Between 1991 and 2014, the number of opioid prescriptions written in the United States rose from 76 million a year to 245 million, and yet there has been no change in how much pain Americans suffer. What has changed is our annual number of opioid overdose fatalities, which more than quadrupled between 1999 and 2017. More than 30% of Americans are currently suffering some form of pain, and more than 40% of older adults suffer chronic pain, but opioids are only effective for short-term therapy; when used for more than a few weeks, these addictive painkillers can actually increase pain sensitivity.
Prescription drug abuse is rampant in the U.S., but so is chronic pain. Addressing both of these problems requires better pain solutions, such as non addictive painkillers.
Non Addictive Painkillers
A recent, preclinical study by scientists at Indiana University found that compounds called positive allosteric modulators (PAMs) will enhance the effects of natural pain-relieving chemicals that the body produces in response to stress and injury. PAMs cause these natural chemicals to relieve pain more effectively without causing tolerance or any lessening of efficacy over time—two factors that greatly contribute to the development of opioid addictions. With over two million Americans reporting problems with these addictive painkillers, and drug overdoses are now ahead of car accidents and guns as the leading cause of death for Americans younger than 50, non addictive pain solutions are greatly needed.
Positive allosteric modulators work by targeting secondary drug receptors instead of the primary drug receptors targeted by opioid drugs. Opioids work on primary drug receptors, turning their functioning on and off like a light switch. Because they are affecting primary binding sites, the effects of these drugs can spill over to other bodily processes. PAMs don’t switch anything on or cause any unintended effects. By targeting secondary drug receptors, they merely amplify natural biological painkillers that are already at work. PAMs target the right brain function, at the right time, to relieve pain, instead of attaching themselves to receptors that are located throughout the body, the way addictive painkillers do.
Animal testing showed that by using PAMs, the experience of pathological pain could be fully reversed without causing tolerance or dependence. This PAM study represents a major breakthrough in the search for non addictive painkillers.
Prescription Pain Pill Addiction in the U.S.
The 2014 National Survey on Drug Use and Health found that 15 million Americans age 12 and up used prescription drugs for non-medical reasons in the past year, and in the past month, 6.5 million did so. Prescription drugs are the most misused and abused drugs in the United States after marijuana and alcohol, and the problem is only growing, fueled by misinformation and widespread availability.
Out of the over 20 million Americans age 12 and up who suffered a substance use disorder in 2015, two million were addicted to prescription pain medications—an addiction that has been proven to sometimes lead to heroin abuse. In fact, four in five new heroin addictions started with an addiction to prescription opioids, with most of the new heroin users explaining that they turned to heroin because it was cheaper and easier to obtain than prescription painkillers. In 2012 alone, 259 million opioid prescriptions were written—that’s enough to hand every adult in the country their own bottle full of pills.
Opioid addiction is a disease that feeds on itself, causing cognitive effects that further impact a person’s ability to make good decisions. We have known about the link between opioids and slowed breathing for a long time, but have only recently recognized the severe psychological and neurological effects of opioids. Depressed respiration can cause coma and brain damage because it limits the amount of oxygen reaching the brain. Opiate addiction can also directly cause the white matter in the brain to deteriorate, resulting in a diminishment of effective behavior regulation, decision-making ability, and stress response.
Signs of Prescription Drug Addiction
The following is a list of behavioral signs that you can look out for if you are concerned that you or someone you love is addicted to prescription drugs.
- Taking extra doses of pain medication, or taking doses more frequently than prescribed
- Running out of medication earlier than expected
- Frequently “losing” prescriptions or medications
- Continuing to use prescription drugs despite side effects or health problems caused by the drugs
- Frequent complaints of unexplained illness
- Legal problems stemming from drug use, such as DUIs
- Engaging in risky behaviors such as unprotected sex
- Using prescription drugs to experience euphoria, or to relax or destress
- Withdrawal from friends and family
- Avoiding social events
- Losing interest in hobbies and activities
- Losing track of time
- Defensiveness about drug use, hostility when confronted
- Secretive behavior, lying
- Unexplained mood swings
- Stealing money or valuables to pay for drugs
- Neglecting school, work, or home responsibilities
- Neglected grooming or hygiene
- Declining performance at school or work
- Storing or hiding drugs in various places throughout the home
- Becoming anxious and irritable when unable to take medication
- Doctor shopping, i.e. visiting other doctors or clinics in an attempt to obtain additional prescriptions
You may also notice physical changes, such as:
- Stomach problems
- Confusion
- Impaired coordination
- Unexplained weight changes
- Major changes in appetite
- Slow or slurred speech
- Clumsiness
- Slow gait
- Constant flu-like symptoms
- Increased tolerance to prescriptions
- Experiencing withdrawal symptoms when trying to quit or cut down
Results of Prescription Drug Addiction
Scientific research suggests positive allosteric modulators can reduce pain without causing tolerance or addiction.
The long-term effects of addictive painkillers on the brain can be devastating, which is why it is important to halt prescription drug abuse as early as possible. Just 30 days of regular opioid use can reduce the volume of brain matter, resulting in drug cravings, difficulty regulating emotions, and increased experience of pain.
Use of addictive painkillers can increase your risk of depression, which can increase your vulnerability to addiction, creating a vicious cycle of prescription drug abuse. Long-term prescription drug abuse causes the brain to rely on drugs to produce the neurotransmitters that control motivation, reward, and feelings of pleasure. As tolerance increases, more and more drugs are needed to simply feel normal, because the brain is no longer producing the necessary neurotransmitters on its own. If someone quits using addictive painkillers, the brain will eventually heal and begin producing these chemicals again, but it can take months, even years, for levels to normalize and normal functioning to return. The earlier addictive painkiller use is stopped, the faster the brain can heal and the more complete that healing will be.
Addictive painkillers can cause impaired cognition, destroying brain cells responsible for thinking, remembering, and learning. Opioids can also reduce blood flow to the brain, resulting in short-term memory loss and increasing your risk of dementia.
Combating the Opioid Epidemic
President Trump recently declared America’s opioid epidemic to be a public health emergency, and promised to fight the problem with three major interventions: increased access to telemedicine so that opiate addicted individuals in remote areas can get treatment, supplying grants to fund treatment for people who have work issues due to opiate addiction, and speeding up the hiring process for opioid addiction experts so they can work on finding solutions to the crisis.
These efforts are valuable, but much more needs to be done if we hope to end the opioid epidemic in the United States.
Preventing and Treating Opioid Addiction in the United States
Prescription drug abuse and overdose have skyrocketed in recent years, primarily due to the most addictive painkillers, opioids like oxycodone, meperidine, hydromorphone, and codeine. Millions of people take opioids without becoming addicted, but anyone who takes prescription painkillers is at risk of addiction, especially if they don’t know the facts about opioid misuse and addiction. Opioid addiction education is a key step in addiction prevention.
Patients need to know that opioids can be safely used for acute pain for a few days, such as after surgery. But anyone who takes opioids for 30 or more days will develop a tolerance and physical dependency that will cause withdrawal symptoms if they cut down or stop taking the medication. Dependence is not the same as addiction, but it can cause a number of physical and emotional problems, and can easily develop into addiction.
These issues do not mean that the next time you take opioids for pain after surgery, you should take a smaller dose than recommended or wait a long time in between doses—that kind of behavior can actually backfire. Your memory of severe pain combined with the intense relief brought on by the painkiller can make you even more vulnerable to addiction. What you can do instead is make sure that you are closely monitored by a physician while taking the drug, and that you exhibit caution during use.
Alternative Pain Management Options
Non-opioid medications, non addictive painkillers, and alternative treatments such as cognitive behavioral therapy, meditation, and exercise are all viable alternatives for pain management. There are proven pain rehabilitation approaches that acknowledge the biological fact of pain, while also taking into account the social and psychological factors that can impact your experience of that pain. Improving quality of life through coping mechanisms that can reduce the experience of pain and allow a return to your usual personal and professional activities can further reduce pain levels by reducing levels of anxiety and depression, which can worsen or even cause the experience of pain. This creates a positive, pain-reducing cycle.
When poorly managed, chronic pain leads to chronic stress, which causes a string of physical reactions such as elevated heart rate and tense muscles that will worsen your pain or create new kinds of pain. Mindfulness techniques, visualization, exercise, and other holistic treatments can reduce the body’s stress response and induce a relaxation response that will allow the body to relieve pain naturally. Cognitive behavioral therapy can teach you how to effectively manage stress, conflict and emotions, while also helping you learn how to detach from pain symptoms instead of latching onto them in ways that will only amplify the intensity of the pain you feel.
These alternative approaches can encourage the body’s natural pain response, and then, once PMAs are thoroughly tested and available for prescription, these non addictive painkillers can be used to enhance that natural, pain-relieving response. In this way, we can end America’s battle with chronic pain—and eventually, opioid addiction.
Treatment Options for Prescription Drug Addiction
Breaking free of the addictive painkillers controlling your life is possible with the right addiction treatment. Treatment is not a one-size-fits-all proposition, but rather something that should be adapted to each patient’s individual experiences, degree of addiction, personal preferences, financial situation, home environment, and physical condition. Customized treatment plans are essential for long term recovery success.
Most people will benefit from inpatient treatment, especially if they are in need of medical detox, and/or have an unstable home situation that may encourage relapse. Inpatient treatment can last two weeks, to several months, to a year, although the average length of stay is 28 days. After inpatient treatment, patients usually step down to an outpatient program that provides flexible day, evening, or weekend treatment, allowing the patient to return home at night to sleep. Many inpatient programs offer services like housing assistance to make this transition easier.
After discharge from an outpatient program, you should still consider yourself in recovery, meaning that you are not once and for all “cured,” but rather, have reached a much healthier, more positive state of being that will need to be maintained through self-awareness, peer support groups, and good self-care. Recovery is a continual journey that can make your life more exciting if you learn to appreciate the ongoing growth, change, and new experiences it can bring into your life.