Understanding Opioid Painkiller Dependence

What is opioid painkiller dependence?

Opioid painkiller dependence can affect anyone and occurs when your body starts to rely on a certain type of painkiller you may have been taking. These painkillers belong to a group of medicines called opioids.

If you feel a strong desire to take your pain medication repeatedly, even after the pain passes, or if you find you have been using higher doses to feel relief, then these are signs you are dependent on it. Opioid painkiller dependence can lead to loss of control over how much to take and the inability to stop, even if it hurts people’s health, their job or their family and friends. When the desire to take opioid painkillers becomes so compulsive that it results in these kind of harmful consequences, it can be considered an opioid addiction.

Since 1992 there has been a 15x increase in PBS dispensing of opioid painkillers(1)

What are opioids and is my medicine an opioid?

Opioids are psychoactive chemicals that relieve pain. The pain-relieving effects of opioids are due to decreased perception of pain, decreased reaction to pain, as well as increased pain tolerance. Opioids can also create feelings of euphoria, because they affect parts of the brain that make us feel good. As time goes on, opioid medications can alter the brain’s chemistry so people begin to feel like they need more and more of the drug just to get through the day. This leads to taking higher doses and an increasing dependence.

As they contain narcotic and psychotropic (affecting the mental state) substances, opioids are among the medications controlled by International, European and national regulations. This is why most opioids are prescribed by a doctor.

Some common opioid painkillers can include codeine, tramadol, oxycodone, fentanyl and morphine. Millions of prescriptions are written every year for opioid painkillers in Australia, so as you can imagine, there are many people like you at risk of becoming dependent on them.

AS time goes on, people feel like they need more and more just to get through the day

Who becomes dependent on opioid painkillers?

Anyone who has suffered from chronic pain and has been given a prescription for opioid painkillers is at risk of dependence. Men, women, business people, tradies, young and old – all are susceptible, so you are not alone.2

Why do some people become dependent and not others?3

No one expects to become dependent, so why do some people become dependent on opioids while others don’t? The answer is some people are just more susceptible to becoming dependent than others, for reasons including:

This means having the tendency to become opioid-dependent in your genetic makeup. So it’s inherited from a family member.

People can absorb medications or other drugs differently because of their individual body chemistry.

A person’s mental health or emotional trauma can contribute to them using a particular drug or medicine.

The way someone lives their life can play a part in dependence, for example, people can be influenced by those around them to abuse substances, increasing their risk of dependence.

How does dependence start?

Treatment4
Opioids block pain messages from reaching the brain and that’s why they relieve pain.
Overuse3
When opioids block pain messages to the brain, a chemical called dopamine is released, which also gives the effect of relief, but in addition gives feelings of pleasure or euphoria. These heightened feelings of pleasure lead to repeated use.
Dependence3
When the effects of the opioid painkiller begin to wear off, pain messages to the brain are no longer blocked and any feelings of relief or pleasure begin to fade, triggering a desire for those same feelings to return.

Recognising the signs and symptoms of opioid painkiller dependence

Opioid painkiller dependence can affect people differently. The effects of opioids also change the longer you use them, so you may notice the symptoms becoming more extreme as time goes on.

It’s important to remember that opioid painkiller dependence is a condition and not something that deserves blame – either blaming yourself or someone close to you who may be dependent. It’s no one’s fault.

The following is a list of some general warning signs and symptoms that could indicate a risk of opioid painkiller dependence. It’s not a complete list, so please talk to your doctor if you feel you are experiencing any of these symptoms or are worried about your risk of opioid painkiller dependence.

Signs and symptoms of opioid painkiller dependence5

  • Using more of the opioid to get the same effect
  • Unable to stop or cut down on the use of opioids
  • Often absent from work or school
  • Losing interest in regular activities
  • Losing friendships or marital problems
  • Having sleep problems
  • Getting angry or irritable often
  • Having sexual problems
  • Having an upset digestion (like constipation)

Getting help

As doctors have a better understanding of dependence as a long-term disease, they have more options to help people manage their condition. Talk to your regular doctor who can help you with your painkiller dependence.

Drug dependence screening test

Take this test to find out if you are at risk of opioid painkiller dependence.

Answer as honestly and accurately as you can. Print your results and a Doctor Discussion Guide and share it with your doctor – it may help you decide on a treatment option that works best for you. Your results will not be saved.

Only a qualified doctor can diagnose opioid dependence. Doctors may use a screening test like the Drug Abuse Screening Test (DAST) to assess an individual’s risk for developing opioid painkiller dependence. This test does not take the place of a medical consultation. If you have any concerns about your health, talk to your doctor. Do not disregard or delay seeking medical advice because of the results of this test. Use your results and recommendations, as well as the sample discussion guide, to start the conversation with your doctor on how to effectively manage dependence. This screening test is strictly confidential. Your personal information will not be collected, saved, or shared with anyone under any circumstances. Review our complete Privacy Policy. Start test
1 Have you used opioid medications other than those needed for medical reasons?
2 Do you misuse more than one medication at a time?
3 Are you always able to stop using drugs?
4 Have you ever had blackouts or flashbacks as a result of opioid medication use?
5 Do you ever feel bad or guilty about your opioid use?
6 Does your spouse (or your parents) ever complain about your involvement with opioids?
7 Have you neglected your family because of your use of opioids?
8 Have you engaged in illegal activities in order to obtain opioids?
9 Have you experienced withdrawal symptoms (felt sick) when you stopped taking opioids?
10 Have you had medical problems as a result of your opioid use (such as memory loss, hepatitis, convulsions, bleeding)?

Your results

Based on the answers provided, you scored:
  • 0-2
    If you are concerned about opioid dependence you may wish to consider talking to your doctor.

  • 3-5
    It is recommended that you talk with a doctor about a potential risk for drug misuse or opioid dependence & treatment options.

  • 6-10
    It is highly recommended that you talk with a doctor about further assessment for drug misuse or opioid dependence.

The sample discussion guide can assist you in starting a conversation with your doctor or other healthcare provider on how to manage your dependence. It includes common questions that you may wish to discuss during your first visit. Remember to print your results and Doctor Discussion Guide.

Print your results Print Doctor Discussion Guide

Source: This test is adapted from the Drug Abuse Screening Test (DSAT), a tool used by some doctors to assess possible substance abuse problems. http://www.turntohelp.co.uk/are-you-opioid-dependent/

References: 1. Blanch B et al. Br J Clin Pharmacol 2014;78:1159-66. 2. The TEDS Report, 2010. 3. Cami J & Farré N Engl J Med 2003;349:975-86. 4. National Institute on Drug Abuse, 2011. 5. Royal College of General Practitioners UK, 2011.