How do you get addicted to painkillers if you have no pain?

I’ve heard that painkillers like Vicodin is addictive, but it seems to me that it would only make sense if the person was in actual pain, and if he were, then he should rightly be getting the medicine. But apparently lots of people get addicted to that, which confuses me because if the drug had addictive qualities, but they have no pain anymore, why would they still feel like they need it? Does a person get something out of the drug if they take it and they’re not in pain?

For example, on the TV show House, Dr. Greg House has a leg pain and walks with crutches. He’s addicted to Vicodin, but he needs it because he actually has pain. There are many episodes devoted to trying to get him off his addiction, which seems stupid because there are no episodes devoted to trying to fix his leg. If he still has pain, why not let him keep having the drug? Is addictiveness really worse than pain? If I have a lifetime pain like he does, I would hope that I would be able to get as much painkillers as I need. Even if my body gets used to it, that’s not my fault, they just need to up the dose or switch me to something else. I’m not living with pain if I can help it

Yeah - they get high, it doesn’t just take the pain away. Ever hear of people saying things like, “wow - they were really giving me the good stuff when I was in the hospital”?

I assumed that’s cause they had pain. I’ve never been in enough pain to need painkillers and I neither do drugs, smoke pot, nor drink, so I have no experience with stuff like that

Some of the opiate derivatives are very mood altering, esp things like Hydrocodone and Oxycodone.
They can be like super charged anti depressants. That is until the effects wear off. There’s always the down side, one can be proportionately depressed when the effect is gone - making them extremely habit forming for many people who take them.

Vicodin (even with the added acetaminophen) and most other opiates have barely any effect on pain for me at typically proscribed doses. I’d have to take so many as to get completely off my gourd to get rid of a moderate headache. OTC Aleve/naproxen is really the most effective pain-killer for me. But if the doc wants to proscribe me a few, I don’t stop him. :wink:

There have been swings of the pendulum on this issue. In the 80’s and early 90’s, there was a lot of fear about addiction in pain management, and lots and lots of people were denied drugs who legitimately needed them. People were afraid to take morphine the day after surgery because they thought they’d get hooked. Blame the War on Drugs.

Now the pendulum has swung the other way and we’re taught that if a patient says they’re in pain, then treat them for pain. We don’t try to figure out if they’re lying, by and large, unless they have a documented history of addiction. We’re taught a few non medical interventions, like massage and meditation, but by and large, if they’re in pain, give 'em a pill. Real life nurses rarely have time to teach someone progressive relaxation or give them backrubs, sadly.

But with a case like Greg House, there’s a real risk of adverse effects when the dose needed to minimize the pain is getting close to the dose that can cause liver or kidney damage or even respiratory arrest. Frankly, if he really needs Vicodin as often as he’s popping them to keep the pain at bay, then Vicodin isn’t the appropriate medication for him. Vicodin has a lot of acetaminophen (Tylenol) in it, and more than 4 grams of acetaminophen a day can cause your liver to shut down. It should be taken no closer than every 4 hours at the prescribed dose to keep you under the dangerous level of acetaminophen. House seems to be taking a lot more and a lot more often.

Hollywood being what it is, they seem to be a bit behind the medical times, though - they’re not searching out better pain management, but trying to suggest he doesn’t need pain medication at all (at least in the seasons I’ve seen, but I’m way behind on the series.) That’s 80’s thinking, not 2011 thinking.

Coming off some pain medications - especially the opiates - can cause some unpleasant (transitory) symptoms which make people feel awful, even if they didn’t start taking the drug for pain. So they become addicted in the sense that they feel bad when they don’t take their drug of choice, so they take more. Plus, of course, there’s the psychological addiction to the feeling good that happens when you take a pain medication you don’t need.

Many opiate addicts describe the feeling they get from their drug as “a hug from God”.

As time passes, it feels less good, but still makes you feel better than you feel without the drug.

I was under the impression that if the person is in serious pain, they didn’t get high (or the high just dealt with the pain) and that the addiction didn’t happen until the pain started getting better, generally speaking. Was wherever I heard that from talking out their ass?

A year or so ago, my doc put me on morphine for severe back and leg pain. It continued for several months until at last I had back surgery. We then tried a taper-off program for six weeks, but when I got to the “every other-day” part, I felt so horrible on the day I skipped it, that decided to go cold turkey. Ten of the worst day of my life, but finally got off the stuff.

All the time I was on it I hated it, although it did dull the pain. I had no appetite, was weak, dopey and lethargic. I asked the doc how in the merry hell anybody would use any narcotic for pleasure.

He told me that in most cases, people in severe pain who use these feel the same and get no high. If continued after the pain subsists, there is a chance they will then get a high and become addicted. Same deal if somebody with no pain starts on the stuff.

Sounds logical, but have no idea how true this is.

Vicodin et al are opiates. They don’t target specific pain, they quell the chemicals in your brain that cause, or rather, essentially are pain. A simultaneous effect is that they increase dopamine production, which is the exact brain-chemical opposite of pain, namely pleasure.

I’m not a chemist, so maybe it quells pain only by increasing dopamine. Either way the downside is that stopping pain with opiates always involves increasing pleasure chemically. And pleasure, especially in nice, neat, pill form, is highly addictive.

This is essentially the answer to your question: Even once you’re out of pain your brain still craves the drug because it wasn’t the pain-numbing aspect it remembers, but the pleasure-causing aspect. This is why opiates should only ever be used when the addiction risk is outweighed by the intensity of the pain. Unfortunately we don’t live in a perfect world so such is (often) not the case.

BTW, Oxycodone & Oxycotin are literally synthetic heroin. The were created to be a more chemically pure and reliable alternative to natural, poppy seed derived opiates. Unfortunately, again, heroin by any other name…

There is always pain, man. Life is suffering, you know. Opiates can take away some of the normal pain of living, and you feel good. Better than it is safe to feel.

I think you’re confusing pain relief with addiction. One is simply the surcease of pain, poften by use of medication, and the other is physical and mental dependency on the medication.

Not everyone who’s addicted to painkillers first takes them because of pain. Some people are never in pain but take them to get high. In other words, some people become addicted to painkillers for basically the same reason some people become addicted to alcohol or street drugs.

Also, some people who first take Rx painkillers for physical suffering continue taking them when they no longer have pain, either because they’ve already become addicted or because they just plain like the way they feel on the drug–in which case they may well become addicted eventually.

I haven’t seen the show House in a few years, but IIRC, Greg House (who, by the way, uses a cane, not crutches) is in pain AND addicted to Vicodin. The two are not the same thing. If others could relieve the pain in his leg, he’d still be addicted to the Vicodin. The reason nobody treats the cause of his pain is because there’s nothing they can do: the character suffered from an infarction (blood clot) in his leg that went undiagnosed (can’t recall why), leading to muscle death in that leg. The dead muscle was removed, leaving him in constant pain.

I hope this helps clear your confusion. If you want to learn more, there’s a very thorough explanation at

I’ve had to take Vicodin on and off with bouts of kidney stones. It’s certainly an effective painkiller, (although with kidney stones, only takes the edge off), but there is a good hour or two of very warm, content, and downright happy feelings. You just love life. Very euphoric, but easy to work up a fast tolerance, which can lead to taking more pills than prescribed to try to achieve the same level of euphoria.

A slippery slope, indeed. I’ve found I really have to watch it, when prescribed.

Of course, this type of “high” might not be one’s poison. Drugs affect people differently. I have an alcoholic friend who just loves the way alcohol makes him feel… I feel like absolute shit, and hate drinking to the point of intoxication. Some love weed (disassociation), or cocaine (speed), or benzo’s like Xanax or Valium (downers), or hallucinogens, etc…

But if euphoria’s your “thing”, then watch out for the opiates.

Pretty much. I believe the “high” from opiates is more of a “side-effect” of using this drug for pain.

The reverse is true, too. Those who abuse opiates recreationally, would get the euphoria they’re after, but the “side-effect” would be pain relief. If you had no physical pain, it doesn’t much matter… you’re after one (or so) aspects of the effect the drug has on your body, and most drugs this powerful have a host of effects (positive or negative).

Opiates aren’t discriminate. :wink:

It’d be like thinking, well, if I drink 2 glasses of wine with dinner, I won’t get drunk, because I’m not drinking it to get drunk… I’m drinking it because I like the taste. Wha? :confused:

So then in the case of House, where they can’t really treat the symptoms that cause the pain, what then? Just tell him to suck it up? I’d rather live with increasing doses of drugs to relieve pain and risk my life than live in pain. I had an issue with my back a few years ago where I had a dull throbbing pain for months. You don’t get used to it, it reminds you of it every single day. It was horrible, I wouldn’t want to live like that for another month, let alone years.

What if they switched him around to other drugs? I think the latest thing House took was Percocet or Propofol, I can’t remember but it started with a “P”. How about a month of that, then to Oxycotin, then to Morphine, then back to Vicodin? That way he won’t have enough time to be addicted to one thing and one drug will be out of his system by the time he goes back to it, so maybe it won’t destroy his liver?

What is unusual about that? Back when I had a functional body I would frequently go out drinking with friends and switch between drinks for the taste. I used to go to the TGI Friendlies across the street from my apartment with my roomie of the time because she liked margaritas and I liked the different ice cream drinks - so I would see what the different ice cream drinks on special were, and drink them - I really love mudslides and creamsickles. Of course I also loved strawberry or banana daqueries, and lime rickeys, and a properly made gin and tonic. My stupid bar trick was to be able to tell the difference between gins by taste alone. I could go home after 1 drink or 20. [the fun of living across the street from your favorite bar =)]

And I seriously doubt that people spend hundreds and thousands of dollars on bottles of wine to get horked out of their minds when a bottle of 2 buck chuck works just fine for that.

Opiates don’t work like that, you can’t just change from one to another in order to avoid addiction. Essentially, all the opiates act the same way in the body, by binding to the opiate receptors in the brain. The differences between the opiates* has to do with binding affinity, (how long it lasts), potency (how strong it is), and ease of crossing the Blood-Brain-Barrier (how fast it works).

The addiction or tolerance is caused by the body getting used to having something bound to the opiate receptors. As far as the body is concerned, it doesn’t matter if it is Hydrocodone (Vicodin/Lortab), Oxycodone (Percocet/Oxycontin/etc), or even Diacetylmorphine (Heroin).
Also, the damage to the liver is due to the acetaminophen (Tylenol) that is added to many opiates, not the opiate itself. Opiates don’t actually have a max dose, since the body just becomes tolerance, requiring higher doses for the same effect. A dose that would kill someone (via respiratory depressions, they stop breathing) with is opiate-native might not even help someone who is a long time heroin abuser.

Oh, and I don’t know what happened on House, but it was probably Percocet (Oxycodone/acetaminophen), not Propofol which is an IV short acting anesthetic.

*Generally, I know there are more differences, but this is in laymen’s terms.

IANAOrthopedic Surgeon, but I’ve never really understood the explanations they give around House’s case. I’m not sure why losing muscle would cause excruciating, lifelong pain in the first place - muscle will regenerate eventually. Perhaps it’s scar tissue preventing that? I don’t know.

But heck, if it really hurts that much and there’s no safe pain medication and TENSdoesn’t work and all his options are exhausted…maybe amputation and a good prosthesis would be a better route.

When I shattered my heel, I was laying in the hospital waiting for pain meds. It was about 70 degrees in the room with active AC blowing and I was sweating. My teeth were clenched to keep from screaming in pain.
Then they came in with an injection for pain. Suddenly it felt like 100 lbs had been lifted off my chest, I was at peace with the world, and life was good.
If I could have ordered a 5 gallon pail of that stuff to go, I would have. :smiley:
Also don’t forget there are two types of addiction physical and mental. What I just described was strictly mental. That drug made me feel GOOD when I was in serious pain (9.95 on a scale of 10) Long time users of Vicoden and the alike can get a physical addiction, where there body demands drugs.
Even though I was sprinkling Vicodin on my cornflakes for the next three months when the pain was over, I stopped taking them. No withdrawal, no cravings.
all I can say is thank OG I am not about drugs or booze like I am about food.

That’s my understanding. You can give most* people in pain a button that gives them opiates on demand, and as the pain lessens they’ll just gradually use less and less. A body in pain reacts differently to opiates than one that isn’t. As an interesting side issue, I’ve read that one emergency treatment for opiate overdose is to do things that would normally induce massive amounts of pain with minimal damage (prodding certain nerves the wrong way and such), because the pain uses up the drug.

  • There are however a small number of people who are simply prone to addiction.