Prescription Drugs and Pain Medications

Addiction rarely occurs among people who use a pain reliever, CNS depressant, or stimulant as prescribed; however, inappropriate use of prescription drugs can lead to addiction in some cases. Patients, healthcare professionals, and pharmacists all have roles in preventing misuse and addiction. For example, if a doctor prescribes a pain medication, CNS depressant, or stimulant, the patient should follow the directions for use carefully, and also learn what effects the drug could have and potential interactions with other drugs by reading all information provided by the pharmacist. Physicians and other health care providers should screen for any type of substance abuse during routine history-taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why.

Prescription drugs make complex surgery possible, relieve pain for millions of people, and enable many individuals with chronic medical conditions to control their symptoms and lead productive lives. Most people who take prescription medications use them responsibly. However, the non-medical use of prescription drugs is a serious public health concern. Nonmedical use of prescription drugs like opioids, central nervous system (CNS) depressants, and stimulants can lead to abuse and addiction, characterized by compulsive drug seeking and use.

Opioids

Opioids are commonly prescribed because of their effective analgesic or pain relieving properties. Many studies have shown that properly managed medical use of opioid analgesic drugs is safe and rarely causes clinical addiction, which is defined as compulsive, often uncontrollable use. Taken exactly as prescribed, opioids can be used to manage pain effectively.

Among the drugs that fall within this class - sometimes referred to as narcotics - are morphine, codeine, and related drugs. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin-an oral, controlled release form of the drug); propoxyphene (Darvon); hydrocodone (Vicodin); hydromorphone (Dilaudid); and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain relieving properties, some of these drugs can be used to relieve severe diarrhea (Lomotil, for example, which is diphenoxylate) or severe coughs (codeine).

Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord they can effectively block the transmission of pain messages to the brain.

In addition to relieving pain, opioid drugs can affect regions of the brain that mediate what we perceive as pleasure, resulting in the initial euphoria that many opioids produce. They can also produce drowsiness, cause constipation, and, depending upon the amount of drug taken, depress breathing. Taking a large single dose could cause severe respiratory depression or be fatal.

Opioids may interact with other drugs and are only safe to use with other drugs under a physician's supervision. Typically, they should not be used with substances such as alcohol, antihistamines, barbiturates, or benzodiazepines. These drugs slow down breathing, and their combined effects could risk life-threatening respiratory depression.

Chronic use of opioids can result in tolerance to the drugs so that higher doses must be taken to obtain the same initial effects. Long-term use also can lead to physical dependence - the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly.

Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and involuntary leg movements.

Options for effectively treating addiction to prescription opioids are drawn from experience and research on treating heroin addiction. Some examples follow.

Methadone, a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms, and relieves drug craving. It has been used for over 30 years to successfully treat people addicted to opioids.

Other medications include LAAM (levo-alpha-acetyl-methadol), an alternative to methadone that blocks the effects of opioids for up to 72 hours. Naltrexone is a long acting opioid blocker often used with highly motivated individuals in treatment programs promoting complete abstinence, and also to prevent relapse.

Buprenorphine, another synthetic opioid, will soon be available. Also, naloxone counteracts the effects of opioids and is used to treat overdoses.

Source- National Institute on Drug Abuse