Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

From painkillers to heroin: A new study

Surprise, surprise. A new study by some researchers at the State University of New York at Buffalo (UB) has shown that increasing numbers of heroin users became addicted after being given legal painkillers for pain.

The study appears in June’s issue of Journal of Addiction Medicine.

The researchers found that many pain patients first got hooked by using legal prescription drugs, and then they progressed to buying illegal opioids off the street. “Later, they purchased heroin, which they would come to prefer,” the study states, “because it was less expensive and more effective than prescription drugs.”

More effective, you ask?

OxyContin 80mg

OxyContin 80mg tablets

If you look at the study results: more than 90 percent of the participants had purchased street-drugs at some point, and not just tidy little pills—almost two-thirds preferred heroin to anything else “and more than half had used drugs intravenously.” Any drug used intravenously is going to be “more effective.”

It also depends on the “effect” you’re looking for. But in terms of either pain- or mood-control, IV is the most bioavailable route (meaning there’s less drug lost to metabolism—it all goes into the bloodstream), and it’s going to give the strongest “effect.”

As to why they’d choose heroin over pills—I’ve never shot up or bought anything off the street, but I understand from friends who have that it’s more difficult to shoot pills, especially pills with non-opioid agents such as Tylenol and especially fillers that clog up the works.

Another troubling fact reported in this study that all the other digests have missed: 74 percent of these pain patients said the physicians who prescribed them opioid painkillers for extended periods never asked them about any personal or family history of addiction before giving them the drugs.

One of the authors, Richard D. Blondell, M.D., a family medicine doc at UB, made a comment in the UB press release that kind of stuck under my skin:

I tell patients that addiction can be an unintended side-effect that occurs occasionally with the use of these medications. . . . Doctors need to be able to help them if this occurs, so doctors will need to monitor the use of these medications closely.

Those are my bolds. I wanted to know what he meant by addiction being “an unintended side-effect.” I mean, when I think of a “side-effect,” I think of those annoying flies-in-the-ointment that disappear when you stop treatment—nausea, insomnia, even sexual dysfunction. But addiction?—it’s permanent, man.

If you took a pill that caused permanent erectile dysfunction, would you call that a “side-effect”? … And ED isn’t even life-threatening. (Although I guess some folks might feel it that way…)

So I asked the good doctor: This seems a rather diminutive way of looking at addiction. Is this really the way you conceive of it? Many physicians do not understand the nature of addiction, they’re afraid of it, and this is why they miss the signs of it in their offices. … I also wanted to know how he proposed to “help” patients with chronic pain who develop addiction, since the solution for many a physician is to kick the addicted patient out of the practice.

I got a reply a few days later, via his PR flak:

Here’s the sensitive issue: many patients are afraid that physicians will shy away from treating “legitimate” pain if doctors are too worried about the risk for addiction. Many patients take these medications long-term without problems. We don’t want to stop that. On the other hand, some patients do develop an addiction which neither the doctor nor the patient ever intended to happen. The use of the word “unintended” is meant to be a non-judgmental term for this. It means that there’s no blame for the patient or the doctor; sometimes it just happens. When it does occur the doctor must recognize it and manage it with care and compassion. Blaming the patient, blaming the doctor, or “kicking the patient out” are not answers that accomplish anything constructive.

He didn’t quite get it.  He was focusing on the word “unintended.” I wanted him to talk about the word “side-effect.”

But it’s great that he’s getting physicians to talk about being non-judgmental and compassionate, and helping patients manage addiction. Blondell has another paper out in this month’s Journal of Addiction Medicine about how chronic pain patients who are addicted do better on steady doses of buprenorphine (Suboxone) rather than tapering doses to become opioid-free. It seems this guy’s orientation is to help some people with chronic non-cancer pain and addiction help manage their pain with some sort of opioids…

Looking forward to seeing how he thinks he can help pain patients with addiction “monitor” their use of painkillers so that they don’t abuse them. That’s one of life’s $64,000 questions.

And since Reckitt Benckiser has just been given the FDA go-ahead for their fancy new Suboxone film, it also seems like it’s time for me to get on the Suboxone story… a whole nother can of worms. Anybody out there with experience with Suboxone??

8 Comments

  1. Interesting post. I can see how the escalation could occur, especially for those who are genetically predisposed to being an addict.

  2. Wow… that is my story…. a prescription for Dilaudid after a back injury …. me thinking that my doc didn’t understand that my injury/pain was getting worse…. buying pills on the streets and eventually heroin….

    2 years in the rooms and this is the first time I heard MY story told….

  3. guinevere

    September 17, 2010 at 11:10 am

    Robin… An enormous number of folks are in our situation of having become addicted after seeking treatment for pain—you’re not alone. Great that you’re here… please stick around. –G

  4. my story 2 i went to the doc to get on suboxone last used heroin 12 hours earlier. he gave me 8 mg for my first dose. 30 min later i was so sick in withdrawal i wanted to die. so now im using because the subs made me ill

  5. guinevere

    October 1, 2010 at 10:39 pm

    Scott… saw you over at ODR, and left a response there…

    http://www.heroin-detox.com/detoxing-buprenorphine-subutex-suboxone/18212-sub-inductions.html#post332236

    Please do not switch between heroin and suboxone. I understand your disappointment—the sub doc probably told you you’d feel better, and instead you felt worse… Many physicians who prescribe suboxone do not understand the characteristics of the drug, and they start out way too high. I think you were dosed too high, is just my suspicion.

    I’ll be writing more about suboxone on the blog… You can also find out a great deal about it on ODR’s suboxone forum. Stick around and don’t give up. –G

  6. After 20+ years of pain pill addiction, I discovered Suboxone, which I believe saved my life. I have been on this med for almost 3 yrs and currently have no plans to discontinue this, bacause besides getting the “monkey off my back” for the 1st time in my life, Suboxone also helps with my chronic pain.

  7. How many death’s have occured from comming off of high doseage pain meds? Also, how will stress, depression, and anxiety affect the person trying to come off of the pain meds?

  8. guinevere

    February 25, 2011 at 8:14 pm

    @Lex… Thanks for your questions. Detoxing is certainly stressful and anxious. However unless clinical depression existed before addiction, usually the depression felt by a person in detox is transitory and dissipates with good self-care: nutrition, vigorous exercise, strategizing about pain control (if chronic pain exists), a program of recovery, etc.

    As for how many deaths have occurred from detoxing off high-dose painkillers?—opioid detox is not a life-threatening process (unlike, in some cases, benzo and alcohol detox). Opioid detox doesn’t kill people. The thing kills is untreated addiction. … Are you maybe suggesting that folks with addiction should stay on painkillers, just to avoid the stress of detox? Maybe I’m not understanding you. 🙂

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