People who are abusing prescription pain pills are not eager for anyone to find out.  Asking them direct questions may not get a straight answer. MATClinics gets lots of calls from people looking for pain clinics, but calling us mistakenly.   We have had conversations with mothers and other family members who are trying to find a pain clinic for their loved ones who after a short discussion reveal that they have been finding one pain clinic after another to help their family member find new prescriptions. Even when the signs are clear, family members can convince themselves there is not a problem.

Opioid based pain pills are incredibly effective at relieving pain and even inducing a feeling of euphoria. Take them for too long, however, and one can become physically dependent. People like how the medications make them feel, take more, and one day might find that if they stop taking them, they start to experience withdrawal symptoms.  So how can you tell if a family member is abusing pain pills?

Names of some popular prescription pain pills that contain opioids (not an exhaustive list):

  • Vicodin and Lortab (hydrocodone + acetaminophen)
  • OxyContin, Percocet, Endocet, Roxicet (oxycodone)
  • Morphine
  • Fiorecet with Codeine, Tylenol 3, Cotablflu (Codeine)
  • Darvon (propoxyphene)
  • Dilaudid (hydromorphone)
  • Demerol (meperidine)

The United States consumes over 80% of all prescription opioids in the world, despite being only 5% of the world's population.  Doctors and other prescribers are still flooding our medicine cabinets with pain pills.   So how can you tell if someone you love starts to abuse pain pills?

Initial signs of abuse:

  1. Early in their use, the medications can make people itchy and even nauseated.  They might even throw up as the medications start to take effect.
  2. Taking a dose above what is prescribed can cause people to "nod out", looking tired and drowsy.  They often don't recognize that they are nodding out and continue to try to talk.  People can also start to show signs of apathy or depression.
  3. In an attempt to get the medications to behave more powerfully, they might try to snort or inject the medications.  Paraphernalia could include straws or rolled dollar bills to snort crushed pills, pipes to smoke it, and syringes for injection.

Physical Dependence

Long term opiate use causes an increase in the number of the opioid receptors in the brain (technically known as "upregulation"). The more opiates one uses, the more receptors one develops and the higher the dose of opioids is needed to occupy those receptors. This is called tolerance. It is a vicious cycle of use and tolerance building. Long term use creates an overabundance of these receptors that without opiate replacement therapy makes abstinence very difficult. The receptors are numerous and screaming for both the endogenous (natural) and chemical opioids.  At that point, people are described as "physically dependent" on opioids. The physical dependence on opioid-based pain pills will drive them to more and more compulsive behavior.  They will have strong cravings and will do what it takes to avoid withdrawal.  

Opioid Tolerance Cycle

Addiction

The behaviors that people adopt in order to satisfy their physical dependence are often called addiction.  We define addiction as behaviors that people engage in in order to satisfy their cravings despite doing harm to themselves or others.  This is an important distinction. Physical dependence is what it sounds like, it's a change in the brain that drives demand for more opioids. Addiction is the resulting destructive behaviors.

Once people are addicted, you may start to see lifestyle and behavioral changes, such as:

  • They might start to isolate themselves from old friends and activities that used to be important in their lives. They might start to hang out with a new and unfamiliar group.
  • They could stop being successful in their work or school.
  • They might start to get in trouble with law enforcement
  • Their social interactions with friends and family could start to fray, showing strange outbursts of anger.
  • They are likely to allow grooming and physical appearance to deteriorate.
  • Mental disorders such as depression that might have been under control, may start to show themselves again, and your family member or loved one may show less interest in addressing their mental and emotional challenges than they did before.
  • Changes in their financial situation:
    • Less money--They used to have money to spend on life's general needs.  Now, despite their isolation, they never have enough money. 
    • More money--If they are dealing, they might start to buy expensive items that they could not previously afford
    • Loans--Are they asking for loans that go to fund unseen acquisitions?
    • Stealing--Are items missing from friends' and families' homes?

It's estimated that more than 70% of people who develop an addiction to pain pills eventually move on to heroin.  Heroin is much less expensive and is very easy to get. Not all users of heroin will shoot it up, many rationalize that they are not a junkie by restricting their use to snorting or smoking. If your family member or loved one does begin to inject, you might see that:

  • They start to wear long sleeved clothing to cover up track marks or 
  • They leave intravenous paraphernalia around.

When pills or heroin are not available, people go into withdrawal.  What does withdrawal look like?  It looks like the flu.  If you are seeing your family member consistently showing signs of the flu, which miraculously cures itself, but then comes back quickly, you might want to take a closer look.  

If you suspect a loved one or family member is abusing prescription pain pills, you need to think about how to help them deal with their addiction.  Remember that as a result of abusing the prescription pills, your loved one or family member's brain has undergone physical changes. Finding a solution will require their buy-in and work.

For a long time, people thought that addictive behaviors could be controlled by a strong mind.  If only people tried hard, went to meetings, and stopped using, they would "recover".  What science has found is that its definitely not that simple for the vast majority of addicts. Its confounding that some people can quit, cold-turkey, but the evidence is clear that they are few in numbers.  More than 9 out of 10 addicts who try an abstinence only opioid rehab treatment regimen relapse within a month.  

Please reach out to us at MATClinics if you suspect your loved one or family member is abusing prescription pain pills. Medication Assisted Treatment is the most effective method to help people addicted to opioids get their lives back in order.