Addictions are devastating and taking the lives of people afflicted with these diseases.   Families are destroyed and patients find themselves crossing lines they never thought they could or would.  Currently, opioid addictions are front and center in the public discource.  It is likely the growing public attention is an unfortunate consequence of escalating heroin addiction and resulting deaths (as well as deaths related to use of the opioid pain medication Fentanyl).  Often opioid (narcotic) pain medications are the gateway into addiction to another opioid, heroin.  In today's illicit drug market, heroin is a cheaper and more potent alternative to narcotic pain medications.  Unfortunately, the potency of heroin is contributing to the alarming rise in the death rate of persons addicted to opioids.  Our body is extremely sensitive to its effects.  With pain meds (Lortab, Norco, Percocet, hydrocodone, oxycodone, etc.) our bodies can tolerate mistakes in dosing much better than they can with heroin.  Small mistakes in dosage that result in a slightly higher dose than the patient usually takes can create catastrophic, lethal overdoses.  Lethal overdoses are very common in individuals who have taken a break from heroin use and upon relapse start at close to or the same dose they were using upon quitting.  

 

The rate of death from substance use disorders  -- particularly with the use of heroin -- is alarming.  Almost every person who uses heroin can name several acquaintances who have died of overdose.  This is true for even adolescents who use heroin (and there are many more than we wish to believe -- particularly in more affluent communities).    However, the addiction is so powerful that otherwise strong, reasonable, good people cannot find a way to stop.  To make matters worse, if a person tries to quit on his/her own, too large of a decrease in dose can create terrible withdrawal symptoms.  Withdrawal is the body's response to its inability to replace the loss of constant opioid concentrations in the blood.  Patients who have experienced opioid withdrawal describe a severe and horrible physical experience that is so overwhelming that desperation for relief drives the person to withdrawal.   Described more specifically, opioid withdrawal, even when the daily dosage was small, lasts at a continuous and unrelenting pace for at least 3-4 days.  During this time, the patient has severe stomach cramps and diarrhea, diffuse and severe muscle aches similar to a very bad case of influenza (the "flu"), sweats, chills, goose bumps, nausea, vomiting, sleepless days and nights, depressed and anxious mood, complete exhaustion, and profound desperation to feel better.   I have witnessed opioid withdrawal hundreds of times -- it brings down the big and small, the strong and weak, and old and the young, the high-powered executive and the homeless person.  Often, people who have maintained their addiction over an extended period of time will say it is the avoidance of withdrawal, not a pleasurable response, that drives continued use.  The euphoria and pleasure experienced during early heroin use becomes elusive and  eventually vanishes -- regardless of the dose used.    

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Another problem is that we develop tolerance to the desired analgesic (pain-killing) effect of pain medication.   If taken over long periods of time, opioids will lose their pain-killing effectiveness unless the dosage is increased.   A physician with good intentions may continue to prescribe higher and more frequent dosages because he/she does not want the patient to be in pain.  Sometimes, the patient will become so reliant on the medication that they become certain they cannot function without it.  Self-destructive behaviors may appear.    This may include buying or stealing others' medication because the patient has finished the prescription well before the refill date.  On a more subtle level, the patient's moment-to-moment functioning may become impaired as the dose increases -- even once the patient develops tolerance to the higher dose. .  An outside observer may notice symptoms such as slurred speech, an unsteady gait, slowed thinking, and a powerful lack of motivation and energy.  These problems are rarely apparent to the patient because they unfold gradually.    Life destroying opioid addiction can be a slow, insidious process -- particularly in patients who suffer from chronic pain.     Unfortunately, the patient may feel reassured by an assumption that their doctor would stop prescribing the medicines were there truly a problem.