I am always a bit fascinated about what happens when that first prescription runs out. A moment when if they didn’t pursue it the cravings would go away ? Is it so strong that they are willing to lie or whatever to get a new prescription from the very first one? Right from the beginning?
I confess I like percocet. But I don’t think I would ever be willing to lie. I had it for renal colic -when it was gone it was gone.
Are most addicts addicted from their own initial prescriptions? Or is it more of a recreational thing someone gives them some at a party or whatever and then they go to the doc to get more?
^^ @veruca , I don’t have the answer, but I can imagine how addiction might happen, based on our own experience one summer. My husband and both kids EACH received prescriptions for opioid pain killers after dental procedures. They wisely shared one prescription and declined to fill the others. But if they had, we would have had lots of extra pills. Anyone who liked the feeling of the medication could have started taking those extra pills and thus begun an addiction.
Fortunately, those drugs are horribly constipating, even after one dose, so that was the limiting factor in my family!
@frugaldoctor when you say they began addiction at the first dose, do you mean physical addiction? There is so much about addiction I am unclear on.
@Massmomm said
It takes more than one dose for me, usually a day or two, but it is so debilitating in that respect, even if I am proactive about preventing it. I get where you are coming from, totally.
@rom828 I have to admit, the descriptions I’ve heard are ones that bring me fear. I don’t know why they do other than the fear that I may experience them one day. My addiction patients describe that their first dose of opioids gave them a feeling energy, a sense of well being, euphoria, warmth, happiness, focus, and the ability to get things done. They recall getting hooked from that point on. Probably 50-80% of my patients started their addiction for legitimate reasons such as surgery, dental work, or trauma. A smaller percentage started for recreational purposes.
From the medical literature, the median dosages of opioids from first use to the development of compulsive use is just 20. That’s not much but those are numbers for those with addiction, not everyone. Most physicians will prescribe at least 30 pills. Furthermore, physicians do not conduct genetic testing prior to prescribing opioids. There are genetic variations encoding the mu opioid receptor. Described as C17T and A118G nucleotide changes that are associated with increased risks of addiction and decreased response to the same dose of opioids vs. non carriers. That’s just at the mu receptor. Then there are variations at the dopamine receptors leading to pleasurable responses to opioids. Of course, gene variations aren’t the only contributing factors.
I’ve become more fearful of opioids the longer I practice addiction medicine. I believe the risk of addiction, with our very powerful opioids, are much higher than we could imagine. I would not allow my D2 to have opioids after her dental procedures and I’ve refused opioids during my invasive procedures.
@veruca From first dose to first withdrawal is a median of 15 doses. Opioid withdrawal is very painful. I wish I could experience it to understand how it can motivate sufferers to continue drug use to avoid it. But much worse is the fact that these drugs take over the Nucleus Accumbens. This is the area of the brain responsible for pleasure. It is what motivates us to locate water, food, warmth and procreate. So, would you lie and steal to get food, water or shelter? I know I would if it meant my survival. Understanding opioid addiction from a brain perspective makes it so much easier to deal with and appropriately treat. Surprisingly, alcohol dependence is more likely an endogenous opioid (endorphins) addiction than what we thought decades ago. This explains why a dose of naltrexone (opioid blocker) may lead to a profound drop in alcohol usage. Despite all that scientists know about addiction, we have so much more to learn before we can stop the opioid overdose epidemic.
Thanks @frugaldoctor. Very interesting. I didn’t know that alcohol and opiates had a different mode of operation so to speak when it comes to addiction.
I was a nurse in the late 80,s early 90s. I think then we were on a" lets not withhold any pain relief " trend.
I remember it being hammered into me in nursing school that we should not allow people to suffer. Is it those kinds of policies that led to our situation now? Or was it more related to the drug companies themselves? economic gain?
I saw a thing on maybe PBS? A small factory in Ohio that makes mugs. The owner couldn’t find workers. They needed no prior experience but the opiate addiction was so strong in that area he couldn’t find anyone to pass the drug test.
@frugaldoctor, your descriptions are very enlightening.
But I still wonder what percentage of people who take an opioid briefly for a medical reason (say, after surgery) have the kind of experience that quickly leads to addiction.
You say that you have avoided opioids for both yourself and your daughter, so I guess the number must be pretty high. I mean, you wouldn’t have let yourself or your daughter suffer if the odds were only 1 in 500, say. But how high are they? 1 in 20? 1 in 10? Worse than that?
Frugaldoctor treats addiction and may know better from other studies but in my experience patients (with legitimate prescriptions) stop taking the medication as soon as the pain dwindles which is why there are all those unused pills in the cabinet afterwards.
This is a really good review and critique of current research on addiction: https://tonic.vice.com/en_us/article/a3z98b/big-pharma-didnt-cause-the-opioid-crisis-most-pain-patients-dont-get-addicted
DH is an RPh. There’s a history of addiction to opioids and many other things on his side of the extended family, and he sees plenty in his profession so we are wary.
Our two daughters had oral surgery less than a year apart and were prescribed opioids. D1 took a few as needed to get through the pain. Nothing interesting. D2 did the same, exact same prescription, but those pills made her feel great. Obviously great, not just less pain. After the first one we couldn’t get her off of them fast enough. Not a scientific study by any means, but eye opening in terms of seeing how an addiction could begin as well as how the same drug affected each of them differently. We’re even more wary of opioids than we were before.
Each kid was prescribed 20 pills. Between them they used 14, and that’s after one of them got a dry socket which extended her pain. That’s a lot of excess.
I’ve taken opioids a couple of times for kidney stones. I’m glad they exist, but I’d rather not need them.
As a lurker in CC for many years, I often wondered when I would feel compelled to write. There were many times I thought I could add some perspective, but someone in this amazing community seemed to share my thoughts (and usually more eloquently) before I got around to it. Well, here I am - my first post!
7 years ago, before there was any media attention about opioid addiction, my then 16 year old son had 2 basic surgeries and was prescribed opioid pain medication. We had no idea about how these meds could lead to addition. He was the 1 person in 4 who will experience either physical or psychological addiction from these meds. He quickly moved to heroin, before we knew there was even a problem. Let me be clear, my son had no sad stories to tell, was not a risk taker, every report card since kindergarten he had “outstanding” in citizenship, he was athletic, no family divorce or family drama. I share his history to remove any ideas that “something must have been wrong” for a child to end up on heroin. What was wrong is that he has a brain that loves opioids and our doctors didn’t alert us to this possibility. My son has 5 years sober, and everyday I quietly celebrate that. But everyday I also quietly worry if today is the day he relapses. I am absolutely thrilled that the word is getting out on the damage these meds can do. At least now, parents can make educated choices. Had I been given this information when my son had surgery, I would have tried over the counter pain relievers first, and if those did not help, I would have removed him off of the opioids within a few doses.
Those with chronic painful conditions, painful procedures, etc. you still have the choice of these meds - they are not illegal. But when my younger son went to the ER for a broken finger 2 years ago, with a pain level of 3, there was no good reason why that doctor offered to subscribe an opioid pain reliever - this is what is wrong.
Since my son’s addition, I had a fibroid embolization procedure. Fibroids die a very loud death by sending out pain signals. Since I refused to bring home an opioid pain killer, my doctor kept me a bit longer in the hospital to make sure I could tolerate the pain. I did fine with my non opioid pain relievers. Sure there was pain, but isn’t that to be expected? Sometimes I think we run to the big guns of pain relievers, instead of slowing down and listening to our bodies. Pain prevents us from overdoing it, alerts us to something wrong, or in my fibroid situation, letting me know something is working. At least now there is conversation, information, and awareness - something my son didn’t have.
@Purr-rito, thank you. Even if this is the only post you ever make on CC, I think you will be able to take credit for saving someone’s life.
Wow, sorry that happened in your family, Purrito! I wonder how common that is.
For us, the very few times we have been prescribed anything, we get off it as fast as possible because they are so seriously and painfully constipating. It just isn’t worth it. I wonder if that just isn’t true for some people.
From what I can find in studies the incidence of quick addiction tends to run higher in teens.
I deal with this some in my legal practice and have recently been to some seminars led by MDs, pharmaceutical professionals and lawyers. A cocktail of ibuprofen and acetaminophen is being recommended as being as effective at pain control as opioids except in the most extreme pain situations, which they described as pain so severe that you can’t eat.
I have a co-worker with no addiction tendencies who had knee replacement. He took the minimum amount of opioids for his post surgery pain for 4 weeks, as recommended, and was shocked at how unpleasant the weaning off process was. That’s scary to me.
Thanks for posting, @purr-rito. (Love the name! Kitten rescuer?) We had the anecdotes from others about how they took opioids with no bad effect, and of course we all knew that the majority of people who are prescribed opioids don’t go on to be opioid addicts.
But a lot of people, not a high percentage but a lot of people, who have been prescribed opioids DO end up addicted, and opioid addiction is terrible for the addict, for the addict’s family and for the rest of us too. How bad should pain be before we take the significant risk of creating addicts in order to treat it?
As far as I can tell, nobody is saying we shouldn’t use opioids to treat cancer pain. A lot of people are saying, rightly in my view, that we shouldn’t use opioids to treat certain other types of pain. A lot of professionals are saying that opioids are a bad way to treat long-term chronic pain, because after a while they stop working and the person is still addicted.
I suggest people take a look at post #29. The link is a devastating critique of the conventional wisdom on the opioid crisis.
As to post # 29, the same author has been making case for real causes of opioid crisis for some time.
https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
Not to get off point, but would Tylenol (ie acetaminophen) even making it to market today, especially as OTC, considering its liver toxicity.
I had major foot surgery last week and 30 pills were written for my pain level. Every 6 hrs for pain. Big note in surgeon’s office that there is no refills of any pain meds. I currently have taken 4 pills and now using Tylenol. Seems like it is harder to get more pain meds at surgerions office which is a good thing.