Unfortunately pill addiction is becoming more and more predominate in today’s society. There are many complexities that are contributing to this uprising and concern today and both the why and how can it be prevented. According to the National Survey on Drug Use and Health in 2009, approximately 16 million Americans age 12 and older used a prescription for non-medical purposes at the minimum once in the year prior to being surveyed, that prescription being either an opioid, stimulant, sedative, or analytic. We will review the why’s and how’s but before we go there, let’s get an understanding of what pill addiction is and the complete extent of the problem on our hands.
When it comes to pill addictions, they are broken down into three categories: 1) Opioids (used to treat pain symptoms); 2) Sedatives / Anxiolytics (used to treat anxiety and sleep disturbances); and 3) Stimulants (often used to treat attention difficulties). Now often times these symptoms may be authentic consequently stimulating a patient to speak to their physician who consequently begins to treat the reported symptoms with appropriate medications. The problem with this is that so many of these medications have a high abuse possible meaning that the medication if not used exactly as prescribed can be easily abused to get a desired effect/mood. Now add into the mix a patient with addictive tendencies and we have a serious problem on our hands. Medications like Vicodin, OxyContin, Ambien, Valium, Xanax, Adderall, and Ritalin are just a few of these abused medications. Changing the way these medications are ingested, using more than prescribed, and mixing with other substances are just three ways to abuse these pills. It should be noted that in no way are physicians to blame for this epidemic – rather they are just a method for an addict to acquire their pills. Physicians are one of many ways we see pill addicts getting these medications. Other ways include buying them on the street, taking someone else’s, stealing, etc. Let’s use opioids for an example.
Say patient, John Doe, sought out his physician after having a serious skiing accident where he broke his ankle consequently requiring a surgery to have screws attached to his broken ankle to assist in the healing course of action. Naturally, John had immense pain with this injury and his treating physician prescribed him OxyContin to treat the pain symptoms. During John’s recovery he continues to take his medication when experiencing pain, unfortunately John starts noticing that he isn’t getting the relief he used to have and increases his dosage until that stops working and he increases the dosage again (building up his tolerance). This pattern continues for twelve months. By this time, John’s injury has healed for the most part but he is nevertheless reporting pain. This is where the problem lies. Opioids can create a sense of euphoria and pleasure due to how the chemicals react to the chemical makeup of the brain – central nervous system. John has learned that and as a consequence struggles with letting go of those pleasurable moods. At this point, the psychological dependence surfaces and can go as far as deceiving John into thinking he nevertheless has pain (phantom pain) due to the OxyContin’s effects on John’s nerves. John then continues to report feeling the pain and now, due to having a high tolerance to the medication and having used it for such an extended period of time, John has a physiological dependence, in addition. The problem for John is that now when he doesn’t use the OxyContin, he will begin to experience withdrawal symptoms such as restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, etc. John continues to rationalize his use and states that he is not addicted and he is only taking what his physician prescribed him for pain.
This is precisely where the problem lies! John has developed an addiction to OxyContin that naturally he doesn’t concede because he rationalizes his pill use, stating that his physician prescribed them. This is one example of a typical patient. The problem is John has both physiological symptoms and psychological symptoms. It is much easier for him to focus on the physical and struggle with seeing the psychological. John may ultimately stop being able to get his pills legally and look to illegal methods such as buying them on the street, stealing/obtaining from friends, etc. This brings us to how do we help John to remove these opioids from his system and treat the addiction?
There are many approaches currently being used to treat pill addictions and it really comes down to the specific pills being used with the objective being to completely eliminate them all together. As far as pharmaceutical interventions, currently opioids are the main class of prescriptions that use Medication-Assisted Treatment also known as MAT. Studies have shown that MAT in combination with behavioral therapy techniques have high success rates compared to those that don’t use MAT. for example, Suboxone (a combination of buprenorphine + natrexone) can be used in collaboration with behavioral therapies and 12 Step facilitation to best help opioid patients (both for prescription opioids and street opioids such as heroin and opium). We have seen patients not using any kind of MAT tend to lose focus of their desires for sobriety due to their struggles from withdrawing and their rates of using while in treatment are elevated compared to those that do incorporate MAT. Using more behavioral alteration approaches and having continued collaboration with external providers are also a necessity.