| Are you addicted to pain pills? You certainly have | | | | occurring on a psychological level are far more |
| company. The cycle of use, dependence, and use | | | | difficult to recognize and treat than are physical |
| is playing out, over and over, in every community | | | | conditions. The psychological addiction to opiates |
| across the country. Note that I describe the cycle | | | | also develops very rapidly, and there is little if |
| as �use, dependence, use'-a description | | | | anything that can be done to prevent it. |
| that is accurate, because in most cases the cycle | | | | Psychological addiction is real, and is extremely |
| of dependence starts when you appropriately use | | | | powerful. The result is a desire to take opiates. |
| medication administered by a person who you | | | | The desire may take the form of physical |
| trust-your physician. | | | | symptoms, such as an increase in pain, and so |
| Pain pills are often called �narcotics'--a | | | | psychological addiction and physical addictions are |
| term that comes from the Greek word | | | | intimately connected. |
| �narcosis', or �sleep'-because of | | | | To health systems, time is money. Patient |
| their sedative effects. Physicians use the word | | | | complaints are handled as quickly (and sometimes |
| �narcotic' to refer to different things in | | | | as superficially) as possible. When a person |
| different situations. For example, when referring | | | | presents in pain, the first determination is whether |
| to controlled substances, �narcotics' may | | | | the pain is a serious threat to health. The second |
| be used to denote drugs regulated by the Drug | | | | determination is whether enough tests have been |
| Enforcement Administration. An anesthesiologist | | | | done to identify the cause of the pain. If the first |
| uses �narcotic' to refer to the portion of | | | | answer is no and the second answer is yes, the |
| the anesthetic that is comprised of drugs that | | | | goal is to clear out the room for the next patient. |
| bind to brain �opiate receptors'. | | | | There is a clock on the wall and a patient list in |
| �Opiate' is another word used by | | | | the hall, and the list has to be clear before the |
| physicians in reference to pain pills. The word | | | | docs and nurses go home. And so there is the |
| comes from �opium', a substance derived | | | | doctor-patients waiting in six rooms, more in the |
| from poppies and used to make heroin and | | | | waiting area, and a person in the room complaining |
| morphine. The �opiate' reference is also | | | | of something that isn't going to kill him/her. And in |
| used for synthetic pain medications that have no | | | | the doc's pocket lies a pad of paper. Amazingly, all |
| connection to poppies or opium save their | | | | that the doctor has to do to clear the room is |
| pain-killing effects. | | | | write on the pad and wish the patient well. |
| Most people have heard of �endorphins'. | | | | That is how addiction starts. Everyone intends |
| Endorphins are produced in the human body, and | | | | well; everyone is honest; everyone is innocent. |
| when released, block pain. Endorphins are often | | | | The patient is not told much about addiction. The |
| referred to as �endogenous opiates' | | | | patient isn't told that within a few days, he will |
| because of their role in pain sensation, even | | | | have some difficulty stopping the medicine. He |
| though they have no relation to poppies or opium, | | | | isn't told that after a week when he stops the |
| and are structurally quite dissimilar. These natural | | | | medicine he will have some diarrhea, he won't be |
| pain relievers have other functions in the body, | | | | able to sleep, and he will feel depressed. He isn't |
| roles not relevant to this discussion. Endorphins | | | | told that the pain that he has might not go away, |
| are one group out of dozens of | | | | and so he may get more potent medicine, and so |
| �neurotransmitters', substances involved | | | | on, and that it will get harder and harder to stop |
| in the communication between nerve cells. | | | | as the medicine gets stronger. I don't know if the |
| Endorphins and other neurotransmitters act at | | | | lack of information really matters; most patients |
| �receptors', the receptor being a lock on | | | | would likely take the pain relief medicine now, and |
| a nerve cell, and the neurotransmitter being the | | | | worry about the rest later. Besides, the doctor |
| key that fits in the lock. Amazingly, poppies | | | | doesn't seem too concerned�and the |
| produce a substance that looks different from | | | | patient is correct. The doctor isn't concerned, |
| the natural key, but that acts like endorphins by | | | | because this was a quick case that got him nearly |
| fitting the exact same keyhole. That | | | | caught up to schedule. |
| substance-one molecule from the sap of a red | | | | Unfortunately, there are pains that do not go |
| flower-has given the human species the ability to | | | | away, even as we patients demand relief. |
| ease suffering in countless individuals, and has | | | | Doctors hate to feel impotent with patients--it is |
| resulted in the deaths of millions of others. | | | | difficult to take a person's money, and then tell |
| Over the years scientists have developed | | | | him that there is nothing that can be done. And |
| synthetic �opiates' with potencies far | | | | so prescriptions are written, even when the |
| beyond anything produced by nature. | | | | problem may be complicated, and the best advice |
| Anesthesiologists use �sufentanil' reduce | | | | to the patient would be �learn to live with |
| responses to pain during surgery. Sufentanil is | | | | it'. This phrase angers patients with pain, but |
| extremely potent; an amount the size of one | | | | sounds intelligent to patients who have struggled |
| grain of salt, say one tenth of one milligram, | | | | to get off opiates. But usually, the person with |
| placed on the tongue would cause respiratory | | | | pain walks out with a prescription. As tolerance |
| arrest in a large man within seconds. More | | | | develops, the pain comes back, and the patient |
| commonly opiates are taken by patients in the | | | | goes to the doctor again, this time leaving with |
| form of codeine, hydrocodone (Vicodin), | | | | stronger medication. Tolerance continues, meds |
| oxycodone (Oxycontin), or hydromorphone | | | | are changed, and tolerance develops again. The |
| (Dilaudid). Prescriptions for these substances are | | | | doctor gets nervous over the situation, realizing |
| handed out to millions of people each day in | | | | that at some point he will not have anything |
| response to complaints of pain. | | | | stronger. Suddenly calls to the doctor are not |
| Opiates relieve pain, and work in different areas | | | | returned, or are returned by a curt nurse who |
| of the brain to elevate mood, ease tension, give a | | | | sounds like the patient's mother. The patient |
| subjective sensation of warmth, and cause | | | | realizes that he is stuck, and becomes depressed. |
| sedation. They can cause nausea and vomiting, | | | | Sound familiar? |
| particularly in patients who are na�ve to | | | | It is not your fault. I know about this stuff inside |
| them. Finally, they change the response of the | | | | and out-I earned my PhD in Neurochemistry at |
| brain to low oxygen and high carbon dioxide in the | | | | the Center for Brain Research in Rochester New |
| blood, and slow respiration. The most common | | | | York, studying drugs that cause addiction and |
| cause of fatal overdose is respiratory arrest, | | | | tolerance. I administered opiate medications every |
| where the brain stops sending impulses to the | | | | day as an anesthesiologist. I literally know |
| diaphragm, and the patient suffocates. This fatal | | | | everything that there is to know about |
| response is most common during sleep, or when | | | | opiates�expect how to stop taking them |
| opiates are taken in combination with other | | | | on my own. I thought I was smart enough to |
| sedative medications. | | | | avoid addiction, but I was wrong-laughably |
| Opiates are addictive. There is no way to take | | | | wrong-and the outcome nearly killed me. It is not |
| them without the body adapting and becoming | | | | your fault. To get better, you will need to |
| dependent on them. �Tolerance' to pain | | | | understand the meaning and truth of that |
| medication begins after the first dose, when the | | | | statement. That is difficult for some, but possible |
| �locks' on nerve cells adjust in response | | | | for everyone. |
| to all of the �keys' floating around. With | | | | My next installment has better news. You can |
| time it takes more and more keys to open | | | | become free. You don't need to leave your family |
| enough locks to cause the reaction at the nerve | | | | to go to a far-away rehab center, and you don't |
| cell. Tolerance is one half of the process of | | | | need to go through painful detox and withdrawal. |
| addiction, and is the reason for | | | | Watch for my next installment, or visit me at my |
| �withdrawal', the sickness that occurs | | | | address below. There is a new development in |
| when tolerance has developed and the drugs, or | | | | treating people dependent on pain pills, a |
| keys, are taken away. The other half of addiction | | | | development that will revolutionize the way that |
| is so-called �psychological', which I | | | | doctors treat addiction. |
| suppose is accurate to a point. For some reason, | | | | Jeffrey Junig lives in Fond du Lac, Wisconsin. He |
| once something is assigned to the psychological | | | | has worked as a neuroscientist and as an |
| category, it is treated differently by physicians, | | | | anesthesiologist, and is a psychiatrist in solo, |
| patients, and the rest of society. | | | | independent practice. Additional information can be |
| �Psychological' does not imply that a | | | | found at the web site of his chronic pain and |
| person has more control than with a | | | | addiction practice, Wisconsin Opiate Management |
| �physical' condition-if anything, things | | | | Center. |