately, as health care professionals and the general public become increasingly aware of the signs and consequences of addiction, more steps are put in place to prevent future cases.
If you or someone you know is facing an opioid addiction, it is not too late to get help. Call your physician, visit Olin Health Center or make an anonymous phone call to the Substance Abuse & Mental Health Services Administration at (800) 273-8255.
Together, we can all play a role in reducing the prevalence of opioid addiction and keeping our friends and loved ones safe.
Farhan Bhutti is a State News guest columnist and a second-year medical student. Reach him at bhattifa@msu.edu.
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