10 Silent Signs You’re Slipping into a Pain Pill Addiction
Only one in three Americans can recognize a serious addiction. Learn the signs of prescription drug addiction before it’s too late.
The prescription problem
An estimated 18 million Americans ages 12 and older have misused prescription drugs at least once in the past year, according to the National Institutes of Health. Yet nearly one-third of 4,600 people polled in a recent Michigan State University study were unable to correctly identify the signs of drug addiction.
We can generally see trouble with others, but we can be oblivious to our own issues. This blindness can often crop up when it comes to addiction. Denial makes it even harder to see it when you are the person with the disease, according to Marc Myer, MD, CEO and co-founder of Hyperion Health, Inc, in Minneapolis-St. Paul, MN. (He is the previous medical director of the Hazelden Betty Ford Foundation.)
“It’s difficult to see the picture when you’re the frame,” Dr. Myer explains. Recognizing denial in yourself can be challenging. What may be easier to recognize is the “story” that seems all too familiar in addicts.
The gateway event
Addiction may be biologically driven, but a door must open for the process to begin. The story can sound familiar: You injure your back and the doctor prescribes you intermittent doses of opiate-based pain medication. (Examples include: percoset, codeine, darvon, demerol, dilaudid, fentanyl, hydrocodone, morphine, oxycontin, tramadol, ultram, and vicodin.)
Dr. Myer explains the most common path to addiction: “Unfortunately, the pain doesn’t go away, and maybe it even gets worse. So your doctor now prescribes a long-acting opioid. Weeks and months go by, during which you’re throwing in the originally prescribed pills along with the long-acting pills in an attempt to stay ahead of your pain.”
At this point, you’re still dealing with pain management—as opposed to addiction—but if this story sounds even vaguely familiar, then you need to be on alert. Check out the 24 secrets pain doctors won’t tell you.
Pain management doesn’t reach addiction until you’ve you’ve begun to experience pain despite taking the highest medically acceptable dosage. That’s what’s called tolerance, according to Dr. Myer.
Tolerance occurs because the use of opioid painkillers slows the brain’s production of endorphins, which are the body’s own painkillers, explains Beverly Hills, CA-based psychotherapist, Fran Walfish, PsyD. Your body doesn’t know or care how you began taking your meds, she says. It doesn’t matter if you obtained them legally or illegally. The fact remains that your body is now becoming increasingly incapable of coping with pain without an external supply of opiates.
The first sign that you’re reaching a critical tolerance level may be that you find yourself running out of pills before your refill is available, according to Shanthi Mogali, MD, board-certified psychiatrist in general and addiction psychiatry at Columbia University in New York City. You might feel anxious about whether you’ll be able to obtain more pills. You might also find that your doctor is unwilling to “cooperate” in prescribing your refills or the dosage you believe you need in order to get relief. It’s important at this point to understand that it’s not that your doctor is trying to hurt you, but that you’ve reached a critical level of tolerance to your meds.
Once you’ve reached the highest dosage your doctor is willing (and ethically permitted) to prescribe, you may resort to “doctor shopping,” according to Dr. Mogali, which involves going to different doctors and visiting hospital emergency rooms with various complaints about pain in order to obtain the meds your body has begun to need in order to feel normal. Find out the group that’s more likely to get prescribed opioids––and get addicted.
Changing the delivery system
A serious warning sign is feeling like swallowing your meds won’t get you relief fast enough. According to Dr. Mogali, as your access to the meds your body needs becomes increasingly limited, you may begin to change the way you use them, such as by crushing and snorting or injecting them.
You may experience depression or irritability with limited access to your meds, says Dr. Mogali. And you may also find that you’re no longer just craving the meds for physical pain relief, but in order to obtain emotional relief, adds Stephen F. Grinstead, a chronic pain and addition specialist at Grinstead Consulting, Training & Coaching in Camarillo, CA.
“You start thinking of the feeling you get more than the pain relief,” observes recovered addict, Todd Crandell. Crandell spent 13 years addicted to opiates before turning his life around, becoming an addiction specialist and founding Racing for Recovery in Holland, OH. “Your mindset changes. You find yourself waiting for the next time you’re supposed to take your pills. You’re excited and eager. Your thoughts start to gear toward a feeling of euphoria you’ll get when you take them,” he says.
You may at this point be willing to acknowledge to yourself that it would be a good thing if you cut down on your usage, according to Dr. Mogali. But there’s the rub. You will have significant difficulty in doing so, leading to further drug-seeking behavior. Read this hopeful firsthand account of a former opioid addict.
Sherry Yates Young/shutterstock
Maybe your insurance company is onto your doctor-shopping, and now you’re paying out-of-pocket for your meds. Or maybe you’re contacting friends and family members who might have some leftover opiates lying around in their medicine cabinets. Eventually, as Dr. Myer points out, your drug-seeking behavior is going to rise to a level where it becomes more important than those family and friends. Maybe you’ll go as far as stealing meds from them. Maybe you won’t show up for work because you’re out trying to find pills.
Maybe you’ve considered trying heroin, not because you want to, but because heroin is an opiate, it’s readily available, cheap, and, as users attest, “provides a better high,” per the National Institute on Drug Abuse.
According to Matt Feehery, CEO, Foundations Recovery Network in Brentwood, TN, 80 percent of first-time heroin users began using as a way of coping with withdrawal symptoms from prescription pain medication.
Withdrawal may first present first as agitation, according to Feehery, but you may not notice it because inherent drug-seeking has already taken a toll on your sense of well-being. “The sudden cessation of drugs can cause significant physical symptoms,” Dr. Mogali says. According to MedlinePlus, symptoms of withdrawal include:
- muscle aches
- runny nose
Later symptoms include:
- abdominal cramping
Find out the 10 ways to safely handle prescription drugs.
Longer-term symptoms of addiction
You may feel increasingly lethargic and less motivated to do the things you used to do and enjoy, says Scott Dehorty, LCSW-C, a psychotherapist specializing in substance use disorders and chronic pain in Columbia, MD. “Your primary relationships are no longer with your friends and family but with the drugs,” says Dr. Myer. “Overall wellness suffers as you begin to ignore all your physiological needs, including food, exercise, and hygiene, with the primary focus being obtaining your drugs.”
It can happen to anyone, but…
Although anyone can become addicted to opioids, Dr. Mogali says, there is greater risk for those with a history of mental illness such as anxiety, depression, or post-traumatic stress disorder. In addition, you’re at a higher risk if you have a family history that includes addiction, Dr. Myer says.
“We worry especially about teens,” says Sara Anderson, national board master addiction counselor in Atlanta, GA, because they can easily access leftover pain meds from their parents’ and grandparents’ medicine cabinets. For that reason, it’s important to dispose of painkillers when you no longer need them. It may be hard to see addiction in yourself, but if you see the signs in your teen or in any other family member or close friend, don’t be afraid to bring it up. “Start by addressing the observations you have made with your loved one,” Dr. Mogali advises. “Sometimes this is all that is needed to start addressing the problem.” When there is resistance to entering treatment, a professional interventionist can be helpful. Here are some more secrets about addiction that addiction counselors need you to know.
- National Institute on Drug Abuse. “What is the scope of prescription drug misuse?”
- Michigan State University. “Prescription Drug Misuse.”
- Marc Myer, MD, CEO and co-founder of Hyperion Health, Inc, in Minneapolis-St. Paul, Minnesota
- Fran Walfish, PsyD, a psychotherapist in Beverly Hills, CA
- Shanthi Mogali, MD, board-certified psychiatrist in general and addiction psychiatry at Columbia University in New York City
- Stephen F. Grinstead, chronic pain and addition specialist at Grinstead Consulting, Training & Coaching in Camarillo, CA
- Todd Crandell, founder of Racing for Recovery in Holland, OH
- National Institute on Drug Abuse: “What is heroin?”
- National Institute on Drug Abuse: “Heroin use is driven by its low cost and high availability.”
- Matt Feehery, CEO, Foundations Recovery Network in Brentwood, TN
- MedlinePlus: “Opiate and opioid withdrawal.”
- Scott Dehorty, LCSW-C, a psychotherapist specializing in substance use disorders and chronic pain in Columbia, MD
- Sara Anderson, national board master addiction counselor in Atlanta, GA