Dr. Earthman’s answers to your questions - April 2009

Julian M.: Can you tell me how long it takes to get addicted to pain killers? What should I look for as far as behavior etc. etc. to know that I (or someone else ) am addicted

Dr. Earthman: There is not a definite answer as to how long it takes to get addicted to pain killers.  First, you must understand that addiction is a broad term that includes physical, psychological, and emotional dependence.  Some people can have physical withdrawal symptoms when stopping pain killers after only a few days of use.  The “hallmark” of addictive behavior is when a patient is using the medication for purposes other than that for which it was prescribed.  Additionally when a patient continues to use the medications despite significant negative impacts on their life they are addicted.

Kathy M.: I am currently taking 20mgs of Oxycontin in the am and also a 10 mg of percocet at 3. The oxycontin is supposed to work for 12 hours but it doesn’t and so my Dr. says it’s ok to take the 3 o’clock one as well. sometimes  when my back is particularly hurting( disk degeneration and scoliosis) I may take another 5mg at bedtime. So I am on 35 mg’s of pain meds daily. Lately, I have no energy at all until after I take my dose. This scares me and I don’t like being addicted. I am wondering if Suboxone would be a good pain management option as well as helping me get off the other. What kind of health issues am I looking at for this amount of time and mgs? Any suggestions for me? P.S. I am 55 years old

Dr. Earthman: Suboxone is a medication that can be used for opiate detox, prevention of opiate abuse relapse, and also for pain control.  Although it has been remarketed over the last 10 years as a substance abuse treatment, the base drug (buprenorphine) has been used by anesthesiologists since at least the 1960’s for pain control.  Some of its benefits include little to no “high” for opiate users (thus no reinforcing effect) and overall much less cognitive impairment than full opiate agonist drugs.  Patients are not likely to develop tolerance and thus have to keep increasing the dose.  Keep in mind though that even if a patient switches to Suboxone they are still going to experience a physical withdrawal if they stop Suboxone “cold turkey.”

Jim F.: Dear Dr. Earthman. I suspect that my son is taking pain killers and may be addicted but I’m not sure. He recently got into a car accident and was given a prescription for Vicodin but now I suspect that he is taking my painkillers for my back and I have noticed that he’s very withdrawn and moody. My question is, what do you look for when you suspect a loved one is addicted to pain killers and what’s a good first step on how to talk to them about it? Do I confront him with evidence? I want my son back!

Dr. Earthman: It is a difficult position to be in if a loved one is addicted to chemicals of any kind.  One thing that happens is that a patient’s natural reward system in the brain (meant to encourage life sustaining behaviors such as eating, nurturing children, protecting others, and sex) gets “hijacked” by the drug and the drug becomes their source of pleasure.  I encourage all patients and their friends and family to be direct and immediate if they feel there is a problem.  There is a classic phrase in substance abuse treatment, “There is never a good day to get sober.”  Do not be afraid of their likely negative reaction.  In reality their negative reaction is their displeasure with themselves for losing control of their life, but many people can’t face that so they project it onto others.  Acting out of love and concern for a family member or friend is never wrong in my opinion.