From relief to reliance: Inside the silent painkiller epidemic
Netcare Akeso warns that the transition from using medications for their intended medical purpose to habitual use, dependency, and addiction can occur within weeks. Substance use disorders involving legal drugs are often overlooked but can be severely debilitating and even life-threatening.
Source: Supplied. Megan Gonsalves, manager of Netcare Akeso’s Crisis Line.
“Tragically, dependence on medication – painkillers in particular – is a fairly common form of substance use disorder. Under certain circumstances, any of us could be at risk of developing a dependence if faced with extreme physical pain requiring pain relief for an extended period,” observes Graeme Hart, an addiction counsellor who practises at Netcare Akeso Stepping Stones.
“People are often introduced to pain-management medication for the first time when recovering from an operation or procedure. When someone takes certain types of prescribed medication for extended periods or self-medicates for longer than recommended, they often build up a tolerance, which means they need to take more and more to achieve the same effect, leading to dependency.
"This can be insidious, and the person may not realise initially that there is a problem developing as the periods between doses start lessening and the pain seems to return more rapidly.
“Emotional dependency may develop from the temporary relief medications provide. When in pain or under stress, it becomes habitual for the person to take the medication, often without realising it, tipping over from dependence to full blown substance-use disorder. The taking of medication is no longer a relief, instead it is needed to try and feel normal. This can become obsessive and hijack the decision-making process, and may lead to major depression and anxiety,” he points out.
“This type of addiction often goes unnoticed because legal drugs are more socially acceptable than other addictive substances. Also, the person may become secretive in their behaviour, visiting multiple pharmacies or doctors to get more of the medication than is allowed, hiding a stash of medication, or concealing empty packaging so others won’t be aware of the extent of the problem.
"Codeine-based medications can be particularly addictive and need to be treated carefully. Oxycontin is an example of a medication that has enslaved many unwitting individuals globally.
“Like other addictions, it can be hard to recognise its grip until it impacts relationships and functioning. The earlier the potential risk is identified, the easier it is to break the habit. When dependence sets in, and intervention is delayed, unfortunately, treatment becomes more difficult. With professional help, however, people trapped in substance-use disorders can be educated and supported in the recovery process,” adds Megan Gonsalves, manager of Netcare Akeso’s Crisis Line.
“It’s important to remember that anyone can develop an addiction to medications. It is, therefore, important to avoid using medication longer than indicated or exceeding recommended dosages. Always consult a healthcare professional to address the root cause of pain or discomfort, rather than relying on medication to mask the symptoms,” she advises.
Hart emphasises that asking for help is not a sign of weakness, but rather a sign of strength and honesty. It is also important to be aware of individuals who may be at a higher risk of developing substance use issues, such as:
- Chronic pain sufferers who require medication on a regular basis
- Those who have struggled with other types of addiction before
- People with unmanaged stress or a history of mental-health concerns such as depression, anxiety and others, and
- Individuals who self-medicate for pain, stress or sleeplessness
- People who use other substances frequently (including alcohol) or in excess
- People who are going through trauma such as divorce or the passing of a loved one.
“A person could have been taking medication periodically for years without it causing dependency, but this can quickly change under stressful circumstances, or due to slight shifts in brain chemistry, triggering a sudden substance-use disorder at any age,” Hart says.
The potential warning signs to be aware of include:
- Taking medication more frequently than medically advised
- Experiencing mood swings
- Engaging in secretive behaviour
- Having excessive drowsiness
- Craving the medication or its effects
- Inability to stop using the medication, even when it affects work, home or other areas of life
- Experiencing physical withdrawal symptoms when the medication is not available
- Obsessive behaviour especially over the obtaining of medication
- Isolating and withdrawing from social or work activities
- Lack of motivation and interest in life (a loss of meaning or purpose)
Managing medication risk
“Although painkillers and other potentially addictive medications serve a medical purpose, the risk of misuse arises when people are unaware of appropriate boundaries in the use of pharmaceuticals. It is vital to address the cause of pain with a doctor, read the package inserts, heed warnings and ask the right questions of a healthcare practitioner or pharmacist before taking new medication,” Gonsalves advises.
“Don’t accept meds from well-meaning friends who have spare tablets from a previous ailment.
“If you are at higher risk, inform your healthcare practitioner when discussing your treatment plan. Ask the right questions, including what the medication is for, how long it should be taken, and at what dosage and frequency. Never exceed the recommendations, and do not share medication with others,” Gonsalves advises.
She suggests exploring non-pharmaceutical options to assist with pain and stress relief, particularly if you know you are at higher risk for developing a medication addiction.
“The danger of legal drug addiction cannot be overemphasised. Just because a drug is legal it does not mean that it cannot be dangerous. It is estimated that 60 million people struggle with opioid addiction globally. In extreme cases, these addictions can lead to organ damage and unintentional fatal overdoses, and profound consequences on relationships and careers.”
Help is within reach
“If you are concerned about dependence or addiction, seek professional assistance for safe withdrawal and detoxification. It is also important to access therapy to help cope with the psychological aspects of recovery,” Hart advises.
He points out that going ‘cold turkey’ off benzodiazepines can be highly dangerous and should be supervised by a GP or psychiatrist.
Substance-use disorders frequently manifest alongside mental health conditions like depression, anxiety or mood disorders. Netcare Akeso’s dual diagnosis units take a holistic treatment approach, addressing both the addiction and psychiatric aspects. The multidisciplinary team includes psychologists, psychiatrists, occupational therapists, an addiction counsellor, a general practitioner and a social worker if required.
"Addiction does not discriminate and can affect anyone; it is not something to be embarrassed about. The longer it is left untreated, the more damage it will cause as a progressive illness,” Hart warns
It is never too late or too early to reach for support for any form of addiction or mental health concern. Netcare Akeso’s 24-hour Crisis Line has experienced counsellors available on 0861 435 787 to listen without judgement and to advise on the options available to assist you or a loved one.
