Chronic Pain Can Lead to Painkiller Addiction

After suffering a foot injury, Lisa, a wife and mother in Kalamazoo, Michigan, became seriously addicted to the narcotic painkiller Vicodin, and was taking 30 pills a day at one point. Joan, a 55-year-old lifelong Kalamazoo resident, says she became addicted to opiates like Vicodin, Percocet, and codeine after necessary surgeries. She would go from doctor to doctor to obtain more drugs.

At one point, Joan was taking 20 Vicodin pills a day, along with Valium and a nightly bottle of wine. “I’m lucky I’m alive, to be honest with you,” she said.

Both Lisa and Joan, who asked that their real names not be used, are part of a nationwide problem. According to the 2007 National Survey on Drug Use and Health, an estimated 6.9 million people ages 12 or older used prescription medications for nonmedical use in the month before being surveyed. That total included 5.2 million using pain relievers, 1.8 million using tranquilizers, 1.1 million using stimulants, and 350,000 using sedatives.

Sally Reames, executive director of the local Community Healing Centers, a nonprofit substance abuse treatment agency, said as many as 30 percent of the patients in their inpatient and outpatient treatment are addicted to prescription drugs, and many have a “secondary” addiction to alcohol, which can be a fatal combination.

Jennifer Wezensky, special to the Kalamazoo Gazette, writes that Lisa was already a recovering alcoholic when she became addicted to prescription drugs. She said her pill addiction was fed by the euphoria and energy she felt when she was on opiates like Vicodin and OxyContin.

Her addiction caused a steep downward spiral that led to prescription fraud, drug court and court-ordered rehabilitation. She stole her husband’s fentanyl patches and other painkillers he needed for back pain, and replaced them with nonprescription drugs. She also had teeth pulled unnecessarily so she could get pain medications.

She also went to doctor’s offices near closing time to listen to nurses call in prescriptions; after picking up the medical jargon, she began calling in prescriptions for herself. After she was caught doing this, she went through the Kalamazoo Drug Court to avoid jail time and ended up in rehab. She relapsed several times, going through seven rehab stints between 1994 and 2003.

Lisa has now been clean for six years and is especially proud that she was able to remain clean after tragedy struck in her family (her husband recently died unexpectedly).

Joan sought help after she lost her job and her marriage ended. She went through detoxification at a hospital and is now in a 12-step recovery program with 16 years clean and sober.

“I had a hole, and I tried to fill that hole up with alcohol and with pain pills,” she said. “Most people that get addicted to pain pills don’t start out with the intention of getting addicted. Most start out with a legitimate medical reason. It works so well on the physical pain, you think, ‘Why not have it work on the mental pain?'”

Dr. Michael Liepman, a professor of psychiatry at Michigan State University Kalamazoo Center for Medical Studies and medical director of the Jim Gilmore Jr. Community Healing Center, says that people often mistakenly believe that prescription drugs are safe because a doctor is prescribing them.

Many patients who end up addicted to prescription drugs start with a legitimate pain condition. They develop a high tolerance for the drug, and it takes more and more of it to achieve the same effect.

“Sometimes people think, ‘If one pill makes me feel better, three will be better,'” said Dr. Richard Tooker, chief medical officer for Kalamazoo County. In the case of pain killers derived from opium, increasing the amount taken can be deadly because these drugs decrease brain activity, breathing rates and heart rates.

“Take three pills and maybe you wake up feeling better, or take three pills and maybe you end up dead,” Tooker said. “You’re really playing Russian roulette with your life.”

For some people, drugs as prescribed don’t give a strong- or fast-enough high. So they start taking handfuls all at once, mixing them with other drugs, chopping up the pills and snorting the powder or injecting a liquid solution made from the pills, Liepman said.

The prescription drugs that Reames has observed are most often abused are Vicodin, OxyContin, and the anti-anxiety medication Xanax. Liepman said he sees extensive addiction to opiate pain killers, anti-anxiety drugs such as Xanax, Klonopin, and Ativan as well as abuse of drugs prescribed for attention-deficit hyperactivity disorder.

Patients with physical addictions who decide to stop taking opiate drugs will go through withdrawal, which can be treated in an inpatient detox program. Opiate withdrawal can feel like a severe case of the flu, with hot and cold sweats, severe aches, anxiety, tremors, nausea and diarrhea, Liepman said.

Liepman said people trying to go off opiates sometimes need something else to help deal with the pain. Many addiction-savvy doctors will put patients on a drug called Suboxone, which is a less addictive opiate substitute that reduces cravings for opiates and provides pain relief, he said. It blocks the effects of other opiates so it prevents abuse. And if you take too much of it, it blocks itself.

It is easier for the recovering addict to manage this pain medicine than the other kinds they have abused, Liepman said.