Opioid Dependence And Addiction
If you take the medicines for a long enough period of time, you're going to find at least two things happen. One is tolerance, which is when you need more medicine to get the same effect.
Then we find that there's something known as hyperalgesia. Hyperalgesia is a condition where the pain is increased.
When we look at people who are able to successfully drop the drugs over a period of about three weeks, we find that the people who are off of the drugs have less pain. They have less depression and they have a greater function.
Again, people taking the drugs for 2-5 years are addicted to the drugs. And the drugs are decreasing, not increasing their quality of life. You become dependent on the drugs and it can take as little as several days or even several weeks.
Unfortunately, when you try to stop the drug, you develop other kinds of symptoms that are misinterpreted for the primary pain problem that you have initially. So, you don't want to get off the drugs. Yet, the initial problem is gone and now the symptoms associated with tapering the drugs are associated with the dependence.
What kind of problems do you have with dependence? You can divide dependence into the psychological realm and the physical realm.
In case of the physical realm, you can have agitation, sleeping problems, diarrhea, excess salivation, extra pain. And all of that is because of the changes that have occurred in the central nervous system.
As far as psychological dependence on the drugs, when you slowly get off the drugs or stop the drugs, you find that you lose any interest, you become flat, you have dysphoria, you just don't feel good, have cravings that you have to go and get some more of the drugs.
Even one dose of the drugs can have some negative impact. If we give a person Hydrocodone or Oxycodone and then give them an injection of the medicine that blocks the effect of the drugs, those people are going to have some sort of symptom
How long does it take you to become addicted to the medicines? For the average person, it is around 1-3 months of taking the drugs. or two or three months of taking the drug.
If we have a problem with the opioids as far as overuse is concerned, the longer you take them, the more you're going to need to get the same effect. You have misused, people taking them for reasons they shouldn't be taking them.
We also have the opioid use disorder. That's the term now used for the addiction to the drug. Addiction means that you compulsively seek the drug, you have a dependence on the drug and you take the drug. You go and search for the drug despite the fact that it has negative consequences, either physical or social or psychological.
Is there a difference between physical dependence and addiction? Yes, technically there is. But doctors and psychiatrists argue about it. And if the experts can't come to an agreement on it, it's not something that we really need to worry about.
What's the likelihood of your becoming addicted to drugs as a long-term user?
Well, the addiction is going to occur in up to 30% of the people. That's in addition to the people who are suffering from dependence on the drugs.
The question is - if we check the urine of people who are getting prescriptions Hydrocodone or Oxycodone and measure if our drugs are in the urine in inappropriate amount. Interestingly, that more than 20% of the time there's some sort of an abnormality in that people don't have any of the narcotic in the system. In other words, the narcotic has been diverted before they take it.
Long-term users have a higher incidence of having some sort of other issues. These are the people who are substance abusers, people who are using things that they shouldn't be using or having mood disorders that make them more susceptible.
These people are more likely to get the drug in the first place and more likely to misuse the drug. They become dependent on the drug and use the drugs over long period.of time.
We also have the deaths from the drugs. People worry about little things in life. We worry about people getting shot with BB guns, and about people who shot with bows and arrows, about people who are injured in schoolyard accidents and about all of these things. But right in front of this, right staring in our face - 16,000 die each year of opioids.
It is a major problem. Once upon a time you could start taking them at a relatively low dose and when the tolerance developed you could take more and you could take an increasing amount of the medicine without causing any problem. However, it is not the case.
Especially it's not the case if you happen to be taking other kinds of drugs like sedatives, hypnotics or sleeping pills or alcohol. You have an increased likelihood of causing yourself significant and serious harm.
Interestingly, after spine surgery people who were taking the drugs had the most frequent cause of death within three years after fusion, probably were taking the narcotics.
Side Effects Of Opioid Drugs
Are the people who are taking the most narcotics or people taking the infrequent narcotics, most likely to have issues. It might be the people who take the drugs infrequently are more likely to have problems.
If we look at the people who are taking the narcotics versus people taking those aspirin-like medicines that we call NSAIDs, people on opioids have a higher incidence of heart disease, fractures, bowel obstruction.
And if we look at some of the other complications of taking these drugs like constipation - 1 of 5 people complain about a serious constipation.
Opioid drugs also cause sedation and dizziness. Dizziness major cause of falls and fractures, especially as we grow older. But young people are not immune to the problem.
The incidence of motor vehicle accidents is significant in opioid users because people have reduced reaction time, reduced tension. They have what we call psychomotor retardation.
The depression is very common. Depression causes pain and pain are treated with narcotics, and narcotics cause pain. We have a vicious cycle.
So, we increase the pain, we increase the dose, we increase the duration of therapy and we increase the depression.
As far as the hormone therapy. Unfortunately, we know that narcotic pain medicines affect the endocrine system in the hypothalamus. There's a chemical that's released that tells the pituitary gland to make a chemical to tell the ovaries or the testicles to work.
It seems that the narcotics negatively impact on the hypothalamus. They block it by making gonadotropin-releasing hormone. As a result, men suffer from a decreased testicular function, decreased testosterone and erectile dysfunction.
Women are going to suffer from a significant impact on the ovarian function. Women can also suffer from amenorrhea or oligomenorrhea, not having periods or having periods that are relatively infrequent.
If we look at people who are taking the drugs after they have the surgery. What is the likely to them being able to get back to work? Well, it's not nearly as good as it would be if they weren't taking the drugs.
The strongest predictor of risk of problems with these drugs may well be not the pain severity, but whether the person drinks alcohol or takes other drugs.
We have alternatives to these medicines. You don't have to take the narcotic pain drugs. For instance, you can try a cognitive behavioral therapy that might work in this case.
We also have an exercise therapy. We say:”Oh my goodness! You have the back problem, you shouldn't exercise!” Well, maybe exercise is going to be able to reduce the amount of pain, recurrence and the likelihood of disability. That is why ought to consider some more exercise.
What about some of the other kinds of things like seeing the osteopath or the chiropractor for some manipulation? Or the acupuncturist, or the massage person. Those seem to make sense. And, certainly, there are a lot safer than taking the pain medicines.
Ideas On How To Use Opioids Properly
Now we come up with some ideas about how we can reduce the problem. We can reduce the problem by drug monitoring programs or maybe some databases that the state can maintain and then the pharmacist can call the database to see if the person is shopping narcotics at different pharmacies./
We can also have a maximum prescribed dose. Maybe, we're going to make some of the drugs incapable of being used for snorting, smoking or injecting.
Bu really what we need to do is we need to focus on the person, the ability of the person to get back to work, to get back to normal. Unfortunately, long-term use of the narcotics is not doing it, it just isn't cutting it.
As we stand now on the precipice of bringing more pain medicines to market, the focus of attention shouldn't be "do we really need another medicine".
We already have too many medicines. Maybe we ought to start restricting some of the prescriptions for these pain medicines. Or make sure that there isn't a diversion from the adults to the kids.
Finally, we got to make sure that there's something about our society, where people don't crave drug-taking. We have lots of issues and the issues can't simply be taken care of by writing more prescription.