Opioid Risk Factors. How Pain Can Lead to Addiction. Assess Your Risks!

Does America have a drug problem or is it more of a pain problem that we suffer through?

OK, well obviously pain suppression needs alone can’t explain the scale of use, but on the other hand, you can’t look at our opioid problem and ignore the fact that many people who abuse these drugs have legitimate pain-relief needs. So what do you do when the medicine you need might do you more harm than good?

Well, for starters, you get informed and you learn how to reduce your risks, so read on to:

1. Learn how and why pain increases addiction risks.
2. Determine your addiction susceptibility - by comparing your current situation against 19 addiction indicators.
3. Learn how to take opioids safely to reduce your risks of addiction.
   

To gain an understanding of how pain and drug problems intersect, consider the following statistics that illustrate the situation.

Pain and Opioid Use Statistics

Statistics from SAMHSA’s Tip 54: Managing Chronic Pain.¹

• As many as 32% of people with chronic pain also have addictive disorders.
• 36% of Americans report experiencing disabling pain within the last 12 months and 56% of adults over the age of 20 report having experienced chronic pain at some point in life (pain that endured for 3 months or more).
• For those over the age of 65, 57% report having experienced pain that lasted for more than a year.
• Between 29% and 60% of people with opioid addiction report chronic pain.

So we can see that pain is all too common and we find a strong association between pain and addiction – but why is this? Beyond the obvious (opioids), what is it about pain that causes such an increased addiction risk?

How Pain Increases Addiction Risk

At one fundamental level, it’s easy to see how pain increases addiction risk:

1. Pain creates a need for strong analgesia.
   
2. You take opioids to control pain.
   
3. Opioids feel very good so you start taking more than you should.
4. Eventually the regular over-stimulation of the brain’s reward and motivation circuits leads to dysfunction and persistent addiction.

Humans are hard-wired to seek pleasure…it’s in our DNA, and it’s why experimenting with addictive drugs can lead to lasting brain changes and a loss of control over use (addiction). Many people who'd never try a drug like heroin will take OxyContin that’s prescribed for pain – and this exposure, easy availability and social acceptance puts a much wider audience at risk of opioid addiction.

But this doesn’t tell the whole story

Chasing pleasure while controlling pain is certainly one pathway to addiction, but if you dig a little deeper you find many other factors that also increase addiction risks, such as:

1. Pain can lead to insomnia, lack of physical activity, lack of engagement with life, reduced social engagement and excessive stress.
2. Life changes like sleeplessness, increased stress, inactivity and social seclusion increase the risks of other mental health conditions, like depression, anxiety or suicidal thinking.
3. Opioids are then used to self-medicate mental health symptoms.
   

If pain and worry keep you tossing in bed at night – night after night – who wouldn’t consider taking a little medication boost to get a good night’s sleep? And once you did it once, you could easily see how that could become a habitual thing…

Should You Take Opioids?

• Should you take opioids? Are you at elevated risk of addiction?
  
• And if you decide to take opioids, should you consider extra precautionary measures (such as limiting your access)?

Well, you shouldn’t make medical decisions without consulting with a doctor – after all, pain management is a complex and not always intuitive business, but for research purposes, you can gain a better sense of your risk profile by considering how many of the following risk factors match your situation.

Opioid Risk Factors

Compare yourself to the addiction risk indicators listed below. The more indicators that match your situation, the greater your risk of addiction.

While many of the following risk factors may seem unrelated to your likelihood of drug misuse, they are research-proven indicators and since they aren’t intuitive, they may give you an alternate look at your risk situation.

• You smoke a cigarette within an hour of waking up.
• You have close friends that have or had drug or alcohol problems.
• One or more family members has or had a drug or alcohol problem.
• You have been treated more than once in the past for a substance abuse problem.
• You have frequent mood swings.
• You often take medication for reasons other than what it was prescribed for.
• Other people sometimes say you have an alcohol or drug problem.
• In the last 5 years, you have used illegal drugs a number of times.
• You are often worried about being left all alone.
• You worry that people close to you will judge you if you take opioids.
• You have a mental illness.
• You often feel like things are overwhelming and that you can’t handle everything.
• You have been arrested or had legal problems more than once in your life.
• You have attended more than a few AA or NA meetings in your lifetime.
• You have been sexually abused more than once.
• You have been in an argument that got out of control and led to one or more people getting hurt on more than one occasion.
• Other people often block you from the success you deserve in life.
• Other people sometimes tell you that you have a bad temper.
• You often feel impatient with your doctor(s).

If the risks of opioids exceed the likely benefits – and this includes most people deemed at high risk to abuse opioids prescribed for chronic pain² - you may want to at least start with trying alternative pain management techniques, such as:³

• Lower risk medications.
• Physical therapy or acupuncture.
• Heat or cold treatment (ice packs or hot packs) - Cold therapy reduces the inflammation and pain of acute injury and hot therapy eases stiff or sore muscles and joint pain.
• Massage or vibration treatment – Muscle manipulation with hands, rollers or vibration devices can ease muscle pain.
• The use of braces or elastic supports (for example a back or knee brace)  – Relieves pressure and pain on afflicted areas.
• Trans Cutaneous Electrical Nerve Stimulation (TENS) – Small electrical pulses to affected nerve regions can block pain signals.
• Chiropractic Therapy.
• Meditation – Can increase calm and coping skills.

Reducing the Risks

If non opioid forms of analgesia don’t provide sufficient pain relief, or, if after examining the situation you and your doctor feel that the benefits still outweigh the dangers, you can reduce your risks by implementing precautionary measures, right from the start.

Examples of safety measures to prevent misuse include:⁴

• Getting small prescriptions to refill frequently, rather than larger more occasional prescriptions (in extreme cases, you can even travel to a pharmacy each day to take a single daily dose under supervision).
• Signing a treatment agreement and knowing that by breaking your end of the agreement you forfeit your right to continuing opioid therapy.
• Agreeing to random urine screening.
• Agreeing to frequent monitoring and frequent visits (with pill counts).
• Agreeing to submit to pill counts – bringing all your opioids in to each office visit. By submitting to frequent pill counts you are less likely to over-use or binge use.