What exactly is meant by prescription drug addiction?

[KidsHappen]

Does this mean that someone is taking a prescription med that they were not prescribed? Does it mean that they are taking one that they were prescribed but don't really need? Does it mean that they were prescribed it and needed it but they are taking more than they should be? How would a person get prescription meds like this? Can you only get addicted to some drugs? Does it have something to do with how long you take it? Or why you take it?

 

For instance, some meds are life long like blood pressure meds or insulin. I have never heard it suggested that you could or would be addicted to them. I guess because they are obviously need. Then there are others that people legitimately need but stopping them can cause withdrawl. Here I am thinking about things like anti-depressants. Can you be addicted to these? And then what about things like sleeping pills? You are prescribed these because you can not sleep. However, once you are taking them if you stop taking them you can not sleep but that is why they were prescribed in the first place. So how would you know if you were addicted to them? Then other meds you are prescribed for a particular purpose such as benzos or pain meds. You can develop both tolerance and withdrawl from the meds. So if you have a chronic condition and need to take them long term you may need to increase the dose and not be able to stop taking them due to the condition. So how would you know if you were addicted to them? Is it a subjective thing? Can two people be taking the exact same med for the exact same reason and yet one is addicted and another is not? If so how do oyu know who is and who isn't?

 

I am asking because I read about so many famous people who are supposedly addicted or were addicted to prescription drugs and I am wondering what exactly this means and how you know and how it happens. I am just confused by the whole concept but it is not the same as non-prescription drugs that people take just to get high.

 

P.S. - I had spent 15 minutes typing this up once already and then my kitten walked across my keyboard and I lost the whole thing. I was so frustrated I didn't know whether to scream or cry. I just started over but GRRR!

[Laurie in CA]

Pain medication is especially addicting (not judging those who are in pain and really need it) particularly oxycotin. This was the one Rush was taking and caused him to go deaf. I think others with sleep problems get pretty desperate when they can't sleep and take accidental overdoses or dangerous combinations. Caution should be exercised when taking anything, prescription or "over the counter". Tylenol can be dangerous to your liver for example if you OD on it or drink alcohol. Weaning off slowly with a doctor's advice is the best way to get off of addicting drugs that are no longer needed. Blood pressure meds, insulin for diabetics, even antidepressants would not be considered addicting drugs in that sense but you would not want to suddenly stop taking them either. I'm sure a pharmacist could jump in here too and they know drugs way better than doctors do. (I'm sorry, it's true)

[secular_mom]

IME with extended family members- some Dr.'s prescribe pain meds that aren't REALLY needed, some prescribe them when they are needed but the meds are addictive and the person finds it VERY hard to get off the meds, or the person asks for higher doses and/or stronger meds. Some people are more lenient about using meds, and may take more than they are supposed to because they feel it will work better. Some people don't keep up with what they've taken, and end up overdosing from taking the med too many times. I think that people who are afraid of becoming dependent on medication are much less likely to misuse meds, and are much less likely to become addicted to them.

 

You can tell when someone is addicted by their behavior- if they haven't had their med they start having withdrawal symptoms, just like someone having withdrawal from illegal drugs or even caffiene.

[hanki]

A very close childhood friend of mine and her husband would take pain pills for no reason other than to feel good and, in her words, to feel like super mom because when she was taking them they would give her lots of energy. They were up to about 25 pills a day/person and it was costing them a fortune. If they tried to stop taking them they would get very sick. They would doctor hop, get prescriptions on the internet, and off the street. Eventually they made their way up to heroin. Don't ask me why, I would think this was just as expensive but I guess it was easier to get (???). At the time, when she finaly admitted to me that she had an addiction, I had no idea that pain pills and heroin were both opiates. She was told when she attempted to get help the first time that many heroin addicts start off taking pain pills. They made several unsuccessful attempts to quit and even went to rehab for 30 days (relapsed 3 days after release). Now a few years later and the use of methadone she is clean. Pain pills are dangerous if not taken correctly and for legitimate reasons.

Edited June 26, 2009 by jjhankins97

[Perry]

Only certain classes of drugs cause addiction. Here's a snippet from wiki

 

In medical terminology, an addiction is a state in which the body depends on a substance for normal functioning and may occur along with physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms. Addiction is generally associated with increased drug tolerance. In physiological terms, addiction is not necessarily associated with substance abuse since this form of addiction can result from using medication as prescribed by a doctor. Physical dependence is different from psychological dependence (addiction). The latter is often characterized by a compulsive need for a drug for psychological reasons, while the former is characterized by need for the drug due to tolerance and the need to prevent withdrawal symptoms on discontinuing the use of a drug. Physical dependence however, commonly occurs with both addiction and therapeutic use of drugs.

 

......

 

 

Physical dependency

 

Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance is suddenly discontinued. Opiates, benzodiazepines, barbiturates and alcohol induce physical dependence. On the other hand, some categories of substances share this property and are still not considered addictive: cortisone, beta blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the initial primary attribution of an addictive substance is usually its ability to induce pleasure, although with continued use the goal is not so much to induce pleasure as it is to relieve the anxiety caused by the absence of a given addictive substance, causing it to become used compulsively.

Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.

The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some people may exhibit alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.

 

 

 

 

When they say "prescription drug addiction" they are generally making a distinction from illegal drugs that cause addiction, like heroin. It's usually an addiction to pain medicine, like Oxy-contin.

[KidsHappen]

I think that people who are afraid of becoming dependent on medication are much less likely to misuse meds, and are much less likely to become addicted to them.

 

See this is where I am and I think that is what is making it so hard for me to understand the concept. I hate even taking my blood pressure and bi-polar meds. If I take anything that makes me feel high or stoned or whatever, it makes me very uncomfortable and then I wonder why someone would want to feel that way. :confused:

[KidsHappen]

Only certain classes of drugs cause addiction. Here's a snippet from wiki

 

When they say "prescription drug addiction" they are generally making a distinction from illegal drugs that cause addiction, like heroin. It's usually an addiction to pain medicine, like Oxy-contin.

 

Thanks. This article was very helpful but it seems like a spectrum and there are some gray areas in the middle. For instance the pp saying someone was taking 25 pills a day is an obvious case of addiction but it seems like the closer you get to a normal dosage the harder it would be to tell and I am just wondering how an observer would tell the difference in those cases. Or is it more of a subjective thing where only the person themselves could say if they were addicted?

Edited June 26, 2009 by KidsHappen

[dirty ethel rackham]

See this is where I am and I think that is what is making it so hard for me to understand the concept. I hate even taking my blood pressure and bi-polar meds. If I take anything that makes me feel high or stoned or whatever, it makes me very uncomfortable and then I wonder why someone would want to feel that way. :confused:

 

I feel the same you you do about taking meds. Pain medications do not give me the high, but they do make me feel out of control. I won't go into the alcohol buzz, though.

 

For many people, the addiction starts with something where the pain meds are a good thing, such as surgery or painful injury. Some people have chronic pain bad enough to need medication. This is where the slippery slope can happen. It isn't taken so much for the 'high', but the pain, whether real or imagined, is greater without them.

 

I have family members who became addicted to pain meds after surgery. My brother broke his leg in 3 places and almost OD'd on pain meds. We found out later that he was allergic to the metal screws that they used to hold the bones together and was in excruciating pain. My mom had to confiscate the meds and dole them out to him. He has since struggled with addiction to various substances. I am sure the genetic predisposition didn't help matters much either (lots of alcoholism and substance abuse in my family tree.)

 

I am sure that for others, there is that "high" element - sort of an escape from the pressures of life. Some use alcohol, others use drugs, some use destructive behaviors. Others use a seemingly good thing to excess. I have a friend who replaced his addiction to alcohol with an addiction to running, both having a deleterious effect on his family.

[HRAAB]

This really hits home with me. My dh has chronic back pain. Bad chronic back pain. The Drs. (2 different neurosurgeons) recommended controlling the pain with medication and putting off surgery until he was older. This was about 4 yrs. ago when he was 47. He was prescribed Norco (Vicodon sp) for the pain. It does control the pain, but he's definitely addicted to it. Just recently the Dr. prescribed a nerve medication to try so dh is in the process of stopping the Norco. He gets what he calls the 'willies' at night. I hate it. It seems like a vicious circle. At this point, he says he thinks he would rather have opted for surgery than becomming addicted to pain meds especially now that surgery seems likely in the near future anyway. Pain meds are very addictive especially since chronic pain is an ongoing battle.

 

Just wanted to add that my dh does not have an addictive nature nor is there any history of addiction in his family. When discussed with the doctor, he acknowledged that this was a side effect of the medication.

 

Janet

[Impish]

I have RSD. I've been reassured over and over and over again that I *won't* get addicted to the meds I'm on because it works on a completely different part of the brain because I am in serious chronic pain. When someone takes them without needing them, it works on a different part of the brain, and produces a different effect.

 

Uh huh. :glare: I then asked about PHYSICAL dependancy, and sure as heck, once I start methadone (the next one one the list, to start next wk) I can't just go off of it, because it will make me sicker than the proverbial dog. But somehow, that's not addiction. It was explained that suddenly going off an antidepressant would make folks sick, but that's not because they're addicted..?

[HRAAB]

I have RSD. I've been reassured over and over and over again that I *won't* get addicted to the meds I'm on because it works on a completely different part of the brain because I am in serious chronic pain. When someone takes them without needing them, it works on a different part of the brain, and produces a different effect.

 

Uh huh. :glare: I then asked about PHYSICAL dependancy, and sure as heck, once I start methadone (the next one one the list, to start next wk) I can't just go off of it, because it will make me sicker than the proverbial dog. But somehow, that's not addiction. It was explained that suddenly going off an antidepressant would make folks sick, but that's not because they're addicted..?

 

So there's a difference between dependency and addiction. Come to think of it, dh's Dr. called it dependency. Nonetheless, he cannot just stop taking it. After 4 yrs. it's a slow process weaning himself off, and not fun.

 

Janet

[Impish]

Yep. Addiction is the craving for the drug, the behaviour. Physical dependency is the body's reaction to the cessation of the drug, and why the weaning.

 

For example, I'm a smoker. Addicted to nicotine. I quit, and its not the PHYSICAL dependency that gets me, its the ADDICTION, the mental, social, addictive behaviour that gives me the jitters, snappy, blah blah blah. Nicotine is out of the body very quickly. Its the learned behaviour, the addictive behaviour thats the problem, not the physical dependancy.

[Alice]

I think there is a difference between addiction and abuse, although the terms are often used interchangably by the media. Many people on chronic pain meds are physically dependent on the meds and would go into withdrawal if they suddenly stopped the drugs. Some also become psychologically dependent on a medication....to believe that you need the medicine more and more to feel better.

 

I think the "addiction" that is referred to in the media is often also meant as abuse. This is when people are doctor hopping in order to get multiple prescriptions or getting prescriptions off the Internet. Or in my patient group, kids who are abusing their ADD meds...actually usually the kids who are prescribed ADD meds are not abusing them but are more likely to sell them to other kids to get high. It's a red flag for us if we get someone who has things like "losing the prescription" happen multiple times. Or if they keep coming in seeking a higher dose or a different medication and then you can realize they have lot of 3/4 filled bottles at home. (I hope noone takes offense at that...most kids on ADD meds truly need them and are taking them appropriately. But abuse has become more and more of an issue.)

[TravelingChris]

I am on opiate pain killers and have been since 2001. I am not addicted and not even dependent on them. That is, I sometimes forget a dose or two and never had any withdrawal symptoms. I also have no 'high' whatsoever. It doesn't make me feel good, it makes me able to function with arthritic pain. On a good day, I don't have hardly any pain. Many days, I still have pain but mostly the kind I can function with. Well done studies have shown that people with chronic pain have a very low addiction rate. Basically, the people who become addicts are people who become addicts regardless of the drug or vice of choice. I don't have an addictive personality. I don't doctor shop, I don't get or try to get multiple perscriptions, etc. By the way, the biggest danger here in the US with opiate addiction is what they mix it with i the pills. That is, you will get harmed by the overdose of acetaminophen faster than the overdose of hydrocodone. I was in a lot of pain until my doctor explained to me that I cannot pick and choose when to take my medication. For medication to work well with chronic pain, you need to keep it rather steady in the blood. By the way, I have been on similar dosings of pain killers for 6 years and it continues to work rather well for me although I did need to go on stronger disease modifying drugs because of functionality issues and also pain.

[stephanie78]

My DH was in a very serious car wreck last year. He broke 3 vertebrates in his neck, several ribs, his sternum, shoulder, had a brain injury, and had several internal injuries. He has already been through surgeries, and faces more. He has endured pain injections, and is of course on pain medicine. His doctors are very on top of things, and change his pain medicine every few months to keep him from becoming dependant on any one type of medicine. They also try to avoid giving him the heavy stuff unless it is absolutely necessary because when he does have surgery they do not want him to be immune to the stronger pain killers. His doctor is very vigilant. I can see though how a person with a doctor who is not as thorough could easily be allowed to abuse prescription pain killers. The doctors have said that my DH will more than likely have to be on this medicine for the rest of his life due to the extent of his injuries. They also take the time to monitor his kidney and liver to make sure that damage is not occuring. We are very thankful to have doctors who are wonderful.

[Desert Rat]

Perscription medication addiction, as I see it, doesn't relate to BP meds or insulin. Mostly it's drugs that are for pain or otherwise alter a person's state. Adults take Ridalin (sp?) because it has the adverse affect that it has on kids, for example.

All of the possiblities you list can define perscribed meds addiction. They get from their doctor; they go to many doctors-overlapping to get more; they take it from relatives or friends, they take too much or crush up pills and snort or shoot them. They steal script pads and write their own. They can get most pain meds from Mexico or off the street. It's a serious, serious problem.

My mom has a bad back. I've watched her slowly get addicted to pills and patches. She insists she needs them but at the same time realizes, as a nurse, that most pain meds are ineffective on back pain. She goes to doctors who give her professional courtesy and write out anything she wants. She refuses surgery to fix the problem stating that the 50% chance of being paralyzed is too high. I say if I were in that much pain I'd do dang near anything to stop it-including ending up in a wheel chair. She recently was told that she had to have a psych evaluation because she was on so many meds and the doctors thought she was just a drug seeker. I can't tell you how big of a tantrum she threw over being questioned. How dare they?!

So, I've got lots of personal experience with addicts whose drug of choice comes to them legal over counters perscribed by doctors. It's just plain miserable.

[mazakaal]

I haven't read all the responses, but I have some experience with this with an extended family member. She became addicted to prescription medication and, because she was friends with a pharmacist and had background in medical research, she managed to convince him to supply her with unprescribed medication. Basically she was self-prescribing. Eventually that source ran out. I think he retired or something. Then she started going to different doctors and telling them the symptoms that she knew would need particular medications prescribed. She didn't tell what other medications she was on and didn't tell the physicians that she was seeing other doctors. So she could get more prescribed medication than was allowed or could get medications that interacted with each other in such a way that a doctor wouldn't have prescribed them together.

 

I'm not sure if I'm making any sense, but what it boils down to is that she had enough medical knowledge that she worked the system to get prescription medication that she shouldn't have had. It wasn't a situation where she was continually on a medication under proper medical care. In contrast, my mom had half her thyroid removed years ago. She has to take thyroid medication every day for the rest of her life. That is not being addicted to prescription medication. That's just having a medical condition that requires prescription medication. Big difference.

[LaxMom]

I have RSD. I've been reassured over and over and over again that I *won't* get addicted to the meds I'm on because it works on a completely different part of the brain because I am in serious chronic pain. When someone takes them without needing them, it works on a different part of the brain, and produces a different effect.

 

Uh huh. :glare: I then asked about PHYSICAL dependancy, and sure as heck, once I start methadone (the next one one the list, to start next wk) I can't just go off of it, because it will make me sicker than the proverbial dog. But somehow, that's not addiction. It was explained that suddenly going off an antidepressant would make folks sick, but that's not because they're addicted..?

I have a withdrawal headache if I don't have a cup of coffee in the morning - I wouldn't call that an addiction, but there is a definite physical dependency (though I'm not exactly sure what my body is "depending" on it for). In other words, if I don't have coffee, I'm not pondering what lengths I'll need to go to to get a cup, I just say "****. I'm going to have a headache later" or "what is up with this headache? Oh, look, there's my still-full cup of coffee from 4 hours ago."

 

A friend's mother was "addicted" to blood pressure medication, inasmuch as she was psychologically dependent on it AND had no physiological need for it. Long story short, 20 years prior, her doc prescribed it when she was stressed out and her BP was up a little (because, of course, why would anyone suggest something like stress manangement when there's a pill for that, right?). She had been on them, with very low BP, since, and completely freaked out if a new doc suggested she didn't need to keep taking it.

 

Sadly, we seem to live in a culture of addiction, in which we need a pill for everything in order to feel ok. (I'm thinking specifically of my pediatician's comment once that, with other parents, he would not be able to take a "wait and see" approach with an ear infection because they demanded antibiotics with every cold... :001_huh: "Just say no", doctor.)

 

I think addiction, like any mental illness, is defined largely on how a dependency affects the rest of the function of your life.

Edited June 26, 2009 by MyCrazyHouse

[KidsHappen]

Ok, another questions has occured to me. How do people pay for all these medications? My insurance only covers a certain amount of one type of medication in a certain time period so I can't have a prescription filled more frequently or have many different prescriptions of the same medication. I know that I could pay for a prescription myself but some meds cost $5 a pill. Who could afford this?

[ChristusG]

I've always wondered this too.

 

But now all I can think of is Dr House and his Vicodin addiction/dependency LOL. I dont know if he really needs them or not! :lol:

 

I am soooo leary to take any type of pain medication because I'm terrified of becoming addicted to it. I had a minor surgery about 8 years ago and they gave me a prescription pain med (cant remember which one now) and told me how often to take it. I never took it. I downed some Motrin, which thankfully took care of most of the pain.

 

I had a really bad toothache about two years ago and they gave me a script for some Tylenol with Codeine in it (I was pregnant at the time so that's all they could really give me). I never took that either. But at that time I was also concerned with the baby, as well as an addiction possibility.

 

I hear of so many people becoming addiction to prescription meds...it is scary.

[Elizabeth Conley]

Strictly speaking, addiction to a prescription drug simply means physical and/or mental dependency on the substance. A patient can be addicted to a prescription drug that is absolutely necessary for their wellbeing. The risk of dependency, or even the fact of dependency, doesn't in itself negate the patient's legitimate need for the medication.

 

There are times when terminally ill patients have been denied appropriate pain relief simply because they might become addicted. This rationale is obviously ridiculous.

 

On the other hand, sometimes doctors prescribe narcotics and other medications their patients don't need, or in excess of what the patient needs. In our community, three patients died before such a doctor was investigated, prosecuted and deprived of his license.

 

The problem wasn't just that some of his patients died. Some of his patients got in serious car accidents, risking the lives of everyone sharing the road with them. One of them rear ended a school bus in broad daylight. She claimed she didn't see it. (Wrap your head around that, if you can!) In general, his patients behaved like drug addicts. A person addicted to prescription drugs can display all of the disturbing behaviors of a person addicted to illegal drugs. His patients caused their families and communities extreme consternation.

 

IMHO, it is very hard to figure out who is to blame when a patient is addicted to prescriptions drugs. I have known 2 such patients. Of the two, I know with absolute certainty that one of them "doctor shopped" until she got what she wanted. The other one was troubled man who attended our church. He had he typical social history of a person with anti-social personality disorder, but had done fairly well in in the year before his addiction became serious. Because he was a legitimate pain patient, he probably rated the narcotic pain relief he requested and received. That being said, his medical condition was somewhat complicated, because he had threatened the safety of a surgeon who operated on him to mitigate his medical problem. The patient had a history of domestic violence and incarceration for assault, so his threats made the surgeon very nervous. The patient was a difficult person to reason with. No one wanted to risk operating on him to relieve his discomfort. On the other hand, no one wanted to give a confirmed sociopath narcotic pain relief either. They did, and the consequences were very unfortunate.

 

One of the accepted definitions of "addiction" is a dependency on something that causes significant social or physical impairment. It can be argued that a less aggressive person than the sociopath described in the previous paragraph could safely have access to higher doses of narcotic pain relief. This is usually the case, but patients can surprise their doctors in this regard.

 

For reasons too complex to explore in this forum, some patients become dangerous when they've been given narcotics, or some of the new psychotropics that can heighten paranoia. (Many of these new psychotropics aren't addictive, nor are they narcotic. This makes them more attractive to responsible physicians. Unfortunately, in a minority of patients, paranoia, rage and psychotic episodes can result from standard dosages.)

 

A third patient, who required treatment for pain, was prescribed one of the new psychotropics in the place of a narcotic. He did not have a public record of dangerous behavior, but under the influence of neurontin, he became extremely paranoid. His paranoia did cause significant social impairment. He became extremely verbally abusive, and it was clear he was desperately unhappy. This is not as unusual as we'd like to believe.

 

The nature of emotional memory is such that the unpleasant thoughts and feelings a patient experienced while under the influence of a psychotropic do not go away after the drug is gone from the patient's system. This is another topic that is too complex for here and now. Lets just say that the psychological harm resulting from an unfortunate side effect of a psychotropic drug can endure long after the patient stops taking the drug. While the patient's rational mind understands that his/her point of view while under the influence was badly warped by the drug, the memories and emotions are absolutely "real" in every other sense of the word.

 

So obviously, prescription drug addiction means different things to different people. Context is important. I wish I didn't know anything about this, but it's a topic that touches most adult lives sooner or later. I'm no exception. You never know when or where you're going to encounter people with serious prescription drug problems. I encountered two in ministry, and one within my extended family. It's been educational; that's about the best spin I can put on it!

Edited June 28, 2009 by Elizabeth Conley

[mommylaw]

I saw this in my chemical dependency rotation in nursing school. There were tons of college kids that started with oxycontin and then switched to heroin. Apparently, it's cheaper and much easier to obtain. :(