One way to avoid getting hooked on prescription painkillers
Limiting use of opiods to just a few days can crub risk of addiction, study says
(Consumer Reports)--Taking prescription painkillers such as Percocet or Vicodin for more than a few days sharply increases your risk of getting hooked on the drugs, according to a new study just out from the Centers for Disease Control and Prevention.
Researchers at the University of Arkansas analyzed the health records of about 1.3 million adults who were prescribed opioids between 2006 and 2015.
Results showed that only about one in 20 people who took prescription painkillers for just three days were still on the drugs a year later.
"But after that three-day mark, it was surprising how quickly the risk of becoming a chronic opioid user started to rise," says lead author Bradley Martin, Pharm.D., Ph.D., head of the division of pharmaceutical evaluation and policy at the University of Arkansas.
About 15 percent of people who take prescription painkillers for a week are still taking them a year later, according to the study findings. At two weeks, that number jumps to more than 25 percent. And one out of three people who take these meds for a month wind up becoming long-term users.
Last year, the CDC released guidelines advising doctors not to prescribe more than three days' worth of opioids for most patients. That's because there's little evidence that they help with anything other than short-term pain. Plus they carry serious risks of addiction, accidental overdose, and even death—especially when taken at higher doses or used longer term.
But the severity of those risks have only recently come to light. And this new study suggests that doctors are still routinely prescribing seven, 14, or even 30 days' worth of the drugs.
“We found that every day you continue to take opioids decreases the odds that you will stop,” Martin says. “I don’t think when clinicians or patients are considering using opioids for a week or two—or even a month—they realize how high the risk is of getting stuck on the drugs.”
But after day three, “it’s surprising how rapidly the risk of becoming a chronic opioid user start to rise,” says Martin.But after day three, “it’s surprising how rapidly the risk of becoming a chronic opioid user start to rise,” says Martin.
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How People Get Hooked
Just like illegal versions of opioids such as heroin, prescription painkillers can cause changes in the brain that lead to addiction, Martin says.
Symptoms of addiction, according to the American Psychiatric Association, include craving the drug between doses; taking more than is prescribed; continuing to take the drug even though it is adversely affecting your health, job, or personal life; and wanting to cut back or stop but not being able to.
But Martin also points out that even people who aren't "addicted" to prescription painkillers can become physically dependent on them. This means that people who take the medication exactly as prescribed can still suffer withdrawal symptoms—including worsened pain, severe stomach upset, muscle aches, flulike symptoms, anxiety, depression, and sleeplessness—when they try to stop.
Although the University of Arkansas study didn’t look at whether people who stayed on the drugs were actually addicted to them, Martin says that “we do know from other research that chronic opioid use is associated with a higher rate of addiction."
Indeed, up to one out of four people who take opioids for longer than three months show signs of having become addicted to the drugs, according to the CDC. And almost everyone who takes prescription painkillers for more than two weeks becomes physically dependent on the drugs.
To make matters worse, the pain-relieving effect tends to diminish over time, Martin says. “For some people, opioids even intensify their perception of pain,” he says.
That can leave people feeling trapped, says Orly Avitzur, M.D., Consumer Reports’ medical director. “Patients taking opioids long term may not be getting significant pain relief but may stay on them because they feel miserable if they try to stop,” she says.
Safer Use of Prescription Painkillers
According to Avitzur, this new research reinforces recent CDC advice calling for doctors to prescribe the smallest dose of opioids for the shortest time necessary to treat pain.
“After surgery or an injury most people can transition to safer over-the-counter painkillers within three days,” she says. “Few people need powerful prescription painkillers for more than a week.”
For longer-term pain, the CDC recommends making nondrug measures such as exercise, cognitive behavior therapy, and rehabilitation programs the centerpiece of your treatment program.
Beyond that, if you need medication for your pain, opioids are often not the best choice, Avitzur says.
“For some types of pain, such as fibromyalgia, migraines, or nerve pain, other prescription medications may work just as well as or better than opioids and are clearly safer,” she says. “And many find that over-the-counter pain relievers such as acetaminophen (Tylenol and generic), ibuprofen (Advil and generic), or naproxen (Aleve and generic) provide sufficient relief, especially when combined with nondrug approaches.”
If you have been taking opioids for more than a couple of weeks and want to quit, Avitzur advises against going cold turkey, which could trigger withdrawal. Instead, see our advice for how to work with your doctor to gradually wean yourself off these narcotic pain drugs.
Finally, if you or someone in your household regularly takes prescription painkillers, talk to your doctor about getting a separate drug, naloxone, that could save someone’s life in the case of an accidental overdose. The rescue drug comes in packaged as a nasal spray or auto-injector; either is easy for anyone to use in an emergency. And the cost is typically covered by health insurance for anyone who takes an opioid.
Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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