The Grapevine

Prescription Painkillers: Tips To Reduce Addiction Risk

After a civil lawsuit filed by New Jersey state authorities, Michelle Breitenbach, a former sales representative for Insys Therapeutics, pleaded guilty to charges that she helped fuel the opioid addiction crisis. She admitted to bribing doctors to prescribe the painkiller Subsys for purposes not approved by the Food and Drug Administration (FDA) on May 30. 

As a part of the ongoing crisis, millions of Americans have experienced dependency or have abused opioid pain relievers. To avoid the risk of addiction, here are a few helpful tips to keep in mind.

Differentiate between addiction and dependency

Being addicted and being dependent are not synonymous terms. "Dependence is defined as having withdrawal symptoms when the drug is stopped, while addiction is the compulsive use of the drug for a state (euphoria) other than pain relief," wrote Jeannie DiClementi, an associate professor of psychology at Indiana University.

Addiction may not be likely when patients use painkillers for short-term pain after an injury or surgery. In such cases, the patient tends to focus on the analgesic and sedating effects of the painkillers, explained DiClementi. But when the individual focuses on the euphoric effect or "the high," he or she is more likely to become addicted.

If at risk, create a plan and involve someone

Patients are typically asked about their pain when doctors help them decide how to take newly prescribed painkillers.

"But, if you’ve had previous addictions or a genetic link to addiction in the family, you’re at a higher risk than the general population," said Dr. Marvin Seppala, the chief medical officer at the Hazelden Betty Ford Foundation, Minnesota.

In such a case, he advised patients to discuss their background openly with the doctor. A structured plan which limits or does not allow for independent decision to increase dosage can be effective. Additionally, Seppala recommended involving someone from your family or a close friend to monitor the medication use with you. "You’re not thinking clearly when you’re in pain," he said.

Take the medications exactly as prescribed

After their doctor prescribes an opioid for long-term use, some patients may become concerned about developing an addiction and reduce their dose. This may actually increase the risk of addiction, according to Dr. Karsten Kueppenbender, an addiction psychiatrist at McLean Hospital, Massachusetts.

By cutting the dose, the patient will end up waiting until the pain becomes unbearable and they have no choice but to take the painkiller. The risk of addiction increases due to the memory of how the pain worsened combined with the relief from the opioid, Dr. Kueppenbender explained.

Think ahead and anticipate withdrawal symptoms

While opioids are effective, the body eventually builds up a tolerance and become desensitized. Withdrawal symptoms are the body’s physical response to the absence of the drug, not necessarily a sign of addiction.

Muscle ache, nausea, disrupted sleep, digestive issues, restlessness are some examples of symptoms. Suddenly stopping painkillers after regular use may lead to severe symptoms. On the other hand, gradually reducing the dose or tapering off is considered to be easier on the body.

"By stepping down gradually, any increased pain or sensitivity is typically short-lived and manageable for most patients," said Mark Sullivan, a professor of psychiatry at the University of Washington in Seattle.