Fortunately, I have a prescription for hydrocodone. I took one of those pills, and it brought the pain under control. Now I can do my work, and get on with my day. When I tell you that I thank God for this medication, I mean it literally. It makes my work possible when I’m in pain. I’m really fortunate in that this medication does not make me feel high. It stops the pain, but that’s it.
And that’s precisely how people get addicted to opioids. They keep expecting “a high” – hallucinations, elation, feeling good – which never happens with this sort of drug. So they decide they are not the addictable kind and keep ingesting the poison. Their brains start manufacturing pain – there’s a medical term for this that I don’t remember right now – to keep getting the drug. The pain becomes “chronic” because it’s necessary to get a fresh dose.
People need to get massively educated about opioids. Or they will keep getting addicted. It is absolutely mind-boggling that even educated folks with every resource at their disposal believe they aren’t addicted because there is no recognizable “high” when the very nature of their pain screams addiction.
There is zero difference between this and alcoholics who say “I just drink socially, I can quit any time, I’m not addicted.”
Clarissa's Blog 
I think the word is psychosomatic?
https://polldaddy.com/js/rating/rating.js
LikeLike
Ah! That previous comment was me. I made a typo on my email address.
LikeLike
It’s definitely psychosomatic but there is a specific term for this phenomenon. It will come to me.
LikeLike
I think the term is “hyperalgesia.”
LikeLike
That’s it, thank you.
LikeLike
Hyperalgesia is a broad term that just means extra sensitivity to pain in general. The term can covers what you mean (the brain can definitely change in ways that lead to hyperalgesia) but it can also mean more trivial things like the temporary extra sensitivity to heat that occurs if you rub capsaicin (from hot peppers) onto your skin. (I did this once as part of an experiment: warm shower water felt burning hot on that part of my skin for several days.)
LikeLike
Well, more specifically, it’s called opioid-induced hyperalgesia (OIH) but I was trying to not be too pedantic. But sometimes being a pedant is what is required.
This is the best paper I’ve read about it: https://www.ncbi.nlm.nih.gov/pubmed/21412369
(If you can’t access the paper, I can send it to anyone who can’t access.)
LikeLike
Thanks for clarifying and posting the link, that’s a really great review. Apologies for butting in: I did my PhD on pain research and I couldn’t help myself (I tried but failed to not comment 😉 ). Pain is such an interesting and multifaceted phenomena. And when something goes wrong with the underlying systems, it can be really difficult to fix.
LikeLike
And even if they get the same scheduled dosage, eventually that will no longer be effective. They will require higher and higher doses, just to feel “normal”
LikeLike
Doctors will say “it’s not an addiction if you need it” … if you aren’t taking it to get high / check out. It’s a moral proposition, not a scientific one: if your motivation is to be functional, then you’re not an [irresponsible] “addict”
LikeLike
Which is a true statement! Medical reality check:
There are legitimate cases of chronic pain syndrome for which maintenance analgesic medication at the opioid level is required. Try telling somebody slowly dying of bone cancer that their brain is manufacturing the pain, so they should just suck it up and take it.
To contemptuously dismiss all such patients as “addicts” is nonsense.
LikeLiked by 1 person
If somebody is dying, addiction is irrelevant, and opioids make sense. Historically, opioids were prescribed precisely when the patient wasn’t going to live long, so it didn’t matter anyways. In the 1990s erroneous information was spread that opioids are not addictive and they started they prescribed for all sorts of minor complaints. The result is the opioid epidemic we are witnessing.
LikeLike
Of course, if the patient who is dying of cancer had their opioid supply cut off after using them regularly, they would experience withdrawal symptoms. Because they are addicted to opioids. Addiction is not a “moral failing” that magically doesn’t happen to people who use opioids for reasons that we personally understand. Addiction is a psychological and physical response to long term use of any addictive substance.
But even while there is more public awareness of the issue, it’s still not being communicated clearly in many states. For example, when I had some dental work done, and the dentist wanted to send me home with hydrocodone and I resisted, he gave me a prescription for an anti-inflammatory, but warned that it can be extremely hard in the stomach lining and can cause internal bleeding if used improperly. When I filled the prescription I got the same lecture from the pharmacist, along with a pamphlet of instructions stating the same. When my dog was prescribed steroids for bronchitis, I was given a list of symptoms to watch out for and a strict tapering schedule. When I had my gallbladder removed, and decided to take the hydrocodone instead of anything that would aggravate my digestive system further, I was given enough pills for a month and told to take them every 4-6 hours for the pain – I was back in work the next week.
LikeLike
That’s a great comment. Thank you!
It’s true that there is this very infantile approach where people try to convince themselves that THEY can’t get addicted because they are such special cookies.
https://polldaddy.com/js/rating/rating.js
LikeLike
Most of the people who are addicted never set out with the plan to become addicts. They had no idea how addictive this shit is. And it’s seriously overprescribed, even today. My gallbladder surgery was less than two months ago. I was also given a month-long supply of hydrocodone even though I said the post-op pain was very tolerable and I have a high-tolerance for pain anyway.
LikeLike
Yes, I’m not unsympathetic, even for the non-dying. It just seems to me that when you can’t really tell why you’re on something — because you still have pain, or because the withdrawal symptoms are so bad, you fail to get off it — it’s not a good situation
LikeLike
They will say whatever they need because doctors are bribed by the companies making these drugs to push them on more and more patients. There is a new book that just came out on how this works that I highly recommend.
LikeLike
There’s that but I think also they actually have bought the propaganda themselves. I do believe in medication, even psychiatric medication, in the right circumstances but I have noticed quite a few doctors have this dope-’em-up mentality that they really think is right. It’s the flip side of the don’t-take-them-seriously mentality. To have a middle ground you really have to be able to treat patients as individuals and in US that is not always possible / allowed, especially not with all these HMO administrators weighing in on every medical decision
LikeLike
I see a lot of medical professionals taking very hard opposite stances on opioids in ways that I doubt are helpful.
You either see doctors prescribing (too many) opioids, and then immediately cutting them off when a patient displays “drug-seeking behavior” (an entirely predictable response to long-term opioid usage), and the immediate cutoff causes withdrawal, which ultimately reinforces the addiction ~or~ you see doctors who believe in the “harm reduction” model – they don’t believe opioid addiction is a moral failing, they do believe their patients have a right to a pain-free life, but they seem to think that opioid dependence can be a stable and healthy way to live, when in reality, it is only going to cause increased pain and dependence – where eventually they’re prescribing enough opioids to disable an elephant just for their patient to feel “normal”
There was actually a really good Ted Talk from the point of view of a patient caught up in addiction to prescribed medications trying to get help for it.
Sorry if the link is ugly/broken
LikeLike
So many conceptual short-circuits here. The problem of what to do if the pain is real & ongoing seems difficult to solve
LikeLike
There were really great pain clinics in this country that studied pain, especially chronic pain and developed all kinds of non-medication treatments. They were all closed at the very beginning of the opioid craze. The statistics are dire. The rate of the closures corresponds very precisely to the rise of opioid addiction.
The very goal of the opioid propaganda (that these companies were very clear about) was to combine people that there was nothing you could do about chronic and severe pain except opioids. But this is a very new idea. Even 30 years ago, everybody knew that there were many other ways. It’s totally 1984, like people’s minds are erased.
LikeLiked by 1 person
It seems parallel to the antidepressants. There was suddenly this new short therapy and these new antidepressants, and suddenly everyone was to be considered depressed and to need the new antidepressants.
LikeLike
Exactly. It’s pure propaganda, and it works to attract crowds of customers who are hooked forever. And the therapies that could actually cure them for good die out.
LikeLike
Also, patients are so steeped in neoliberal mentality that they are completely alienated from their bodies and see their bodies as tools of production. So they demand that a correct button be pressed so they can go back to work and everything immediately. I saw this in myself after my surgery last month. Thank God, I’m not into pills but the mentality was definitely there. It’s scary.
LikeLike