(In response to the bolded portion) It depends on what they are taking them for. People taking them recreationally (“addicts”), have a much harder time coming off of opioids, both physically and psychologically, than people who were actually taking them for pain control. Often pain patients do have to taper off slowly to avoid withdrawal symptoms, but they usually don’t experience the same suffering that addicts do.
I remember a scene in The People vs. Larry Flynt where Larry Flynt (played by Woody Harrelson, IIRC) had been taking opioids long-term to cope with the chronic pain from his gunshot injury, and his wife Althea had been taking his painkillers recreationally. After the experimental surgery successfully eliminated the pain, Althea came in and offered him some more painkillers, and Larry said something like “No, I was taking them for the pain. I don’t need them anymore,” and stopped. Althea, who had been taking them recreationally, was unable to stop.
Now, I don’t know how true-to-life the scene was, but it’s plausible; I’ve spoken to ex-chronic pain patients who claimed they were able to stop taking opioids virtually immediately once their pain disappeared, with little to no ill effects, even though they were on dosages that would be dangerous to a non-tolerant person. In two cases I was even able to confirm this with the patient’s doctor.
So, some people certainly can come off of long-term opioid use relatively easily … but usually not, of course.
A friend of mine runs a pain clinic at Loma Linda in California. It’s got a lot of people in it who self-refer, after getting doped to the gills by their previous pain treatment centers. And they come in reporting that they’re on massive amounts of narcotics which don’t let them do much in the way of meaningful interaction with friends and family, and they still hurt anyway.
There is a role for opiates in chronic pain for some patients. But it’s not the first tool in the tool kit to reach for. Nor the second or third. Often not even the fourth.
Tho I wouldn’t describe an opiate addict as someone who uses opiates “recreationally”. More like living to use, and using to live. The alternative to not using an opiate acutely for an addict is really quite a complete and utterly pathetic despair and incomprehensible demoralization.
I would say it really depends on the type of pain and what is causing it. Opioids are the gold standard of pain relief, but chronic pain is often quite a different beast than the acute pain that most of us are familiar with, which usually has an immediate cause like the femur jutting out of your thigh. Opioids work great for that. For neuropathic pain, though, and a lot of other chronic pain … it doesn’t seem to do squat.
And even some acute pain doesn’t respond well to opioids … I’ve heard that platypus envenomation, for instance, is incredibly resistant to opioid pain management.
Good point. I have been using the term “recreational” to mean use in a non-pain-control sense, but as you point out, it’s really not accurate. There are recreational users, of course, but by the time you’re addicted, it’s not so “recreational” anymore.
So, do you happen to have a more accurate term for the type of drug use that I’m talking about? I guess “abusive” might work…
I would venture to say that it’s more a case of a different type of user than a different type of use.
“Recreational” opiate addicts are a pretty much self-selecting population of addiction sensitive individuals, whereas patients who use opiates for pain control are a mixed population - some will become addicted to the same degree as the “recreational users”, but most won’t.
I’ve seen patients who were treated for pain become full-blown addicts, but I’ve also seen heavy “recreational” users who did not become addicts - they simply moved on when moving to anew city etc.
So although there may be factors of environment, ‘style of use’, type of drugs etc, I believe the real determining factor in the appearance of addiction is the user himself.
