Every so often, one of my clients will tell me they are addicted to pain pills. I have a unique background that leaves me a good position to help these clients. During my residency year, I spent six-months working at a methadone clinic with 300 heroin addicts. During my post-doc year, I worked at a chronic pain clinic helping people taper off of long-term use of pain medications.
These two experiences may not appear to be related on the surface, but they are. This is because both heroin and pain medications like Oxycontin, Percocet and Fentanyl turn to morphine in the body.
There are two classes of medications in this group. ‘Opiates’ are naturally occurring drugs like heroin, morphine and opium. ‘Opioids’ are man-made drugs that include Oxycontin, Percocet and Fentanyl. Both opiates and opioids lead to addiction. Getting off both opiates and opioids follows the same general principles.
When people are addicted to opiates or opioids, they experience symptoms of withdrawal that are quite uncomfortable. They will say they experience pain in their bones. This is not physiologically true because their bones are not involved, but the pain that is experienced definitely feels like it comes from their bones.
People in withdrawal will ‘leak from everyone orifice’ in their bodies. This means they will vomit. They will sweat. They will experience diarrhea, a runny nose, and weepy eyes. They will feel, in summary, like they have the worst case of the flu in their lives.
Although it feels awful, withdrawal from opiates or opioids will not kill the person. The drugs will leave their body and they will recover, assuming they are otherwise in good health.
Opiates and opioids are both classified as ‘downers.’ This means, when people are using these drugs, that they are ‘on the nod.’ They feel deeply relaxed. Calm. At peace. They do not feel anxiety. But these drugs also induce depression.
When someone is addicted to opiates or opioids, one of the outward signs of their addiction is that they do not communicate very well. They don’t recall what they said or what they were told very well. They have trouble retaining information. Their memory, in short, is poor. And they have difficulty concentrating.
People sometimes become addicted to pain pills following an injury or surgery. People that become addicted will say they like the feeling the pills give them, and that they were reluctant to give them up after the initial reason for the prescription resolved. If their physician stopped prescribing them the pills, they often found another physician who would, or they started buying pills off the street.
People sometimes say that the pills make them feel better in a way that antidepressants never did. They say, when we discuss their coming off the medication, that they are not sure they can function without the pills.
Some people say that their pain is high and that they need the pills to function. What few people know, however, is that the pills actually cause them to perceive that their pain is much higher than they would if they were not taking any pills at all.
The reason for this perception is called “the rebound effect.” Here’s how it works. A person initially takes a pain pill because they are experiencing pain and want relief. When the pill wears off, rather than the person’s pain level returning to where it was before they took the pill, their pain shoots even higher.
The person doesn’t realize this worsening of their pain is the effect of the medication wearing off. Instead, they perceive that their actual pain has worsened, and so they take another pill. This cycle leads the person to believe they need the pills to manage their pain long after they started taking the pills, even though the original issue may have resolved long ago.
So how can people get off pain pills? When I worked at the pain clinic, a team of professionals that included a physician, a pharmacist, and a psychologist would help people to taper off the medications. The physician would write a series of prescriptions that slowly reduced the amount of medication the person took over a period of several weeks until they reached a dosage of zero. Tapering would be conducted over six to twelve weeks, depending on how much medication the person was taking to begin with. The higher the initial dose, the longer the taper would take.
The idea behind tapering, rather than stopping the medication ‘cold turkey,’ is that people find the withdrawal symptoms easier to cope with when they are milder and last a longer period of time, rather than being hit by more severe withdrawal symptoms all at once.
There were three groups of clients at the pain clinic that would arrive to participate in a taper. One group said that they needed the medication and would not willingly participate in the program. These people were not usually successful in coming off their medication. The second group would say they were open to participating in the program and seeing what would happen. These people were usually successful and would benefit from the program. They would report, when everything was over, that they had had no idea that they could function without the use of any pain medication. They would also share that their family members were thrilled, because they felt like they had their family member back for the first time in years.
The third group would come in and actively ask for help. They would say that they knew they were addicted, and that they wanted help getting off the pills. They would say they had tried to quit cold turkey but that it had been too hard. This group would be successful in completing the taper, and would report that they were thrilled to be off the pills for good.
I have written these last three paragraphs to illustrate that a person’s motivation to get off of pain medication is critically important to whether they will be successful in getting off the pills. When someone has sufficient motivation, they will most likely be successful.
Psychologists must work to meet their clients where they are in their motivation. If they are still contemplating taking action, and a psychologist tries to get them to plan how to get off the pills, or tries to move them directly into action, then this mismatch in readiness will likely lead to failure.
Sometimes people are not able to get off of pain pills because they are using the pills to self-medicate. They may not have other coping skills in place to help them manage emotional pain. When this is the case, psychologists that help their clients to first develop alternative coping skills will likely have more success helping their clients to get off of pain pills over the longer-term.
Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta
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