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.

This is the thing @NeverDropYourMooncup I would never take so much opiate that I am unable to be present for my children, in fact I frequently choose pain over opiates for this exact reason. I think that proves I am in control of pain meds, rather than them being in control of me, hopefully...

Witnessed this at the chemist chap is prescribed 7 days medication at a time he went in the pharmacist said we need to discuss your usage his response was im dying "but you will be addicted" he was very gentle and said my dear im dying there is no need for me to die in pain

They gave him his medication

I've seen the consequences of pain killer addiction and it's devastating.

A close friend was on a cocktail of tablets to manage pain and epilepsy. She was lovely but I started suspecting that she had a bit of a pill-popping problem. She was only in her 20's and the picture of health from the outside yet she was always at the doctor's or hospital asking for something else to be prescribed. It's not my place to comment on someone's health though, so I never said anything.

A few years down the line, her doctor changed some of her medication and refused to prescribe the old stuff. She ended up buying it from dodgy drug dealers and getting into loads of trouble due to owing money. She'd gone from my lovely, funny friend to a drug addict basically. She died last year from a cardiac arrest at 32

An extreme story but that's the reason you have to be careful. Addiction does happen and it can happen to anyone.

Watch 'Dopesick' on Disney +

That is taking over recommended dose though they only way to manage addiction would be to haul you in at no notice for blood tests and if you had over limit in blood it would be stopped. That is different from taking recommend dose everyday.

Stopping a dose that’s not abuse is not going stop addition becoming problem small percent of people. In fact more likely mean turn alcohol or other drugs.

Oh and I have chronic pain and have been on just about everything going, luckily I've never been addicted. However my then GP four years ago said he wouldn't prescribe emergency diazepam ever again ( I used it once every few years and only had four tablets at a time). He said if I wanted it then I could go on the street and find a drug dealer to sell it me. He was so nasty at the time. I still wonder if I'm able to complain or if it's far too late.

I dont know if it's already been mentioned, but when your body gets addicted it means you need more and more of the same medication for it to work. This isn't good for your body and can have other side effects. Also psychologically can be harmful.

Imo, addiction and dependence are two very different things. Taking them as prescribed, for pain only - that counts as dependence, and as long as you're being completely transparent with your gp, is fine. Tbh I think UK doctors are more hesitant to prescribe due to the addiction risk and also the mess with prescription pills in america

Addiction is when you're taking it for a reason other than what it's preecribed for, etc. I'm an addict. I've never gone to a dealers or done street drugs, and while my drug of choice was dihydrocodeine, it was never prescribed by a gp for actual reasons.

I had a lot of knee problems in university so mam gave me her (prescribed) cocodamol, and after I left uni that continued. I lost a job (unrelated), was assaulted at another job, and at some point (I can't pinpoint when) I was no longer taking it for physical pain - if I ever really was. It was for the high, and I loved it. I justified it like crazy! Helped by a drugs training course telling us they do not discuss painkillers because they do not class them as using.
After a while, I behan buying drugs offline. All perfectly legal - tell an online dr a cock and bull story and be sent 100 painkillers. Repeat on numerous online sites. I then switched from cocodamol to dihydrocodeine thinking I'd use half as much - I didn't! It became an absolute obsession, and I got loans and sold my baby jewellery to pay for it. Through all this I didn't 'look' like a 'junkie'. I worked full time, and seemed to function.
I got on a subutex script purely so that if I couldn't get drugs then at least I wouldn't feel unwell. I'd no.intention of stopping, thinking myself invincible. I moved away for a new job, qnd over time I have changed. Again I'm not sure when - but I was talking to drugs worker yesterday and the change in me from 3years ago is massive.
My last day on my script is Tuesday coming, I'm in NA, I'm working with a sponsor etc. I'd always advise being very careful re sharing medications. You think it's a kindness but it's really not - I'd have never gone and scored heroin, but a little white pill? Yes please! In my area, back home, sharing meds is a very common thing. I think my situation wasn't exactly unusual as my gp seemed resigned when I told him. We're not as bad as america - but we could be.
For me, I know I've got to be very careful about taking opiates or any 'fun' medications. I was on propranolol- and worked out that taking 3x the doze gave quite a nice high.

As I say, there's a difference between dependence and addiction but worth keeping an eye on it

@Missey85

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

It is easy to be judgemental when you are not 'walking' in our shoes.

I sincerely hope you never develops lifetime chronic pain. As I would never wish my daily pain and tiredness on anyone.

I always wondered this when they kept showing Steve Arnott on Line of Duty taking painkillers. The guy had a bad back and was in agony when he didn't have his medication, why shouldn't he take it?!

@OldTinHat

Watch 'Dopesick' on Disney +

Have done. It is a terrible medical travesty.

I have read the whole thread and there are so many stories which touched me, either with sorrow or sympathy. Thank you for all the posts it is giving me loads to think about and I am trying to sort out the future.

They have a duty of care to you, and its responsible that they are checking in and keeping the conversation open about addiction

The problem is, addiction grows and spirals out of control.
I have a family member who has been on strong opiate medication for years and years. He was reliant on it to get through the day, it wasn't a shock when I'd see him getting withdrawal symptoms when we would see him. Being sick, sweating, runny nose, but it was shrugged off as maybe he forgot his medication that morning and we would get him home, to his medication.

We've recently just found out that he has graduated to injecting opiates when his medication isn't enough. It seems on the severe end of the scale, but its scary how this has happened and come from a dependency from something he was prescribed from his GP.

I am on Amitriptyline and Gabapentin daily for my nerve pain in my legs and arms.
(This is due to some nerves died in my legs and arms, consultant said my nerves will never regrow, so I get broken nerve messages to my brain saying my arms/legs are numb, burning, freezing, water running down them, and lightening strikes alongside the pain. No treatment and it will never get better)

I am also on daily thyroid meds, steroids and immune suppression treatment.

Lastly I have ad hoc 30mcg/50mcg Zapain. Which I only take when I have the abdominal pain, which is intermittent but intensively pain when I have it. So I take this in a week block or so, then nothing for weeks or months.

I only take prescribed medications and ironically hate taking tablets but I have to in order to have some resemblance of a life.

The issue, rather than addiction, is tolerance.

Many of these drugs need increasing doses for the same effect. Very shortly you will move from a “therapeutic” dose to an overdose. While it probably won’t kill you, because you’ve built that tolerance, there us a definite risk it might. All it takes is a drug interaction, or anything that affects your tolerance, and you’re dead. Also where do you stop, prescribing ever increasing doses.

So it’s carefully monitored to try and keep the doses within appropriate limits, and also monitor the effectiveness of pain control.

Personally, if you’re terminally ill I don’t think it should matter. Give all the pain relief, because if it does kill you better to go pain free from the drugs than months in uncontrolled pain.

For management of non terminal condition it’s difficult. Ideally you find a solution, a treatment that improves the cause. If that can’t be done then yes, careful monitoring and also trying different medications, changing every so often to try and find the most effective pain relief for the patient while reducing the risk of addiction and tolerance.

@2020isnotbehaving
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.

This sums up how I feel. I don't want to end up begging a GP to allow me not to be in Chronic Pain. So far things are OK but over time the pain gets worse, it is worrying.

If the only viable options are live in pain or be pill dependent, of course dependency is ok, even preferable.

Some people are very judgmental towards drug addiction or dependence, no one starts out with the intention of becoming addicted and people become addicted or dependent to many drugs even things like laxatives or mild painkillers. GPs can come under fire for not reviewing medication and just keep on providing the same prescriptions without reviewing the patient and their unmet care needs. With chronic pain the pain team and anaesthetists are the experts, they are the ones who manage this much better and hopefully new therapies come up all the time to help chronic pain sufferers. It's so depressing waking up each day in pain so I hope you can get proper relief.

Have they ever considered nerve blocks

NC for this....

I was prescribed Tramadol 10 years ago - I fell absolutely in love with it but knew I was addicted and taking too much, for its pain relieving properties but also for the high. As time went on I ended up taking more and more just to keep the withdrawals at bay. I came off it cold turkey and relapsed 3 times, it was awful. I finally managed to kick it for good about 5 years ago.

However, I genuinely needed pain relief for a the original chronic condition. I was so scared to start taking strong opiates again so struggled on for a couple of years just taking OTC.

I was then prescribed Zapain about 5 years ago and take the minimum dose I can get away with and never ever abuse it. However, I don't kid myself, I do have a dependency, even at a very low dose. If I have a few days gap whilst waiting for my next prescription, the withdrawals start.

Dopesick Sounds like you have had a tough time with your medication.

I don't get a high off my meds just a dampening down of pain. However I know to be wary of Tramadol in the future.

@KittenCatcher

Have they ever considered nerve blocks

No, as the damage is to the base of my spine. My consultant said they didn't operate or biopsy that area (Dorsal Root) as it could cause further problems with my mobility.

All I can say is that I'm extremely glad I don't live in the US. I know I would have been a prime candidate for OxyContin and I would have got horribly addicted.

My advice would be to take the weakest painkiller you can get away with. The lure of Tramadol was too great for me, I'd steer clear if I were you!

Personally I'm not sold on the breakthrough pain theory either. In my experience it's just the onset of withdrawals.

I take Cocodamol 30/500 during the day and Tramadol and paracetamol every evening. I have lupus that doesn’t respond to immunosuppressants because they give me horrendous side effects due to my other conditions- Addison’s, asthma, pituitary issues, kidney issues etc etc. So with steroids and these painkillers I can lead a fairly normal quality of life - I have a disabled son to care for and I can’t afford to just be lying on the sofa all day. With the painkillers I can function. Couldn’t care less if I’m addicted or not. It’s completely irrelevant to me. Thankfully my many specialists are understanding and happy to support me.

People who have never suffered chronic pain will never understand.

Also to answer your original question, you said you're likely to be on the pills for the rest of your life so why worry about addiction?

The major problem with addiction is when your body builds a tolerance to the medication and you need to start taking more and more to get the same therapeutic effect.

I take two Zapain per day. By the end of the day I'm usually in a fair amount of pain but I refuse to take anymore because it's a slippery slope. So I accept that my pain is relatively under control in the daytime and worse in the evening. I'd rather live with that than full blown addiction again.