What is painkiller abuse? |

Causes

Opioids come in two forms: natural and synthetic. Natural opioids are derived from the opium plant; synthetic (artificial) and partially synthetic opioids are structurally similar to natural opioids. Morphine and codeine are purified from the crude opium latex. Partially synthetic drugs derived from morphine include heroin, oxycodone (OxyContin), hydromorphone (Dilaudid), and oxymorphone (Numorphan). Synthetic compounds that resemble morphine in their chemical structure include fentanyl (Duragesic), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone, and dextropropoxyphene (Darvon).

All opioids exert their effect by modifying the transmission of the nerve impulse between neurons (nerve cells). Neurons are separated from each other through short spaces called "synapses." When the nerve impulse reaches the terminal end of one neuron, neurotransmitters are released into the synapse. The neurotransmitter travels across the synapse and binds to receptors on the terminal of the next neuron to allow continuation of the nerve impulse. In the case of opioids, this neurotransmitter is dopamine.

Opioids act to increase and maintain the concentration of dopamine in the synapse by two methods. Some drugs prevent the reuptake of dopamine from the synapse by binding to proteins that normally transport dopamine. Other drugs act to increase the release of more dopamine from the presynaptic neuron terminal. The result is the maintenance and enhancement of the pleasurable effect promoted by dopamine.

Opium and its synthetic counterparts have structural similarities to natural pain relievers in the body called endorphins. Endorphins are secreted by the pituitary gland in response to pain stimuli, resulting in the relief of pain by binding to pain receptors and preventing transmission of the pain impulse. Endorphins are also secreted in response to pleasurable activities, such as eating and sex, resulting in a high that is similar to that caused by morphine. Endorphins are more potent than morphine, but they do not lead to addiction because they are broken down by enzymes and do not accumulate.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are painkillers that act in the body by a different mechanism. The most common NSAIDs are acetaminophen, acetylsalicylic acid (aspirin), and ibuprofen and are readily available over the counter. NSAIDs act by inhibiting the cyclooxygenase enzymes 1 and 2 that are involved in the synthesis of prostaglandins. Prostaglandins are involved in a variety of body processes, including sensitization of nerve endings.

NSAIDs are most commonly used for headache relief; however, they are often used to treat symptoms for which they are not recommended, such as anxiety, sleep problems, and stress. Authorities generally agree that the use of NSAIDs rarely leads to physical dependence.

Risk Factors

Painkiller abuse may include self-medication, or the use of the drugs without a prescription to relieve pain or other symptoms. Chronic pain is a common cause of painkiller abuse. A person with chronic pain may begin to take painkiller medication beyond the physician’s prescription in larger doses or more frequently. People also use drugs for recreational purposes to produce euphoria, an emotional state of intensely pleasurable feelings.

More painkillers are available than ever before because of an increasing awareness and desire of physicians to reduce severe pain in their patients. In many cases, only opioid drugs can reduce severe pain. Physicians need to balance the need for relieving a patient’s pain versus the chance that the patient’s opiate use may lead to addiction. The ready availability of painkiller drugs can lead the patient to ignore alternative means of pain control. Additionally, many pain medications first became available in the 1990s.

Social factors can be important in painkiller abuse. Exposing drugs to adolescents and young adults is a critical factor, as it can lead to a lifetime of drug abuse. A family structure lacking stability or that is disruptive and violent can result in a lack of good role models and a poor sense of direction for children. Pain medications may be readily available at home, leading teens to take them to relieve pain or stress without a doctor’s prescription.

Peer pressure, the influence of friends and acquaintances in school and on the street, can be an important driving force, too. Adolescents often seek acceptance within particular groups, and adolescents may be prone to drug experimentation within these groups. Some persons of any age are more likely to become drug dependent, especially those who lack confidence or self-esteem, who may look to drugs to fill a void or to overcome loneliness or depression.

Genetic susceptibility can be a factor in painkiller abuse, although it is difficult to separate genetic from environmental influences. An estimated 40 to 60 percent of the variability of addiction is caused by genetic factors or by combined genetic and environmental interactions.

Symptoms

Signs of painkiller abuse can be psychological or physical. Psychologically, the person abusing drugs is focused on obtaining more drugs. He or she may increase the dose over time and often continues to use drugs after his or her medical condition has improved. Physical appearance often declines, and the person may show shifts in energy, mood, and concentration. He or she may withdraw from family and friends and might neglect household and work responsibilities.

Typical symptoms of painkiller addiction are feelings of euphoria, lethargy, mental confusion, nausea, and poor judgment. Less specific symptoms include slurred speech, shallow breathing, bloodshot eyes, constipation, and unusual drowsiness. The addict eventually develops a tolerance for the drug, requiring higher doses to obtain the same effect. Withdrawal often occurs if the addict abruptly stops using the drug. Withdrawal symptoms may include agitation, muscle aches, insomnia, anxiety, cramps, and nausea and vomiting.

Screening and Diagnosis

A physician will take a complete history of the patient, perform a physical examination, and send blood or urine samples to a laboratory to test for the presence of suspected drugs. Although blood tests are more likely than urine tests to detect drugs, urine tests are more common. Opiates are usually found in the urine within twelve to thirty-six hours of last use. A particular drug abuse screening test was developed in 1982, and it consists of questions to be answered by persons concerned about their involvement with drugs.

Treatment and Therapy

Treatment of painkiller addiction requires the person to stop using the drug. Abrupt discontinuation of drugs by long-term users, that is, going “cold turkey,” results in severe withdrawal symptoms. A more practical treatment involves slowly decreasing the use of the drug (through a process known as detoxification); complete abstinence follows.

Drugs such as buprenorphine and nal-trexone block the effect of opiates on the body, thereby reducing withdrawal symptoms and the length of withdrawal. Patients taking buprenorphine also can become mildly addicted to that drug. A newer version of the drug has been introduced; it is combined with another drug, naloxone. When this drug combination is injected, the person goes into withdrawal, thus preventing abuse in use.

Psychological addiction may continue long after physical withdrawal from the drug. The recovering addict can experience difficulties in coping with daily activities, and there is a great danger the user will return to drug use. Each patient needs to be treated on an individualized basis. The detrimental mental and emotional states that led to drug use need to be identified and addressed, and the patient needs to be taught how to avoid drugs and drug culture. These changes may include new activities and new social and relational contacts.

Prevention

Prevention is based on removing the risk factors. Education of children by family and teachers about the dangers of painkiller abuse is paramount. Parents need to keep prescription pain medications away from children, and sharing information about drug use can become part of a school’s curriculum. Additionally, for persons taking prescription painkillers to manage chronic pain, it is important to use the medication only at the prescribed dosages to avoid developing a dependency.

Bibliography

Abbott, Francis, and Mary Fraser. “Use and Abuse of Over-the-Counter Analgesic Drugs.” Journal of Psychiatry and Neuroscience 23.1 (1998): 13–34. Print.

Byrne, Marilyn, Laura Lander, and Martha Ferris. “The Changing Face of Opioid Addiction: Prescription Pain Pill Dependence and Treatment.” Health Social Work 34.1 (2009): 53–56. Print.

McCoy, Krisha. "Opioid Addiction." Ed. Michael Woods. Health Library. EBSCO, Jan. 2014. Web. 27 Oct. 2015.

"Prescription Painkiller Overdoses." CDC VitalSigns. Centers for Disease Control and Prevention, July 2013. Web. 27 Oct. 2015.

Twombly, Eric, and Kristen Holtz. “Teens and the Misuse of Prescription Drugs: Evidence-Based Recommendations to Curb a Growing Societal Problem.” Journal of Primary Prevention 29.6 (2008): 503–16. Print.