DEAR DOCTOR K: My doctor has prescribed prescription painkillers — opioids — for my severe back pain. They relieve my pain, but how can I reduce my risk of becoming hooked?
DEAR READER: Simply being aware of the risk of addiction is a good first step in ensuring that you do not become addicted to prescription painkillers. I’ll explain a little bit about painkillers. Then I’ll describe some steps you can take to prevent addiction.
Opiates are natural painkillers. They come from the seedpod of the Asian opium poppy plant. They include opium, morphine and codeine. Your brain also makes its own natural painkillers, called endorphins.
Opioids are created by man-made chemical modifications of opiates. Examples of opioids include heroin, oxycodone (OxyContin, Percocet) and hydrocodone (Vicodin).
Opiates and opioids are very effective painkillers. They bind to a group of receptors called opioid receptors. It’s like a lock and key: The opiate or opioid is the “key,” and when it attaches to a receptor (the “lock”), your pain is lessened. There are opioid receptors in the brain and spinal cord and in the gut. They also are on the white blood cells that are a key part of the immune system. We’re not sure what they do in the gut, or on white blood cells.
The natural painkillers that your brain makes (endorphins) also attach to these receptors. When a person is badly injured, the brain releases these natural painkillers to try to reduce the pain.
Opiates and opioids reduce the intensity of pain signals reaching the brain and reduce feelings of pain. They can also produce a feeling of well-being and euphoria.
Most doctors consider it appropriate to prescribe opioids for chronic pain caused by cancer or for end-of-life pain. But the use of opioids to treat other long-term problems, such as chronic back pain, arthritis or migraine headaches, is controversial. Some doctors worry that patients might become addicted. Other physicians argue that narcotics are safe prescribed in low doses for limited periods of time.
In truth, the risk of opioid addiction among people with chronic pain is low. But there are exceptions. Some people are born with a greater tendency to become addicted. Anyone with a personal or family history of drug abuse or mental illness is at increased risk of addiction.
If you haven’t already done so, discuss with your doctor your treatment goals, how to take the medication safely and what side effects you can expect.
The following tips, from the National Institute on Drug Abuse, can further help you prevent misuse of prescription medications:
— Keep your doctor informed about all the medications you take. This includes over-the-counter drugs.
— Take your medication only as prescribed.
— Read the information provided by your pharmacist before taking your medications.
— Discuss your medication with your doctor or pharmacist. Don’t hesitate to ask questions if you are unsure about its effects.
— Throw away any unused pills once your back pain improves.
By working with your doctor, you can gain the relief these powerful painkillers provide while minimizing your risk of becoming addicted.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.