There are ways to use medications to ease pain and not become addicted.
a drug and/or a specific dose and you might need to increase your dosage or change drugs.
What does addiction Q
painkiller. What signs should I watch out for? You’re not alone in being afraid of ad- diction; many patients share your fear. Let’s begin with what you shouldn’t worry about: Patients often confuse physical dependence and tolerance with addiction. It’s true that abruptly stop- ping medication can lead to withdraw- al (which indicates dependence), but that is a physiological issue, not a psy- chological one and should not be con- fused with addiction. Withdrawal and dependence aren’t limited to opioids, either, and dependence can develop in several weeks or even days. Depen- dence isn’t something to be concerned about; you simply need to ensure you have enough medication to control your pain, and if you do decide to stop, do so gradually. Tolerance, on the other hand, simply means that more medication might be needed—that your body has built up a tolerance to
I’m concerned about becoming addicted to my
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look like? Watch for the four C’s: compulsive use; out-of-control use; crav- ings; and continued use despite harm. Addiction isn’t just physiological; it’s psychological as well. So if you feel like you’re losing control over your medications—craving it between doses (and not simply for pain relief)— and can’t stop overusing it despite the fact that it’s negatively impacting you socially, physically or psychologically, then it’s definitely time to talk to your doctor. Switching to another opioid might help, or you and your
doctor might try strategies to help you regain control over your medicine, like having a friend or family member hold and dispense your meds, or prescribing a small quantity at a time. You should also know that about 85
percent of addictions appear before the age of 35, so if you’re older and have never had a problem with drugs, alco- hol or pain medications, do not have addiction in your family and do not have any major, untreated psychiatric problems (this might cause you to self- medicate), the likelihood that taking opioids for pain control will cause ad- diction is quite low. And if you do have a history of addiction, including in your family, it is important to let your physi- cian know. There are many ways you can work with your doctor to allow you to take your pain medication in a way that eases your discomfort while main- taining your sobriety. —steven d. passik, ph.d., psychologist, professor of psychiatry and anesthesiology at Vanderbilt University Medical Center, Nashville, Tennessee
Q
I suffer from painful cluster headaches. I’ve read that some people turn to hallucinogenic drugs to find relief. Do these drugs work? Standard treatments like high-flow oxygen and triptan-type medicines are quite effective for most people who have cluster headaches but not all, and triptans can bring on more attacks later. Prednisone, lithium and verapamil can reduce the severity and frequency of symptoms, but no medication does it all, which is to end a single attack, break a cluster series early and extend the pain-free remis- sion period. Patients have noticed that hallucinogenic drugs such as LSD and psilocybin-containing mush- rooms, though illegal, can quickly shut down attacks and lengthen the time between attack periods. Clus- terBusters, a nonprofit organization for people who experience cluster headaches, sponsored my labora- tory’s research on the effects of hal- lucinogens on this type of headache. Our first publication of this work, in the journal Neurology, found very promising effects, but unfortunately it’s not enough to recommend these drugs as a treatment for cluster head- aches just yet. Clinical research must first be completed to satisfy the U.S. Food and Drug Administration. But on an encouraging note, that first survey in my lab has led to more re- search, including a very small trial of a version of LSD, 2-bromo-LSD, that does not cause intoxication but may still offer relief. Should these results continue as the research expands, we may yet have a powerful new medication without the hallucino- genic side effects. —John H. Halpern, M.D., assistant professor of psychiatry, Harvard Medical School and director of the Laboratory for Integrative Psychiatry at McLean Hos- pital, Belmont, Massachusetts