Are you addicted to pain pills? You certainly have
company. The cycle of use, dependence, and use is playing out, over and over,
in every community across the country. Note that I describe the cycle as use,
dependence, use' a description that is accurate, because in most cases the
cycle of dependence starts when you appropriately use medication administered by
a person who you trust your physician.
Pain pills are often called narcotics'--a term that comes
from the Greek word narcosis', or sleep' because of their sedative effects.
Physicians use the word narcotic' to refer to different things in different
situations. For example, when referring to controlled substances, narcotics'
may be used to denote drugs regulated by the Drug Enforcement Administration.
An anesthesiologist uses narcotic' to refer to the portion of the anesthetic
that is comprised of drugs that bind to brain opiate receptors'. Opiate' is
anoth er word used by physicians in reference to pain pills. The word comes
from opium', a substance derived from poppies and used to make heroin and
morphine. The opiate' reference is also used for synthetic pain medications
that have no connection to poppies or opium save their pain-killing effects.
Most people have heard of endorphins'. Endorphins are
produced in the human body, and when released, block pain. Endorphins are
often referred to as endogenous opiates' because of their role in pain
sensation, even though they have no relation to poppies or opium, and are
structurally quite dissimilar. These natural pain relievers have other
functions in the body, roles not relevant to this discussion. Endorphins are
one group out of dozens of neurotransmitters', substances involved in the
communication between nerve cells. Endorphins and other neurotransmitters act at
receptors', the receptor being a lock on a nerve cell, and the
neurotransmitter being the key that fits in the lock. Amazingly, poppies
produce a substance that looks different from the natural key, but that acts
like endorphins by fitting the exact same keyhole. That substance one molecule
from the sap of a red flower has given the human species the ability to ease suffering
in countless individuals, and has resulted in the deaths of millions of others.
Over the years scientists have developed synthetic opiates'
with potencies far beyond anything produced by nature. Anesthesiologists use
sufentanil' reduce responses to pain during surgery. Sufentanil is extremely
potent; an amount the size of one grain of salt, say one tenth of one
milligram, placed on the tongue would cause respiratory arrest in a large man
within seconds. More commonly opiates are taken by patients in the form of
codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), or hydromorphone
(Dilaudid). Prescriptions for these substances are handed out to millions of
people each day in response to complaints of pain.
Opiates relieve pain, and work in different areas of the
brain to elevate mood, ease tension, give a subjective sensation of warmth, and
cause sedation. They can cause nausea and vomiting, particularly in patients
who are nai"ve to them. Finally, they change the response of the brain to low
oxygen and high carbon dioxide in the blood, and slow respiration. The most
common cause of fatal overdose is respiratory arrest, where the brain stops
sending impulses to the diaphragm, and the patient suffocates. This fatal
response is most common during sleep, or when opiates are taken in combination
with other sedative medications.
Opiates are addictive. There is no way to take them without
the body adapting and becoming dependent on them. Tolerance' to pain medication
begins after the first dose, when the locks' on nerve c ells adjust in response
to all of the keys' floating around. With time it takes more and more keys to
open enough locks to cause the reaction at the nerve cell. Tolerance is one
half of the process of addiction, and is the reason for withdrawal', the
sickness that occurs when tolerance has developed and the drugs, or keys, are
taken away. The other half of addiction is so-called psychological', which I
suppose is accurate to a point. For some reason, once something is assigned to
the psychological category, it is treated differently by physicians, patients,
and the rest of society. Psychological' does not imply that a person has more
control than with a physical' condition if anything, things occurring on a
psychological level are far more difficult to recognize and treat than are
physical conditions. The psychological addiction to opiates also develops very
rapidly, and there is little if anything that can be done to prevent it.
Psychological addiction is real, and is extremely powerful. The result is a
desire to take opiates. The desire may take the form of physical symptoms,
such as an increase in pain, and so psychological addiction and physical
addictions are intimately connected.
To health systems, time is money. Patient complaints are
handled as quickly (and sometimes as superficially) as possible. When a person
presents in pain, the first determination is whether the pain is a serious
threat to health. The second determination is whether enough tests have been
done to identify the cause of the pain. If the first answer is no and the
second answer is yes, the goal is to clear out the room for the next patient.
There is a clock on the wall and a patient list in the hall, and the list has
to be clear before the docs and nurses go home. And so there is the
doctor patients waiting in six rooms, more in the waiting area, and a person in
the room c omplaining of something that isn't going to kill him/her. And in the
doc's pocket lies a pad of paper. Amazingly, all that the doctor has to do to
clear the room is write on the pad and wish the patient well.
That is how addiction starts. Everyone intends well;
everyone is honest; everyone is innocent. The patient is not told much about
addiction. The patient isn't told that within a few days, he will have some
difficulty stopping the medicine. He isn't told that after a week when he stops
the medicine he will have some diarrhea, he won't be able to sleep, and he will
feel depressed. He isn't told that the pain that he has might not go away, and
so he may get more potent medicine, and so on, and that it will get harder and
harder to stop as the medicine gets stronger. I don't know if the lack of
information really matters; most patients would likely take the pain relief
medicine now, and worry about the rest later. Besides, the doctor doesn't seem
too concerned+and the patient is correct. The doctor isn't concerned, because this
was a quick case that got him nearly caught up to schedule.
Unfortunately, there are pains that do not go away, even as
we patients demand relief. Doctors hate to feel impotent with patients--it is difficult
to take a person's money, and then tell him that there is nothing that can be
done. And so prescriptions are written, even when the problem may be
complicated, and the best advice to the patient would be learn to live with
it'. This phrase angers patients with pain, but sounds intelligent to patients
who have struggled to get off opiates. But usually, the person with pain walks
out with a prescription. As tolerance develops, the pain comes back, and the
patient goes to the doctor again, this time leaving with stronger medication.
Tolerance continues, meds are changed, and tolerance develops again. The
doctor gets ner vous over the situation, realizing that at some point he will
not have anything stronger. Suddenly calls to the doctor are not returned, or
are returned by a curt nurse who sounds like the patient's mother. The patient
realizes that he is stuck, and becomes depressed. Sound familiar?
It is not your fault. I know about this stuff inside and
out I earned my PhD in Neurochemistry at the Center for Brain Research in Rochester New York, studying drugs that cause addiction and tolerance. I administered opiate
medications every day as an anesthesiologist. I literally know everything that
there is to know about opiates+expect how to stop taking them. I thought I was
smart enough to avoid addiction, but I was wrong laughably wrong and the
outcome nearly killed me. It is not your fault. To get better, you will need
to understand the meaning and truth of that statement. That is difficult for
some, but possible for everyone.
My next installment has better news. You can become free. You
don't need to leave your family to go to a far-away rehab center, and you don't
need to go through painful detox and withdrawal. Watch for my next
installment, or visit me at my address below. There is a new development in
treating people dependent on pain pills, a development that will revolutionize
the way that doctors treat addiction.
Jeffrey Junig has worked as a neuroscientist and as an anesthesiologist, and is a psychiatrist in solo practice. Additional information can be found at http://wisconsinopiates.com, the web site of his chronic pain and addiction practice, Wisconsin Opiate Management Center. He is available for consultations or presentations through Explain Medical Consulting at http://explainmedical.com,
Article Source: http://www.free-articles-zone.com
