A new tool to help you recover from pain pill addiction: Are you addicted?

Are you addicted to pain pills? You certainly have company. The cycle of use, dependence, and use is playing out, over and over, in every community across the country. Notethat I describe the cycle as �use, dependence, use��a description thatis accurate, because in most cases the cycle of dependence starts when you appropriately use medication administered by a person who you trust�your physician.

Pain pills are often called �narcotics�--a term that comes from the Greek word �narcosis�, or �sleep��because of their sedative effects. Physicians use the word �narcotic� to refer to different things in different situations. Forexample, when referring to controlled substances, �narcotics� may beused to denote drugs regulated by the Drug Enforcement Administration. Ananesthesiologist uses �narcotic� to refer to the portion of theanesthetic that is comprised of drugs that bind to brain �opiatereceptors�. �Opiate� is another word used by physicians in reference to pain pills. The word comes from �opium�, a substance derived from poppies and used to make heroin and morphine. The �opiate� reference is also used for synthetic pain medications that have no connection to poppies or opium save their pain-killing effects.

Most people have heard of �endorphins�. Endorphins are produced in the human body, and when released, block pain. Endorphinsare often referred to as �endogenous opiates� because of their role inpain sensation, even though they have no relation topoppies or opium, and are structurally quite dissimilar. These natural pain relievers have other functions in the body, roles not relevant to this discussion. Endorphins are one group out of dozens of �neurotransmitters�, substances involved in the communication between nerve cells. Endorphinsand other neurotransmitters act at �receptors�, the receptor being alock on a nerve cell, and the neurotransmitter being the key that fitsin the lock. Amazingly, poppies produce a substance that looks different from the natural key, but that acts like endorphins by fitting the exact same keyhole. Thatsubstance�one molecule from the sap of a red flower�has given the humanspecies the ability to ease suffering in countless individuals, and hasresulted in the deaths of millions of others.

Over the years scientists have developed synthetic �opiates� with potencies far beyond anything produced by nature. Anesthesiologists use �sufentanil� reduce responses to pain during surgery. Sufentanil is extremely potent; anamount the size of one grain of salt, say one tenth of one milligram,placed on the tongue would cause respiratory arrest in a large manwithin seconds. More commonly opiates are taken by patients in the form of codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), or hydromorphone (Dilaudid). Prescriptions for these substances are handed out to millions of people each day in response to complaints of pain.

Opiatesrelieve pain, and work in different areas of the brain to elevate mood,ease tension, give a subjective sensation of warmth, and cause sedation. They can cause nausea and vomiting, particularly in patients who are na�ve to them. Finally, they change the response of the brain to low oxygen and high carbon dioxide in the blood, and slow respiration. The mostcommon cause of fatal overdose is respiratory arrest, where the brainstops sending impulses to the diaphragm, and the patient suffocates. This fatal response is most common during sleep, or when opiates are taken in combination with other sedative medications.

Opiates are addictive. There is no way to take them without the body adapting and becoming dependent on them. �Tolerance�to pain medication begins after the first dose, when the �locks� onnerve cells adjust in response to all of the �keys� floating around.With time it takes more and more keys to open enough locks to cause thereaction at the nerve cell. Tolerance is one half of the process of addiction,and is the reason for �withdrawal�, the sickness that occurs whentolerance has developed and the drugs, or keys, are taken away. The other half of addiction is so-called �psychological�, which I suppose is accurate to a point. Forsome reason, once something is assigned to the psychological category,it is treated differently by physicians, patients, and the rest ofsociety. �Psychological� does not imply that aperson has more control than with a �physical� condition�if anything,things occurring on a psychological level are far more difficult torecognize and treat than are physical conditions. The psychological addiction to opiates also develops very rapidly, and there is little if anything that can be done to prevent it. Psychological addiction is real, and is extremely powerful. The result is a desire to take opiates. The desire may take the form of physical symptoms, such as an increase in pain, and so psychological addiction and physical addictions are intimately connected.

To health systems, time is money. Patient complaints are handled as quickly (and sometimes as superficially) as possible. When a person presents in pain, the first determination is whether the pain is a serious threat to health. The second determination is whether enough tests have been done to identify the cause of the pain. If the first answer is no and the second answer is yes, the goal is to clear out the room for the next patient. There is a clock on the wall and a patient list in the hall, and the list has to be clear before the docs and nurses go home. Andso there is the doctor�patients waiting in six rooms, more in thewaiting area, and a person in the room complaining of something thatisn�t going to kill him/her. And in the doc�s pocket lies a pad of paper. Amazingly, all that the doctor has to do to clear the room is write on the pad and wish the patient well.

That is how addiction starts. Everyone intends well; everyone is honest; everyone is innocent. The patient is not told much about addiction. The patient isn�t told that within a few days, he will have some difficulty stopping the medicine. Heisn�t told that after a week when he stops the medicine he will havesome diarrhea, he won�t be able to sleep, and he will feel depressed. Heisn�t told that the pain that he has might not go away, and so he mayget more potent medicine, and so on, and that it will get harder andharder to stop as the medicine gets stronger. Idon�t know if the lack of information really matters; most patientswould likely take the pain relief medicine now, and worry about therest later. Besides, the doctor doesn�t seem too concerned�and the patient is correct. The doctor isn�t concerned, because this was a quick case that got him nearly caught up to schedule.

Unfortunately, there are pains that do not go away, even as we patients demand relief. Doctorshate to feel impotent with patients--it is difficult to take a person�smoney, and then tell him that there is nothing that can be done. Andso prescriptions are written, even when the problem may be complicated,and the best advice to the patient would be �learn to live with it�. Thisphrase angers patients with pain, but sounds intelligent to patientswho have struggled to get off opiates. But usually, the person withpain walks out with a prescription. As tolerance develops, the paincomes back, and the patient goes to the doctor again, this time leavingwith stronger medication. Tolerance continues, meds are changed, and tolerance develops again. The doctor gets nervous over the situation, realizing that at some point he will not have anything stronger. Suddenly calls to the doctor are not returned, or are returned by a curt nurse who sounds like the patient�s mother. The patient realizes that he is stuck, and becomes depressed. Sound familiar?

It is not your fault. I know about this stuff inside and out�I earned my PhD in Neurochemistry at the Center for Brain Research in Rochester New York, studying drugs that cause addiction and tolerance. I administered opiate medications every day as an anesthesiologist. I literally know everything that there is to know about opiates�expect how to stop taking them. I thought I was smart enough to avoid addiction, but I was wrong�laughably wrong�and the outcome nearly killed me. It is not your fault. To get better, you will need to understand the meaning and truth of that statement. That is difficult for some, but possible for everyone.

My next installment has better news. You can become free. Youdon�t need to leave your family to go to a far-away rehab center, andyou don�t need to go through painful detox and withdrawal. Watch for my next installment, or visit me at my address below. Thereis a new development in treating people dependent on pain pills, adevelopment that will revolutionize the way that doctors treataddiction.