"I am currently taking an opioid medication prescribed by my doctor. I had surgery on my knee and I am taking the medication as prescribed. How do I know if/when I develop a problem with this medication?”
Every day, many well-meaning doctors and dentists prescribe opioid medications, such as oxycontin, hydromorphone, Percocet, Demerol* and even Fentanyl* for post-surgical pain or for serious, acute pain due to the patient’s treatment needs. The truth about opioid medications is that while they help with pain, the long-term effects of these kinds of medications may cause the patient to develop a tolerance to the prescription dose which may require a higher dose to achieve the same pain-relieving effects. Building a tolerance to the medication isn’t necessarily a bad thing, but recognizing this and talking to one’s physician is imperative for ongoing medication treatment. It is important to talk with your physician about why you might need a refill and to ask about other pain reliving alternatives.
Developing a tolerance is a normal process. Even coffee drinkers find that it used to take one cup of joe to get started in their day, but soon many begin to require 2, 3 even 4 cups of coffee in order get the same effect! This is tolerance.
Opioid tolerance is common among long-term opioid users. The physician will be able to help you in the process called “titration”, which is gradually stepping down one’s dose. Going to quickly can create some awful symptoms, called withdrawal. This can lead to horrible side effects, such as sweats, shaping, seizures, even death.
So how do we know if there’s a problem? And what is the difference between dependence and addiction?
First, dependence tells us that we are becoming so tolerant to the medication that it takes more of the same drug to get the desired effect. Therefore, an open line of communication with our physician is important, so that the titration process can begin safely.
Addiction, on the other hand, is having the dependence to the medication and being willing to go to any lengths to get the medication, use the medication and recover from its effects. Often, people with this problem are willing to commit crimes or to go to ANY length, to obtain the medication! When this occurs, this person will need some immediate medical assistance.
Keeping track of how many days, weeks, etc. is important to avoid serious withdrawals and keeping the dependence from becoming an addiction! Keep your physician aware of any concerns you may have to avoid a serious problem…one that can be deadly!
*Synthetic opioids which are created in a laboratory and used for medical purposes only.
Now, to discuss how we know when we have a problem with opioids – here are some examples:
1. Using more than prescribed each day/week, resulting in running out of medications before they are ready to be refilled.
2. Doctor or pharmacy shopping. This entails either attempting to go to several different physicians to get scripts, and/or trying to get those scripts filled at different pharmacies.
3. Feeling the effects of withdrawals when discontinuing these medications. Examples are: feeling sick, like the flu (symptoms), irritable, runny nose, edgy, feeling cold at the same time you may be wrapped in blanket(s) and sweating, etc.
4. Selling your left-over medications when you are finished with them. All unused medications should be either flushed or given to the local police department/sheriff’s office for proper disposal.
5. Purchasing additional medications from “friends” or associates (this is also very illegal!)
6. Obtaining opioid medication(s) from friends, family or neighbors (“borrowing a few”).
7. Purchasing and/or consuming illegal opioids (heroin, “Roxy’s1” or any other illegal or legal substances) on the ‘street’.
If you experience any of these behaviors, go to the nearest physician or ER and advise them of your situation, so that you can begin safe detoxification.
Should you have any questions or doubts about the opioid medication or any other medications you’ve been prescribed, talk with your physician so that you can arm yourself with knowledge. It is very easy to become dependent and addicted to the opioid medications. ALWAYS ask before you begin taking medications such things as how habit-forming, or what are the side effects of a specific medication. Being safe is better than being dead! There is no “do over” once you die.
1 – “Roxy or Roxy’s” is the street name for a synthetic opiate known as Oxycodone.
Joe Stringer is a clinician with Pingora Behavioral Health Clinic. Joe has extensive history and knoweldge of working with individuals strugging with mental health and substance use issues.