Prescription Painkiller Addiction: 7 Myths

Experts Debunk Myths About Prescription Pain Medication Addiction

Medically Reviewed by Louise Chang, MD on August 10, 2011
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2. Myth: Everyone gets addicted to pain drugs if they take them long enough.

Reality: "The vast majority of people, when prescribed these medications, use them correctly without developing addiction," says Marvin Seppala, MD, chief medical officer at the Hazelden Foundation, an addiction treatment center in Center City, Minn.

Fishman agrees. "In a program where these prescription drugs are used with responsible management, the signs of addiction or abuse would become evident over time and therefore would be acted on," says Fishman.

Some warning signs, according to Seppala, could include raising your dose without consulting your doctor, or going to several doctors to get prescriptions without telling them about the prescriptions you already have. And as Weiss points out, being addicted means that your drug use is causing problems in your life but you keep doing it anyway.

But trying to diagnose early signs of addiction in yourself or a loved one can be tricky.

"Unless you really find out what's going on, you'd be surprised by the individual facts behind any patient's behavior. And again, at the end of the day, we're here to treat suffering," says Fishman.

Likewise, Weiss says it can be "very, very hard" to identify patients who are becoming addicted.

"When it comes to people who don't have chronic pain and they're addicted, it's more straightforward because they're using some of these drugs as party drugs, things like that and the criteria for addiction are pretty clear," says Weiss.

"I think where it gets really complicated is when you've got somebody that's in chronic pain and they wind up needing higher and higher doses, and you don't know if this is a sign that they're developing problems of addiction because something is really happening in their brain that's ... getting them more compulsively involved in taking the drug, or if their pain is getting worse because their disease is getting worse, or because they're developing tolerance to the painkiller," Weiss says.

"We know that drugs have risk, and what we're good at in medicine is recognizing risk and managing it, as long as we're willing to rise to that occasion," says Fishman. "The key is that one has to manage the risks."

3. Myth: Because most people don't get addicted to painkillers, I can use them as I please.

Reality: You need to use prescription painkillers (and any other drug) properly. It's not something patients should tinker with themselves.

"They definitely have an addiction potential," says Gharibo. His advice: Use prescription pain medicines as prescribed by your doctor and report your responses -- positive and negative -- to your doctor.

Gharibo also says that he doesn't encourage using opioids alone, but as part of a plan that also includes other treatment -- including other types of drugs, as well as physical therapy and psychotherapy, when needed.

Gharibo says he tells patients about drugs' risks and benefits, and if he thinks an opioid is appropriate for the patient, he prescribes it on a trial basis to see how the patient responds.

And although you may find that you need a higher dose, you shouldn't take matters into your own hands. Overdosing is a risk, so setting your dose isn't a do-it-yourself task.

"I think the escalation of the dosage is key," says Seppala. "If people find that they just keep adding to the dose, whether it's legitimate for pain or not, it's worth taking a look at what's going on, especially if they're not talking with the caregiver as they do that."

4. Myth: It's better to bear the pain than to risk addiction.

Reality: Undertreating pain can cause needless suffering. If you have pain, talk to your doctor about it, and if you're afraid about addiction, talk with them about that, too.

"People have a right to have their pain addressed," says Fishman. "When someone's in pain, there's no risk-free option, including doing nothing."

Fishman remembers a man who came to his emergency room with pain from prostate cancer that had spread throughout his body. "He was on no pain medicine at all," Fishman recalls.

Fishman wrote the man a prescription for morphine, and the next day, the man was out golfing. "But a week later, he was back in the emergency room with pain out of control," says Fishman. "He stopped taking his morphine because he thought anyone who took morphine for more than a week was an addict. And he was afraid that he was going to start robbing liquor stores and stealing lottery tickets. So these are very pervasive beliefs."

Weiss, who has seen her mother-in-law resist taking opioids to treat chronic pain, notes that some people suffer pain because they fear addiction, while others are too casual about using painkillers.

"We don't want to make people afraid of taking a medication that they need," says Weiss. "At the same time, we want people to take these drugs seriously."

5. Myth: All that matters is easing my pain.




In other words, pain relief isn't enough.









7. Myth: My doctor will steer me clear of addiction.

Reality: Doctors certainly don't want their patients to get addicted. But they may not have much training in addiction, or in pain management.

Most doctors don't get much training in either topic, says Seppala. "We've got a naive physician population providing pain care and not knowing much about addiction. That's a bad combination."

Fishman agrees and urges patients to educate themselves about their prescriptions and to work with their doctors. "The best relationships are the ones where you're partnering with your clinicians and exchanging ideas."

WebMD Feature



Christopher Gharibo, MD, director of pain medicine, NYU Langone Medical School and NYU Hospital for Joint Diseases.

Scott Fishman, MD, chief of the pain medicine division and professor of anesthesiology, University of California, Davis; board member and past president, American Academy of Pain Medicine.

Susan Weiss, PhD, chief, science policy branch, National Institute on Drug Abuse.

Marvin Seppala, MD, chief medical officer, Hazelden Foundation.

Department of Health and Human Services: "2007 National Survey on Drug Use & Health: Detailed Tables."

National Institute on Drug Abuse: "NIDA InfoFacts: Prescription and Over-the-Counter Medications."

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