For the many people who end up addicted to pain pills, struggling with pain pill or heroin dependence because they have pain issues, there is nothing but frustration. The patient cannot deal with unrelenting pain and needs more pills at greater dosages. The doctor becomes uncomfortable writing those prescriptions and suspects the patient is manipulating him. What alternatives are available?
Many people have tried the pain clinic route. A case manager at one medication-assisted treatment (MAT) program describes a particular case demonstrating the difficulty for those who try to go in this direction.
Stumbling Blocks to Coordinated Treatment
She talks about a client she’ll call Vicky, who wants to participate in the Suboxone program offered at this clinic. Vicky reached out to the program because she is addicted to oxycodones, resulting from a back injury years ago. The doctor reviews her assessment, which is the report created by the counselor who initially interviews each new prospective patient. He believes that treatment with Suboxone will conflict with her inability to resolve her pain issues, and he refers her to a pain clinic.
The case manager then contacts the pain clinic, where the admitting clerk is reluctant to schedule the patient. The clerk’s initial response is, “You know we’re just going to be giving her all kinds of medication.” The case manager states that at this time the doctor feels her old back injury pain constitutes a diagnosis dominant over her addiction diagnosis, and so it is hoped the clinic can help her with her pain—and then the addiction management can begin. The difficulty is compounded by the need to obtain old records documenting the injury and past attempts at treatment. It’s an effort that takes massive coordination—and frankly, it’s often beyond the patient who has to decide whether she would rather live with the addiction or the pain.
Vicky’s case is typical among the many people who seek treatment for opiate dependence. Years ago, doctors did not dispense pain pills so freely; they were reserved for end-of-life treatments for cancer or other severe illnesses and injuries. When the pharmaceutical companies began more aggressive marketing of their products over the last 10 or 15 years, they insisted the pills weren’t addictive. Treatment with pain pills gradually became an accepted part of the medical treatment plan, with tapering just an abstract concept.
A Look at Opioid and Heroin Dependence
Pain pills are not always the best therapy for pain management, however. A panel report released by the National Institutes of Health (NIH) contains nine review areas necessary to treatment chronic pain without risking opioid and ultimately heroin dependence. The report reviewed evidence relating to patients treated longer than a year for chronic pain.
For patients suffering from fibromyalgia or other ailments that do not stem from tissue damage and inflammation, pain pills do not successfully resolve their pain. Those experiencing migraines who take pain pills often will begin suffering from rebound headaches that are actually caused by the opioids. Key questions asked by the panel included:
- Is opioid therapy really more effective than alternative treatments?
- Does its effectiveness depend upon the type of illness or injury, patient age, or other patient illnesses?
- How often does pain medication therapy result in opioid dependence? The report does not address resulting heroin dependence.
- Should types of opioid treatment be rotated for better results?
- What are the best ways to taper patients off pain pills?
Doctors and substance abuse treatment professionals will gather this year to discuss those and many other questions, and we don’t have the answers here—yet. But one thing is clear: Health care providers at last recognize the dangers of pain medication therapy for those suffering from prior addiction disorders or from mood disorders. They finally understand that they have to take a good look at the complete patient before they just bring out the prescription pad.
They are also admitting that using the medications that often result in pain pill or heroin dependence has been tempting because their use is cheap. What that means is that pain pills simply get patients in and out of exam rooms much quicker.
There is also evidence that patients who are tapered from their heroin dependence through methadone programs have a much lower incidence of overdose. If you’re someone suffering from pain medication addiction or abuse, don’t give up hope. The work is ongoing to find better solutions. In the meantime, pick up the phone and call your local methadone program. If you suspect that you have an addiction, the people there can help.