We lost another one. On Friday we found out that the musician Prince died aged 57 on 21 April听补蹿迟别谤 on , a prescription drug approximately 80 times more potent than morphine and hundreds of times more potent than heroin.
Immediately after his death, the media wondered whether it was (yet another) overdose story, but those close to him insisted that even in his partying days, he didn鈥檛 use drugs or alcohol.
Perhaps that was true at some time 鈥� or perhaps it was never true and was just a story of who we needed him to be, while he quietly struggled with pain and pills and eventually physical dependence, never quite getting the help he needed.
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This is a worryingly familiar story. And I鈥檓 not just talking about . The medical journal JAMA recently reported that .
How did it get so bad?
According to a , more than 30 per cent of people in the country have some form of acute or chronic pain at any one time. For older adults, it is around 40 per cent.
Chronic pain, a condition with a fluid definition and timeline, is a very personal and subjective experience. It leaves victims debilitated and depressed. It stands to reason that doctors have been fighting it with painkillers.
Sure, there are other treatments 鈥� such as talking therapies and 鈥渁cceptance and commitment therapy鈥� (which is exactly what it sounds like) 鈥� but it makes sense that the single most effective remedy has been prescription painkillers, with opioids offering the most powerful relief.
Often prescribed
Given the prevalence of chronic pain, it is perhaps hardly shocking that
But painkillers, by design, mask the symptoms of disease in the absence of anything identifiable to fix, cure or heal 鈥� so you need to keep them coming. Unfortunately, the repeated administration of any opioid will almost inevitably result in increased tolerance to its desired effects and physical dependence.
In a cruel twist notorious to opioids, tolerance to their analgesic and euphoric effects occurs rather quickly, causing people with chronic pain to seek higher doses, whereas tolerance to respiratory depression 鈥� caused by the drug interfering with parts of the brain that control breathing 鈥� happens slowly.
In other words, every dose increase because it鈥檚 鈥渘ot working as well鈥� sends the risk of an ever higher.
Because people stay on top of their pain by taking more pills, it becomes harder to stop or only take them when needed, with true physical dependence threatening withdrawal symptoms such as diarrhoea, insomnia, vomiting and flu-like characteristics identical to those experienced by users of illegal opiates such as heroin.
With consequences like these, people with chronic pain are motivated to take the medication at regular intervals, whether needed to handle the pain or not.
Tolerance, dependence or addiction?
Unlike both tolerance and physical dependence, addiction is not a sure-fire outcome of long-term opioid use. In fact, contrary to popular belief, true addiction only occurs in a small percentage of people, even among those who have a predisposition to addiction.
A 2008 in the British Journal of Pharmacology distinguished addiction from physical dependence and tolerance by showing that the underlying mechanisms in addiction are completely different 鈥� being slower to develop, longer-lasting and disruptive to several brain processes.
Referring to those with prescription opioid problems as drug addicts is misleading and stigmatising.
The healthcare field has made enormous progress in awareness and identification of chronic pain, leading to a drastic increase in diagnosed cases. But in good faith, doctors have found themselves in a catch-22 once tasked with treating it.
There is no doubt that the risk of addiction to opiate prescription medication is real. But addiction itself isn鈥檛 the biggest problem 鈥� tolerance is where the danger began and this, perhaps, is where the medical field needs to focus to stop the epidemic of overdoses.
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