The death of actor Philip Seymour Hoffman from an apparent heroin overdose earlier this month has highlighted issues about the use of prescription painkillers. It’s a topic relevant to cancer patients and survivors like me, who often must continue to take narcotics for pain long after our treatment has ended.
According to government statistics, rates of prescription opiate abuse have risen steadily over the last decade. Meanwhile, the number of people reporting that they have used heroin in the past 12 months has doubled since 2007, to 620,000.
Hoffman, who died at the age of 46, had quit taking heroin more than 20 years ago, but reportedly struggled to break away from a prescription painkiller habit just last year.
Dr. Jason Jerry, an addition specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, told The New York Times that people often start with a prescription for a painkiller. But soon they’re getting their pharmaceutical opiates — such as Vicodin OxyContin, and oxycodone — illegally.
According to Dr. Jerry, half of the heroin addicts at his clinic started on prescription opiates. But in many parts of the country, heroin is actually cheaper than prescription opiates, leading people to switch to the street drug.
And yet millions of people continue to use these drugs safely. Fear of addiction should not deter cancer patients from seeking adequate pain relief.
A serious error made by health professionals and the public is to use “addiction” to describe physical dependence or tolerance, according to the World Health Organization’s (WHO) Pain and Palliative Care Program.
“Addiction is defined only by psychological dependence, i.e., compulsive use of a drug for its mood-altering properties, and continued use despite harm,” says a WHO news release. “Physical dependence is a normal physiological consequence of chronic opioid therapy. Tolerance means decreased effects with a stable dose of a drug. “
The WHO goes on to say that there is a misconception that opioids are “bad” drugs because they are often associated with drug addiction and criminal activity. However, studies have shown that when they are used appropriately for pain management, opoids are effective, safe, and have an extremely low potential to produce addiction.
Unfortunately, patients who request more pain medications are sometimes mistakenly perceived to be in danger of becoming addicted, even though they are only seeking better pain relief.
But opiods are safe compared to many other medications. The most prevalent side effect of long-term opioid use is constipation. On the other hand, chronic use of common over-the-counter analgesics can cause stomach, kidney, and liver damage.
My doctors have prescribed me oxycodone for pain out of this very concern that those other medications might damage my liver or kidneys — organs that were already compromised during chemotherapy and as the result of my bone marrow transplant.
My pain comes and goes due to factors relating to the prednisone I take to control inflammations resulting from my bone marrow transplant. Prednisone can also weaken the muscles in your legs, leading to pain after exertion.
In fact, people sometimes look askance at me for taking oxycodone, as though I am on the road to becoming an addict. They ask, “When are you going to get off that stuff?”
I told my doctor that I was afraid of becoming addicted. He said: “Ask yourself if you want to take it because it makes you feel good or because you are in pain.”
If it’s for pain, he said, it’s best to go ahead and take. And if I ever need help stopping, he will be there for me.
So far, so good. But when the pain goes away, so do the pills.
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