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Opioid addiction fuelled by painkillers

Opioid addiction, fuelled by OTC medication and prescription pain killers, has reached epidemic  proportions in the US but is becoming a growing problem in the UK too. According to a recent BBC News investigation, GPs in England prescribed nearly 24 million opioid-based painkillers in 2017, the equivalent of 2,700 items every hour.

‘As a doctor, I have seen a growing number of teenagers and adults who have been given one medication for a headache or a period pain and liked the mildly euphoric opioid effect. They then find themselves drawn back to that feeling at times of stress and, because these drugs are so readily available, tolerance and dependence leads to a rapid increase in the quantity consumed.
They can be the gateway drugs for the stronger prescription opioid painkillers and for heroin, but they also have a serious sting in the tail.

Taking large doses of the anti-inflammatory component of these preparations causes gastric inflammation and serious blood loss from the stomach. The addiction is so strong that people will continue taking them despite suffering these dangerous physical effects. However opioids are formulated, their pharmacology is such that their addictive potential is huge, and they should be treated with the utmost respect by patients and medical professionals alike.

However opioids are formulated, their pharmacology is such that their addictive potential is huge, and they should be treated with the utmost respect by patients and medical professionals alike.

Prescriptions for these drugs have risen in the last five years, with one in every 11 NHS patients2 regularly taking a potentially addictive substance. Opioid addiction is a serious and growing problem, which I have seen at the Priory’s Hayes Grove Hospital over the last five years. The pathway, from prescribed strong opioid painkillers to illicit use and dependence, is increasingly well trodden.

It can be very difficult for professionals to recognise when an opioid prescribed to someone who has a condition associated with chronic pain has become a drug of abuse and is being used to manage other painful emotions, or is being taken to ward off withdrawal. There is often not a clear demarcation between appropriate long-term use and addiction.

Signs of prescription drug addiction – and getting help

These drugs create dependence by causing long-lasting changes to the brain’s ‘reward system’.
“The common factor is that they produce an alteration in your mental state shortly after you take one, and that is usually a positive feeling or the relief of distress.
There are many pathways to addiction with prescription drugs. For some people, they will have been prescribed the drugs appropriately but then their use switches from managing pain, in the case of opioids, to managing other distressing emotions.
Repeated use can lead to tolerance, needing to use more to get the same effect, and then withdrawal symptoms – feeling ill because you don’t have the drug.

It can be difficult to recognise when drugs are being abused.

It is important for friends and relatives to be vigilant about recognising potential symptoms in a loved one they are concerned about, as it can be difficult for professionals to recognise when prescription drugs are being abused. This is not clear cut.
Seeking help, or encouraging a loved one to seek help, can be extremely difficult – but it can be done. People addicted to opioids can struggle to see themselves as ‘addicts’ and may not want to associate with people who have been addicted to drugs, such as heroin, although the challenges they face are very similar. If they have an underlying mental illness or personality dysfunction then that should be treated once they have detoxed and stabilised, to reduce the risk of relapse.

The steps to recovery

The key step to recovery is recognition that you have lost control of the drug use and that it has come to control you. Help is at hand, from placed like the Priory, and the two main stages in treatment are getting clean from the drug and then staying off it.
If the patient is still suffering from pain then an important part of the treatment is to agree an alternative plan for managing the pain without opioids.

The second stage of treatment involves attending relapse prevention programmes, such as those run by the Priory and other organisations such as Narcotics Anonymous.
Managing the second stage can be more difficult. The physical withdrawal is very similar and managed in similar ways, but a key factor predicting the outcome of the treatment is how motivated a person is to address the problem.’

Dr Paul McLaren
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