The Role of Pain Management in Treating Opioid Addiction

Autumn Hahn, LMHC, CHt 2018

The profile of “an addict” is changing. 83 years ago, when Alcoholics Anonymous (AA) was founded, an alcoholic was male, between 30 and 60 years old, with a job and a family, who had been a functional drinker for many years before tolerance built up and problems around drinking began. In the 1980s cocaine use was typical at business meetings and only a handful of people were seen to use so heavily that it became a problem. In the 1990s, we had public service announcements about “your brain on drugs” and viewed an addict as being a person on skid row, who had lost everything but kept using. In 2018, we know that addicts and alcoholics can be teenagers, grandparents, homemakers, homeless persons, the traditionally employed, any truly anyone. There has been a rise in use for teens and women, and overdose rates are multiplying.

How does someone become addicted to opiates? Opiates are a class of prescription medication that is given after surgery or for severe pain. They were initially designed to be used for a short time, but pain can linger, and prescriptions can be extended. A problem begins when the dosage prescribed does not feel like enough to lower the pain response in the person taking the medication. That person then may take an extra pill to feel better. Tolerance starts to build up, and it takes more of the substance to have the same pain-killing effect. Eventually, 1 extra pill becomes 2 and more. This makes the prescription run out before refill time and the person, now addicted, must find ways to get more of the same substance, or a similar substance. They may initially substitute one pain medication for another, ask friends if they have leftover medications, take medications from someone who “won’t notice they are missing” such as an elderly person or anyone who has prescriptions they have access to, or go to various doctors with complaints of pain (also known as “doctor shopping”) for additional prescriptions. Some people have gone so far as to cause injuries to themselves to be prescribed additional medications for obvious acute pain. No one is exempt from tolerance, a natural occurrence in the body.

Once addicted, getting a constant, steady supply of medication can be difficult. Doctors and pharmacies have plans in place to monitor how much of which medications a patient is prescribed, and the systems are designed to notify the responsible parties when it seems there is too much medication going to a particular patient. A person may then be suddenly cut off and left to their own devices to find more. This is often when a person will buy pills from others, or turn to heroin, which is sometimes cheaper than opiates. According to the American Society of Addiction Medicine (ASAM, Opioid Facts and Figures, 2016), 4 out of 5 heroin users began using prescription pain killers. Our typical heroin addict is no longer a grubby man in his 40s or 50s, but a soccer mom, or a veteran who served in Afghanistan.

Opioid addiction is severe and often fatal. 10-18% of all substance users in 2016 were using opioids or heroin. Opiates are lethal. In 2015, opioid use killed 33,091 people in the US alone: 20, 101 people using prescription pain killers, and another 12,990 people using heroin. This shows a 4x increase since 1999. (ASAM 2016) A dramatic rise in deaths is being seen over the past 3 years based on the rise of prescription Fentanyl, a strong pain killer that is being sold as, or mixed with, other opiates, causing accidental overdose.

Removal of the substance does not constitute treatment. Detoxifying the body of opiates is a painful process as all the nerves that have received pain blocking will become unblocked. Clients sweat and have chills, may vomit, curl up, and generally feel very sick. Detoxifying at a treatment center like Evolutions Treatment Center in Miami, Florida is recommended because we are equipped with 24-hour nursing and can administer medications that alleviate many of the symptoms of withdrawal. Concurrently, clients will have the ability to attend group and individual therapy sessions, when they are well enough to attend, to learn about the process of addiction and recovery, and how to keep their life from becoming what it once was.

We understand the need for pain management. Pain is not in the head, but in the body. Pain is real and can be severe. At the time the person was prescribed pain killers, there was a need for significant pain to be blocked from the nerves. Removal of the pain killers (including heroin) does not remove the pain. We teach clients how to change their body’s response to pain so that they physical sensations are muted or turned off completely, within their control, without the use of any substances. Clients are taught a 4-point process of self-hypnosis that blocks the pain from where it is processed in the mind so that it cannot travel back to the nerves. These tools assist the client with retaining sobriety after having left treatment. We understand that pain may be chronic and ever-present in some people, or may be sporadic in others, but knowing how to control it with the mind, without adding any chemicals to the interaction, is a long-term solution. This process is included in the cost of treatment. We know that moderation is not an option once addiction has been identified, so going back to one’s prescriptions is unreasonable, and we want to set you up for long-term success.

For those seeking alcohol or substance abuse disorder treatment for the first time, or past attempts at recovery have proven unsuccessful; or if you are seeking licensed PHP, IOP, or OP Mental Health programs:  please call 866-771-7091.