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One of the most contentious topics on SteadyHealth is painkiller addiction. People who are addicted to opioid painkillers, of course, have a uniquely valid perspective on the problem. For the rest of us, however, here are 10 suggestions for avoiding it.

The opioid painkillers are a family of drugs that includes the opiates hydrocodone (Vicodin), hydromorphone (Dilaudid), morphine, codeine, fentanyl, and oxycodone, anong others. (The painkllers are described as opioid, while the pain relieving agent in them is an opiate.) The unique characteristic about these drugs is that if a smaller dose achieves pain relief, a larger dose results in even more pain relief. It's the increasing effects of increasing doses that makes them very addictive.

If you take two Aspirins for a headache, chances are that taking three won't make you feel 50% better.

But if you take one tablet of oxycodone for your back pain, two will make you feel even less pain, and 10 might make you feel terrific. But the more opiate painkillers you take, the more you need, and once you get started, it's hard to quit.

It's better not to  become addicted in the first place. Here are 10 suggestions.

1. Choose your family well.

OK, it isn't really possible to choose your biological family. However, if a first-degree relative, that is, your mother, your father, your brother, or your sister suffers an addiction to opioid painkillers, there is a 40 to 70% chance that you will, too. Personal choices and willpower do make a difference, and environment does, too, but the predilection for addiction is largely, just not totally, genetic.

If you never come in contact with painkillers, of course, you won't ever be addicted to them. On the other hand, even if no one in your family is addicted to painkillers, you may have a problem with them due to your unique combination of life experiences.

What can you do if you know you have a genetic predisposition to opiate addiction? Stay away from the drugs. Making sure you don't get started with opiates is the easiest way to avoid addiction, although the social and family costs of staying away from drugs may be very high.

2. Use opioid painkillers for acute pain, not chronic pain.

The best use for opioid painkillers is to treat severe pain that will diminish soon. Heart attack patients are usually given morphine, which has the added benefit of reducing the amount of blood the heart has to pump. Vicodin may be prescribed for a dislocated shoulder, at least until it is popped back into place. Oxycontin may be prescribed for a broken back.

Oxycontin, however, usually should not be prescribed for chronic back pain.

If pain isn't going to go away any time soon, it is generally a mistake to prescribe a drug that will drive a desire for more, more, more. People who are expected to die of their injuries or disease are offered opiates, but people who have to live with chronic pain need other kinds of treatment.

3. Don't mistake mental clarity for lack of side effects.

People who are addicted to opioid painkillers, as long as they continue to get their drugs, usually do not suffer obvious mental side effects. Their judgment (at least on matters not related to drug use) is usually sound, and they are safe driving and operating heavy machinery. Mental clarity, however, usually depends on ever increasing doses of the drug, and the first few hits at a higher dosage level can be accompanied by dangerous emotional and mental instability.

Continue reading after recommendations

  • Chou, Roger MD. Argoff Charles H. MD. 11 Tips for Better Opioid Prescribing. Medscape News. 10 September 2014.Mind map by SteadyHealth.com
  • Photo courtesy of JosephLeonardo by Flickr: www.flickr.com/photos/joeruny/6960822698

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