… it’s the people who use them incorrectly AND DON’T FOLLOW THE RULES, take more than is directed, and use them for emotional issues that get into trouble. Those of us with chronic pain use them to do normal tasks (laundry, cook, housework, etc). They can be a very safe and effective way to manage chronic pain when used as prescribed. I’ve never heard of someone who takes something as prescribed who becomes an addict. I worked drug and alcohol rehab as a detox RN- and every last one of the drug addicts used drugs inappropriately, and generally illegally- and forfeited normal life and relationships to get more of the drugs. Those who use them as prescribed don’t do that.
Those who do not use opiates as prescribed are making a choice ( at least initially) to use them for non-medical issues (emotional). They make a decision that makes them more vulnerable to addiction (not to be confused with tolerance or dependence). Addiction involves emotional symptoms like cravings, and behavioral issues such as doing anything to get more, not maintaining relationships (personal, work, legal, etc), and in general disregards anything in their life in order to maintain drug use, eventually violating the law to maintain/obtain drug supply, or type of drugs used (heroin is cheaper and easier to get than many prescriptions due to changes in availability and MD’s willingness to prescribe them).
What are the differences between addiction, tolerance, and dependence? A LOT of people become tolerant or dependent on various types of meds but aren’t necessarily addicted. Tolerance is the body’s getting used to a dosage, and then needing more to get the same effect- but that isn’t the same as addiction. Dependence is the body getting used to a medication in their body, and when that medication is discontinued, they need to do so gradually to avoid withdrawal symptoms- there aren’t emotional ‘needs’ to keep getting the med, and it’s not the same as addiction. Addiction ALWAYS includes emotional and behavioral components.
For those of us who live in chronic pain, all of the talk about the ‘opiate epidemic’ is terrifying. We need the meds to have a normal life (to some degree). There is no emotional or behavioral need for the pain killers- JUST the need to ease pain that has been verified by diagnostic testing. For the government to tell physicians how to treat patients is bizarre. For a personal physician to be limited in how to treat a patient he/she actually knows is cruel in many cases. There are entire physician groups here where I live (associated with one of the local hospitals ) that are not allowed to prescribe opiates if they are general practitioners, or primary care docs. How is that rational? If there is a known cause for pain, why does someone have to see another doctor (specialist) to get pain relief- waiting weeks at times to get an appointment or test done?
I have a pain management doctor. With degenerative joint disease, degenerative disc disease, carpal tunnel syndrome, TMJ, a knee that can’t be replaced because of a history of pulmonary emboli (blood clots in my lungs)- so I will NEVER surgical pain relief), fibromyalgia, renal insufficiency (so can’t take NSAIDs like ibuprofen), etc, opiates give me some relief and “enough” quality of life to live independently, and not wish I was dead. I still have days when the opiate I take (as prescribed) isn’t enough. I get spine and knee injections many times per year. My pain doc has rules in order to be his patient. He doesn’t changes doses over the phone. No early refills. Have to go to the office to get a paper prescription because of the type of meds he prescribes. They do random urine tests to check for other meds. I like that he has rules- he’s not a pill mill or “Dr. Feelgood”. He’s board certified in pain management.
Consider the population that is involved in the “opiate crisis”… they are rule breakers that have high risk consequences for high risk behaviors. Addiction isn’t their fault, but getting treatment is their responsibility. Restricting those who DO follow the rules is mean… and the suicide rate will increase among chronic pain patients who can’t get relief, even when they’re the ones who follow the rules.
Deal with the addicts- not “punish” those who take pain meds as prescribed. Those with chronic pain didn’t choose their physical conditions….addicts (in the beginning) choose to not follow the prescription instructions, and use meds for non-medical uses. That’s not the problem of those who DO follow the instructions.