Is painkiller addiction/dependence ALWAYS wrong?

[Worrysaboutalot]

With the following caveats :-

: The person is a fully functioning adult person with reasonable mental health and able to make long term decisions.

: The person had one (or several) chronic conditions which are extremely painful and life long with no chance of pain ever ceasing.

:The painkillers have been prescribed by a consultant or GP who has all the medical record information and is monitoring the patient regularly.

:The person has been told they will be on these medicines life long.

I ask because I have several medicines, two of which are controlled and can be addicted. I can only have a month or less medication at a time, because of the risk of addiction. One of the pills I use for breakthrough pain, requires a GP appointment to discuss its use.

But despite all the 'it is addictive' concerns, yet I have been told I will be on this medicines for the next 30/40 years aka the rest of my life.

If I will be on these pills for the rest of my life, why the concern I will become addicted to them?

AIBU to not understand why I have to have the same facts repeated to me every few weeks, when this treatment is life long?

It does worry me. I don't want to get addicted to medicine but I can't live with the chronic pain, I was in before them.

There are many women on this site who have similar concerns, many who have to jump hoops and practical beg for the pain relief they need.

I am not sure of the answer really.

It's not just gps. I've previously had a psychiatrist refuse to prescribe some meds because of the addictive nature of them.
I'd been referred by GP as a result of contras with some meds and heath and the gp wasn't able to prescribe what was needed.

At GP level it's been locums that have mentioned addiction and not prescribed. Thankfully the pharmacist they get in knows what she's doing and bothers to read my history.

Now when I put in a repeat I put on the email I know they are addictive, please read why I am on them. This was suggested by the practice manager and pharmacist after I put in a complaint with regards to gp's withholding.

I'm on Zapain for the long haul. Yes, it is addictive and I'm in no doubt that I am addicted. Whilst I use my pills as directed and take less than the max daily amount, I still get particular physical symptoms if I ever run out or go a day without taking any. What I don't do is overuse them, I don't constantly think about getting more Zapain and my usage does not cause me any problems.

My choices are these:

Keep going as I am
Take no pain relief whatsoever
Use painkillers which are less effective
Use painkillers which are just as effective or even more so, all of which come with a risk of, yes you guessed it, addiction.

The question to ask yourself is this: Are you using your prescribed painkillers as directed by the doctor? If so, that's fine. If not then that's a cause for concern.

WRT the constant reminders - I suspect medical professionals are obliged to do so. As long as you know that you are using them responsibly, there's no need to worry.

I forgot to add: When/if the time comes to discontinue use, any responsible HCP will implement a tapering program rather than insisting you stop cold turkey.

We had this with my father when he was terminally ill. The doctors decided to wean him off a pain medication because it was addictive, he had dreadful withdrawal and the replacement didn't work as well. He was dead within the year so I fail to see why they were son concerned.

The doctor has a duty of care towards you and to make you aware of all the side effects of any medication including addiction/dependence. If the doctor keeps prescribing the same dose of the same medication then you may find you no longer get the pain relief you want so may need something different or a stronger dose, have you been referred to the chronic pain team for management instead. Maybe they can look at how much breakthrough medication you need and adjust your regular dose instead.

The concern is probably due to some of the over-prescribing by some doctors and the opiate crisis in the US. I wouldn't worry unless you are increasing doses regularly and depending on them for anything other than pain relief.
Zapain are pretty low down on the scale of addictiveness compared to other opiates. I've used them for over 15 years at low doses (2 to 4 a day) and they still work reasonably well.

Because previous years saw GPs dish out prescriptions and never check on the patients ever again, missing increasing doses, medications being sold because the patient didn't actually need it anymore, patients actually taking it to deal with withdrawal symptoms instead of the original conditions, stashes of hundreds of packets in the cupboard, rebound pain, missing new treatments that could stop pain/cure/put conditions into remission and the consequences of overuse including liver damage and death.

I've been on the same dose as you and was told that it would be permanent (it wasn't, new treatments came along that have been fantastic). I tapered off each time as soon as I could but wouldn't have had an issue with staying on them if necessary - HOWEVER, when the GP didn't have any appointments and couldn't issue a new prescription until they'd seen me, that was extremely unpleasant.

I grew up with a mother on multiple painkillers. She was always more aggressive first thing in the morning when it was ten hours after her last painkillers - I had to try and keep out of arm's reach until the drugs had kicked in or I'd get punched in the head for looking at her funny or some such bollocks. After she had surgery to resolve the issues she had been prescribed painkillers for, she continued to take them as normal because 'she needed them'. Twenty years later, she was screaming down the phone at me because she'd been kicked off her doctor's list 'Because they think they know better than I do how many tablets I need'.

'Um, how many are you taking in a day?'

'Hardly any and they don't do a thing anyhow'

'But a month's in a week? How many is that?'

'Next to nothing. Only about 17 Tramadol and ten Codeine. Might as well be sugar pills, they're as useless as the benzodiazepines'.

'That does sound like a lot. What actually happened?'

'Well, I put that stupid bitch receptionist straight. She told me that she'd made me an emergency appointment to talk to the doctor because ''Your last prescription was issued six days ago and he's not allowed to issue a repeat for a month that soon''. Well, I told her if she didn't do it right away I'd stab her stupid face because I'm not one of those druggies and the doctor has known me for forty years'.

My sympathies as your situation sounds really tough to deal with.

There is a difference between abusing painkillers and using them for legitimate medical use.

The issue is tolerance, where over time you need more and more of the same drug (if an opioid) to get the same result.

I think knowing a medication is addictive is important. I once cared for someone in their 80s at home whose fentanyl patch was not changed on time (at the time in their care plan they were responsible for it not us carers). They had withdrawl symptoms and it took the best part of a day to sort because they didn't know that's what was going on. Patch use was continued but became carer responsibility and added to meds chart to ensure it couldn't happen again.

When someone's on prescribed medication, I'd not describe that as "addiction", even if they depend on those drugs to function and take them every day of their life. "Addiction" means something else. It indicates that the amount taken is not well-managed or is at risk of becoming completely out of control.

Someone who is addicted may require more and more, to the point that it's very unhealthy and even immediately life-threatening. Doctors monitor things to prevent this from happening, ideally.

You’ll probably be referred to a pain management clinic to help you find other ways of coping, or to look at other forms of pain relief, eg amitriptyline or gabapentin/pregabalin.

Meantime, if you’re hitting the co-codamol every day be careful of constipation. Drink litre of water, eat mostly fruit/veg, and drink prune juice.

Also, the reason it is bad is because it feels horrible. After more than a few days on co-codamol I get a feeling like ants crawling all over my body. It is so horrible it makes me quite keen to never get addicted!

What meds are you on, do they still help or can the pain team suggest something else

The best pain management I ever received was from a ward nurse. Not to wait until the pain is unbearable but when it starts.

There's also some psychological aspect about not watching the clock for the next dose.

Applying this I find helps massively with my pain management. For me it's not about getting addicted as there's loads of things I could easily get addicted to (and have done) that are equally as damaging , but the tolerance side of things. I know when/if this kicks in switching again will be very difficult.

YABU a pill popping junkie is still a junkie! Its no different

Agree with you OP.

I take codeine regularly for chronic pain, as I can't take NSAIDs and paracetamol does absolute zilch for me. Tramadol made me feel horrific so I'm happy to stick with codeine for now.

I've been on dihydrocodiene for the best part of 4 years. I can stop taking it with no issues (except upset stomach!) but I figure it's not too much of an issue. I take 60mg a day (was on 4 x 60mg)

I also agree if they are only meds you can take and it’s agreed leaving you without them will do more harm than good then it’s least of two evils.

There are dangers to addiction as in stopping suddenly or running out will give specific withdrawal symptoms that brings its own health issues. This is not same as needing them to cope with long term pain issue where there is nothing else that works. Ideally we could fix all pain but withholding it because your body can’t cope without and then you can’t cope without due pain makes no sense.

Many of us on chronic pain have this issue, more than happy to try something, anything, but when it’s only thing being offered the constant justification and begging and phone calls and emails and dealing with one GP allowing and another deciding No. I think it’s in your best interest to be in unbearable pain because other wise you have take these everyday makes sense in no way at all.

I had bowel cancer and had quite a lot of it removed and I have to take codeine every day. I would be house bound without it, but with it I can lead a normal life, travel, work, go on long walks etc.
The doctor said there were worse things than being on codeine for the rest of one’s life.
Apart from helping my digestive problems I find it makes one feel very calm.

My GP has prescribed cocodamol, tramadol and oramorph for me to decide for myself which I need on any given day. I have excruciating pain while waiting for both hips to be replaced. I have end stage osteoarthritis and really can't have anything resembling a normal life without these painkillers. My GP made it clear on my notes that I know how to use them safely, that I don't want to take the oramorph on a day when I could get away with something weaker but that there are plenty days when that's the only thing that'll touch the pain. One of the other GPs has refused my repeat prescriptions a few times. My own GP has explained to her why I'm on the different ones. I'm also allergic to NSAIDs.

Today I had a call from the receptionist saying one of the GPs had asked her to call me because she has a medication query. It's the one who refused to prescribe in the past. I'm a bit worried about what this will be about. It's only within the last 3 months that my own GP has got my medication sorted out to work for me so I don't know why she's meddling! I know I would be due a review in December but they didn't say it's a review, they said it's a medication query 🤔

Presumably "being addicted" means you'll need /want more heavy doses?

I wouldn't rely on GP/other health professional reviewing medication; was once prescribed something which had contra indications with other medication I was being prescribed. Took many calls/emails & persistance, including going to a meeting with the patient information leaflet. Consultant claimed he wasn't aware.
I insisted on an overall review of all my medication; it was decided the first one should have been discontinued eight months previously.

@Missey85

YABU a pill popping junkie is still a junkie! Its no different

It is different - 'Junkie' refers to addiction from taking drugs in order to give pleasure and then taking more in order to avoid withdrawal symptoms (along with still chasing that original warm, cosy blanket of joy). Taking a medication in accordance with medical advice purely for the purposes of managing symptoms of a condition in full knowledge of the consequences/risks, undergoing regular reviews and essentially, not with the intention to get high, is miles away from being a junkie.

My mother crossed over. My childhood experiences meant I was determined that I didn't. I did have to taper off the medication twice, but that did not make me an addict - continuing to take it when I didn't need it for the original condition anymore would have done.

The OP is not taking them to get high but is debating whether it's appropriate to be made aware of risks and consequences of taking them for a prolonged period along with monitoring. Which it is. It's ensuring that they are receiving the appropriate treatment and not causing even more problems as a result.

@Glitterblue

My GP has prescribed cocodamol, tramadol and oramorph for me to decide for myself which I need on any given day. I have excruciating pain while waiting for both hips to be replaced. I have end stage osteoarthritis and really can't have anything resembling a normal life without these painkillers. My GP made it clear on my notes that I know how to use them safely, that I don't want to take the oramorph on a day when I could get away with something weaker but that there are plenty days when that's the only thing that'll touch the pain. One of the other GPs has refused my repeat prescriptions a few times. My own GP has explained to her why I'm on the different ones. I'm also allergic to NSAIDs.

Today I had a call from the receptionist saying one of the GPs had asked her to call me because she has a medication query. It's the one who refused to prescribe in the past. I'm a bit worried about what this will be about. It's only within the last 3 months that my own GP has got my medication sorted out to work for me so I don't know why she's meddling! I know I would be due a review in December but they didn't say it's a review, they said it's a medication query 🤔

Probably making sure that you aren't taking all of them at once and spending the day off your tits like my mother would have done. Duty of care and all that.

I don’t personally agree with the statement of “if the gp is prescribing and monitoring, then you’re safe”.
I was on a certain specific kind of painkiller for many years. The amount I was allowed to take per month was (in hindsight) ridiculous.
However, as I was in pain, and trying to hold down a ft job, as well as being a a single mum, I was grateful for the amount of painkillers the gp was allowing me to have.
The awful upshot of it, for me, was that the painkillers contributed to infarction on the brain, which an MRI scan revealed.
Bloody scared the daylights out of me as I thought I could trust the medication amount.
Since then, I’m not allowed even one of the painkillers that helped cause the infarction.
So I’m only allowed ten doses per month of a combo of aspirin and paracetamol.
These meds are only effective sometimes, to add to the misery.
So my thoughts are, that one should always question the amount of prescribed painkillers your gp allows.
I know this is extremely difficult, as it feels like you’re shooting yourself in the foot so to speak.
However, I wish wish wish I had questioned my meds, given the damage they were doing without my knowledge.
Best wishes to all whose lives are badly impacted by pain…..