How to avoid getting "hooked" on your back pain medication

You have no doubt heard about the travails of countless celebrities, athletes, and politicians who have succumbed to an overdose of prescription drugs. Behind the splashy news headlines, however, lies a real problem that has ruined the lives of people rich and poor, young and old, in big cities and rural areas across the country—prescription painkiller addiction. If you’re taking prescription pain medication to relieve back pain, could you, too, be at risk?

Drugs To Watch Out For

According to a recent U.S. national survey on drug use and health, nearly 5 percent of people age 12 or older used a prescription pain reliever for non-medical reasons in the previous year. And it’s not just a problem for people at the younger end of the spectrum. By 2020, according to a study in the Annals of Epidemiology, a projected 2.7 million people over age 50 will abuse prescription drugs—up 190 percent from 911,000 in 2001.

For people taking prescription painkillers for back pain, there are two classes of drugs to watch:

Opioids. Among abused prescription drugs, opioids, such as oxycodone hydrochloride controlled-release (OxyContin), are the most notorious. In fact, drugs in this class were responsible for most of the accidental drug poisoning deaths reported from 1999 to 2006 (the most recent year for which data are available), according to the Centers for Disease Control and Prevention (CDC).

Opioids work by attaching to receptors in the spinal cord and brain that block the perception of pain. They can also produce euphoria by indirectly boosting dopamine levels in the parts of the brain that influence our sense of pleasure—hence their addictive potential. But when taken in excess, opioids also slow breathing, making these drugs potentially fatal.

In April 2010, the U.S. Food and Drug Administration (FDA) approved a reformulated version of OxyContin that is more difficult to misuse or abuse, and the manufacturer discontinued shipping original OxyContin to pharmacies in the United States. In 2013, the FDA approved updated labeling indicating that physical and chemical properties of the reformulated drug make it harder to manipulate for abuse.

Muscle relaxants. Drugs in this class also have addiction potential. The most addictive is carisoprodol (Soma), and its abuse has escalated in the last decade in the United States. According to the previously mentioned survey, 1 percent of Americans age 12 and older reported non­medical use of Soma.

The name "muscle relaxant" is something of a misnomer since the drugs do not directly relax the muscles. Instead, they act as a depressant on the central nervous system (CNS), reducing brain activity to produce a mild sedative/pain relieving effect. Like opioids, the drugs also generate feelings of euphoria and at high doses can cause a dangerous slowing of breathing and heart rate.

Maximizing Pain Relief, Minimizing Risk of Painkiller Addiction

Far from being prescription painkiller abusers, many older adults are reluctant to take any medication associated with a risk of abuse or addiction. Doctors, too, may hesitate to prescribe certain medications because of fears the patient may become addicted. The apprehension over opioid pain relievers has even spawned a name—"opiophobia."

The good news is that if you take pain medication for a legitimate ailment or injury, you have a slim chance of developing an addiction. In fact, most medical professionals agree that for the majority of people, short-­term opioid use is an appropriate way to address acute back pain.

It’s also safe to use a muscle relaxant for a brief period early on to relieve musculoskeletal pain (if you’ve had back pain for more than a month, a muscle relaxant may not provide much relief). Still, it’s wise to be aware of the addictive potential of painkillers and to keep in mind these two steps to reduce your risk of becoming addicted.

Most important, tell your doctor if you have a personal or family history of drug or alcohol abuse or of a mental illness such as depression or bipolar disorder. People with these histories are more susceptible to prescription drug abuse than the general population. If you have such a history, ask your doctor whether there is a safer, alternative drug you can take for your back pain.

Second, even if you don’t have a history of substance abuse or a psychological disorder, it’s important to use the medication your doctor has prescribed only as directed. That means carefully following your doctor’s instructions on how much medication to take, when to take it, and for how long—short-­term use (one or two weeks) is key. And if you don’t get the benefit you expect, ask your doctor before taking extra pills.

Treating an Addiction

Medical professionals today think of addiction as a disease not a personal shortcoming. So if you think you may be addicted to a medication (see the danger signs above), don’t be ashamed to talk to the doctor who prescribed it. Be proactive and don’t wait for your doctor to bring it up.

Drug therapy, coupled with psychological counseling, has been shown to be the most effective way to treat an opioid addiction. The medications most commonly used are methadone, buprenorphine (Buprenex, Suboxone, Subutex), and naltrexone (Revia, Vivitrol). These medications counter the effects of the drug on the brain and behavior, helping to relieve withdrawal symptoms and minimize drug cravings. Counseling, on the other hand, helps prevent a relapse by teaching new patterns of thinking and behavior as well as coping skills.

If you suspect you may be addicted to a muscle relaxant, don’t attempt to stop taking it on your own. Withdrawal symptoms from these drugs can be potentially life threatening and “detox”—clearing the drug from your system—must be done under the supervision of a doctor. Counseling also can help during this process.

Watch for the Danger Signs of Prescription Addiction

The hallmarks of a drug addiction problem are craving, in which the mind develops an overwhelming, compulsive desire for the drug, and loss of control, an inability to stop using the drug even when it causes harm. People who are addicted to prescription pain medications may also doctor shop (get prescriptions for pain medications from multiple doctors), steal or forge prescriptions, “accidentally” misplace prescriptions or lose pills to get another prescription, and take higher doses of medication than prescribed.

If any of these behaviors sound like things you or someone close to you is doing, it is important to seek assistance from a health professional. Your doctor or insurance provider may be able to refer you to a counselor with specific experience in treating addiction problems. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) hosts a substance abuse facility locator on its website at www.findtreatment.samhsa.gov.

Publication Review By: Lee H. Riley III, M.D., and Suzanne M. Jan de Beur, MD.; updated by the Editorial Staff at Healthcommunities.com

Published: 04 Aug 2011

Last Modified: 17 Apr 2013