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Written by Steven Burns
From his column To Your Health

I got the call from a pharmacist early one morning, several years ago. “Doctor, we have a prescription here for Susan Smith (name changed), for oxycodone. Did you write this prescription?” I knew that Susan took this medication sometimes for pain, but I didn’t remember writing a prescription recently. “By the way,” the pharmacist said, “the prescription is on a prescription blank from Community Hospital Emergency.” That made it clear. “You need to call the police,” I said. “I have not been on staff at that hospital in several years.”

Imagine that you have pain every day. For some of you, that will require no imagination at all. Statistically, 20 percent of American adults have pain that disrupts their sleep a few nights every week.

Now, imagine that you have a medication that keeps the pain away for sixhours at a time—but you can only have enough for one dose every eight hours. This means, of course, that you will be in severe pain for at least two hours, three times a day. What would you do to get more medicine?

There you have the quandary that confronts physicians and patients every day. We have the ability to write prescriptions for pain that work for most people, but the medications themselves cause 17,000 deaths annually from overdose. And patients who have pain frequently want more of the medication that keeps the pain at bay. Are they then addicts?

We have the ability to write prescriptions for pain that work for most people, but the medications themselves cause 17,000 deaths annually from overdose.

The answer is more complicated than you might think. When we are discussing legal narcotics, the medications can be abused, both by people who want to control their pain, and by those who use them for the emotional feelings the medications can cause—“getting high.”

There are three classifications of dependence or abuse of narcotic pain medications: dependence, addiction, and pseudo-addiction. Most people, including many physicians, get them mixed up. Dependence occurs when a person has taken a medication for long enough that they have withdrawal symptoms when they don’t. With opioids (drugs derived from opium, or poppies, such as oxycodone, hydrocodone, codeine, etc.), withdrawal effects include shaking, chills, nausea, diarrhea, and pain. Even patients who use pain medications responsibly will have these effects when they stop taking them—and most willingly go through withdrawal to get off the medicines when they are no longer needed.

Addiction is defined as the “persistent compulsive use of a substance known by the user to be harmful” (Merriam-Webster). Most addicts will do almost anything, including stealing from family members, to get the drug. About 5 percent of people who use narcotics are addicts, and many of them will use whatever narcotic they can get, including heroin, the illegal opioid.

Pseudo-addiction is a newer term, referring to patients who exaggerate their pain symptoms so that they can obtain enough medication to control their pain. In medical practice, it can be hard to distinguish between addiction and pseudo-addiction, as the activities of the two groups appear similar. People who fear pain will take actions, including dishonest requests and claims of losing pills, to make sure they have enough medication.

So what are we to do? Ethics require physicians to treat pain, and yet the drugs are potentially dangerous. Used for long periods they can hyper-sensitize the patient, making the pain worse than it would be without the drug.

Susan Smith had transitioned from pseudo-addiction to addiction. In the long run, she spent a few months in jail for forging a narcotics prescription. Several years later, she called me and thanked me for reporting her to the police. She said it was the start of turning her life around. It was one of the best phone calls I ever received.

If you have leftover hydrocodone or oxycodone from an injury or surgery, you should dispose of it. Leftover medicines are easily stolen and sold on the black market, adding to the national drug abuse problem. Flushing them down the toilet is not the preferred method of disposal—some drugs have been detected in communities’ ground water. Many pharmacies now accept unused medications for destruction.

If you are a person who is taking opioid medications regularly, you should work with your physician to find non-opioid pain control techniques such as physical therapy, massage, and non-opioid medications. Most people can get off narcotics and still have good pain control.

And if you are an addict, there are many programs, including Narcotics Anonymous, that can help you to get off the drug and stay off. You start by being honest with yourself, and then seek help from someone else. Of course, you should seek assistance from the God who heals, as well. He is the one best-suited to help you.

Dr. Steven C. Burns is board-certified in family medicine and has been in practice for almost 30 years.

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