It’s no secret that opioid addiction is a serious problem in the U.S., and it continues to rise. Now, new Centers for Disease Control and Prevention (CDC) research shows how easy it is to become hooked on opioids, finding that many people prescribed opioids for short-term use are still taking the medication a year later.
For the CDC study, scientists analyzed prescription data for almost 1.3 million non-cancer patients who were prescribed opioids for the first time between 2006 to 2015. What they found was disturbing: People who had a one-day prescription of opioids had a 6 percent chance of being on the drug a year later, those who took opioids for 12 days had an almost 25 percent chance of still being on the drug a year later, and those with a monthlong prescription had a worrisome 30 percent chance of continuing to be on prescription opioids a year later.
Patients in the study were only meant to be on opioids for the short-term and suffered from things like pain from surgery, fractures, or headaches—but they ended up seemingly forming a long-term dependence.
Last year, the Food and Drug Administration (FDA) slapped a “black box” warning on opioids, which is the strongest warning the FDA can use. The warning specifically warns users about the potential for addiction, abuse, and overdose. The CDC also warned doctors last year about the danger in prescribing opioids for long-term pain.
Opioid abuse is especially worrisome in women. According to the CDC, every three minutes, a woman goes to the ER for abusing prescription painkillers like Vicodin and Oxycontin. Opioid abuse is also on a deadly trajectory: Deaths from prescription painkiller overdoses among women have increased more than 400 percent since 1999, the CDC says. With all of that in mind, it’s understandable that you might be hesitant to take opioids, even when your doctor prescribes them to you—and you’re smart to be wary.
Even if you don't become addicted to opioids, it's possible to develop a dependency.
People can get hooked on opioids because they increase the amount of the feel-good hormone dopamine in the reward center of the brain, addiction expert Marc J. Romano, Psy.D., director of medical services at Delphi Behavioral Health, tells SELF. Opioids can give people a feeling of euphoria that lasts anywhere from a few minutes to hours, he says, noting that they also increase energy, decrease anxiety, and improve mood. “Individuals often find the both the physical and psychological effects to be desirable, which increases risk of ongoing use, increased tolerance, and subsequent dependence,” Romano says.
Other people keep taking opioids even though they don't have any pain anymore because they feel "weird" when they come off, Medhat Mikhael, M.D., pain management specialist and medical director of the non-operative program at the Center for Spine Health at Orange Coast Memorial Medical Center in Fountain Valley, Calif., tells SELF. "Some of our patients have said that they don't like it, but they have a fear of stopping because of the feeling they got," he says.
But even if you don't become addicted to opioids, there's a risk that you can still become dependent on them. Sarah Wakeman, M.D., medical director for substance use disorders at the Massachusetts Center for Community Health, tells SELF that all patients who take opioids for chronic pain relief (i.e. more than 90 days) will become “physiologically dependent” on them, meaning they will get sick with withdrawal symptoms like diarrhea, nausea, and vomiting if they stop the medication suddenly. “This does not mean that they are ‘addicted,’” she says. “Addiction is compulsively using a drug despite negative consequences.”
Here's how you can help yourself avoid addiction and dependency.
1. Know your risk factors: While anyone can develop an opioid addiction, not everyone is at the same risk level. James J. Galligan, Ph.D., a professor of pharmacology and toxicology and director of the neuroscience program at Michigan State University, tells SELF that a previous history of drug use—including cigarettes and alcohol—is a strong predictor that a person may struggle with opioids. Genetics also play a role, Wakeman says (so, if you have family members who have struggled with addiction, you’re at a higher risk), as do factors like a previous trauma and psychiatric illness. “Unfortunately we can't yet tell an individual what his or her personal risk is of developing addiction, so for those who are vulnerable and are exposed to these powerful drugs, opioid use disorder can develop,” she says. However, she says, it’s important to talk to your doctor if you’re concerned that you might be at a higher risk for problems with opioids. For example, a person who has a history of substance abuse who needs opioids may want to ask her doctor for a small number of pills at a time and have a loved one keep the medication and give it to her as instructed.
2. Take medication only as prescribed: If you have to take opioids, Romano says you should only take your medication as prescribed and talk with your doctor to come up with a plan around managing the need for opioid painkillers, Wakeman says. And when you no longer need them for pain, destroy them—don’t hold on to them for the “just in case.” “The risk is too great for someone to take this medication when not in pain,” he says. If you feel off when you stop taking them, Mikhael says it's important to talk to your doctor—they may recommend coming off the medication slowly.
3. Seek other pain management options: There are opioid alternatives that may work, such as non-steroidal anti-inflammatory drugs (NSAIDs), Romano says. The use of anti-seizure medication, such as Lyrica and Neurontin, and psychotropic medication traditionally used to treat depression, such as Cymbalta and Amitriptyline, have also been prescribed for pain management, he says. Other non-medication alternatives to treat pain, such as yoga or meditation, have also been proven to be effective for some patients.
4. Know that for most patients, opioids are safe and effective. If you're prescribed opioids and you have concerns, Emily Feinstein, J.D., Director of Health Law and Policy at The National Center on Addiction and Substance Abuse, tells SELF that it's important to talk to your doctor. "There are many ways to manage pain without opioids," she says. "If you and your doctor decide that the benefits of taking opioids outweigh the risks, your doctor can help you develop a safety plan to monitor your opioid use, which may involve more frequent check-ins."
And don’t freak out if you actually need them—especially if you have no previous history or family of addiction. “Most patients taking opioids for pain relief do not become addicted or dependent,” Galligan says. “If taken as prescribed and only for pain relief, the risk for addiction is low.”
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