"Today we're asking - are you dependent on prescribed painkillers? Public Health England has done its first big review of addiction and dependence on pain killers, anti depressants and drugs such as sleeping tablets and anxiety medication. One in four adults had been prescribed at least one of these types of drugs in 2018. The health body found that over half a million adults had been prescribed opioid painkillers for at least three years. That's despite official advice that such medication is only suitable for short term pain management or for those with terminal conditions. Are you worried about your use of painkillers? Are you a doctor that prescribes painkillers?" This was a phone-in programme - don't know if they're following up on it. I don't think that they referred to variation in whether different people get addicted or not. Listen at https://www.bbc.co.uk/programmes/m00088mr#play
I've been on opiate based painkillers for several years now. I am dependant on them, as without them I am in more severe pain, being in severe pain further reduces my capabilities, as well as being 'unpleasant', and I don't like this. Precisely why they've taken the position that opiates stop working after 3 months is beyond me. Yes some people may develop a tolerance, I know I did, but that's not the same as being addicted. It just means that you need more, it doesn't mean that when the pain stops you can't stop the painkiller. I have done this on several occasions, for months at a time, with no 'withdrawal'. If the media is to be believed this is not the case for everyone, but possibly they should figure out why, and an appropriate treatment for those people, rather than wage a media campaign against them. Some people will be negatively affected by some things, other not so much. That's just life, not everyone's the same. ETA - unless of course they have been prescribed inappropriately. Opiates, whilst they do reduce neuropathic pain, will gradually damage the nerves (I think, I am not a doctor, alter the function a bit anyway), making 'untreated', or inappropriately treated, worse over the medium to long term - I know this from experience. Opiates are not for neuropathic pain, they can provide pain relief but at a cost of increasing pain. there are other drugs for neuropathic pain. These should be used instead. I don't know about now but 25 years ago it seems some doctors didn't know that. Maybe these doctors are still practising and still don;t know that, so are prescribing opiates for conditions where it is not appropriate. Maybe that would explain the 3 months thing.
I haven't listened to this yet but I will as I find the all or nothing approach to some of these drugs frustrating. After surgery I refused to have morphine when I came home as I knew it could be addictive and didn't want to risk it. My GP has provided short term courses of Tramadol when required (until I realised that it causes insomnia) and diazepam (ironically for insomnia) but we have had open and frank conversations about these drugs and I have done some research so I know they are a bad idea, long term, for me. But this blanket "opiates bad" is frustrating as hell as there are few alternatives for pain management. When I have seen pain management teams the first option seems to be pregabalin or amytriptiline as a first line. Surely with more of us living with long term pain this should be a more nuanced conversation and properly investigated and researched...oh, wait. I see the problem.
I have been on opiates for some years. There is a big difference between dependency and addiction, and it is not a black and white issue. I carefully monitor how many I have so that doesn't creep up and not to take them two days running. It is important to respect the strength and power of these medications...but that doesn't mean they are the devil incarnate. Without them my ( already poor) quality of life becomes much, much worse. If you have never lived with constant pain you can't imagine the toll on your mental health and ability to do simple things. BTW: These opioids are not 'pain killers'- when you have pain at this level nothing 'kills' the pain, it is about turning down the volume on it slightly.
I've used tramadol for many years. I do eventually build tolerance, but I can manage it by rapidly reducing the dose, and then putting up with a pretty unpleasant 10 days on one tablet a day. After that, I start again on a low dose, which works well. Without it, I'd have little quality of life – or be able to sleep, as much of my pain is at night – so dependance isn't an issue. I'm also dependent on sulfasalazine to manage my psoriatic arthritis. This isn't a life-threatening disease, but my quality of life is much better if the inflammation is kept down by the drugs. Strangely, no-one has ever suggested they're a bad thing.
What I like about methadone for chronic pain is that it is long acting and one doesn't develop a tolerance as much as one does with morphine-type opioids. German engineering. It has other actions besides on the opioid receptors in the brain (some glutamate thingie). It's cheap and is used in addiction medicine. That said, it doesn't always work to knock the pain back down. But on a daily basis, I would say it gives me an average of a 60% reduction of pain, which is very good. It clears my brain (pain really dulls brain function) and gives me energy. I've tried three times to taper off (due to the bad press and restrictions) and after 10 days, I was over the snotty nose, et al symptoms. But then the incredible fibro stiffness (like God up there with his magnificent Holy Wrench twisting my muscles as hard as he can) set in. And so I took my pill and got relief. And this is why fibro patients who want to taper off, often get back on their opioids. They work for at least some patients. Of course, methadone can knock out respirations and can kill you if you take too much, or drink alcohol or use another CNS (central nervous system) depressant. When methadone doesn't cut it pain-wise, I will take a very small dose of klonopin (a benzodiazepine drug) and that quiets the over-activation of the the CNS which is a big part of fibro.
