How potent painkillers can deliver addiction

Posted at 9:01 PM, May 04, 2016
and last updated 2016-05-04 21:07:23-04

When Aaron Marks was in high school in the late 90s, two things happened simultaneously: one, he had his wisdom teeth out and two, he was prescribed Vicoprofin - a painkiller combining hydrocodone and ibuprofen. It was the first step down a path that would – a few short years later - lead to a heroin addiction.

Around that same time, Marks said, it was as common to see someone show up at a party with a bottle of painkillers as a six pack of beer or a bag of pot – painkillers they would find in their parents’ medicine cabinet.

“You’re taking these pills, you’re thinking this came from a doctor, this is fine. What’s the big deal? Next thing you know, you’re basically a heroin addict without the heroin,” he said.  The pills gave way to heroin while Aaron was in college at the University of Cincinnati.  The dealer who sold him pills ran out, and said “You know what? If you snort one line of this (heroin), it’s going to do all the same things the pills are going to do, and here…have it for free.”

Aaron’s experience was being repeated across the country, as prescription opioids – once used mostly for post-surgical pain and end-stage cancer – were prescribed for all sorts of things from dental to lower back pain.
Cleveland Clinic psychiatrist Jason Jerry specializes in addiction medicine and said the proliferation of opioid meds coincided with something else.

“Suddenly the pharmaceutical industry started pressuring state medical boards, lobbying them to sanction doctors for under management of pain. They went so far as to really influence the implementation of the “fifth vital sign,” into patient charts all across the country.”

According to Dr. Jerry, now we have a situation where every time a hospital patient gets their blood pressure and pulse checked, they’re asked “What is your pain on a scale of 1 to 10?” Decades of repeatedly asking that question, Jerry believes, has set up the expectation that there should be no pain.

And patients think, “Maybe my pain ought to be at zero. Maybe I should be demanding more.”  Those demands for potent painkillers were met, and delivered addiction along with pain relief.

In terms of how opioids such as oxycodone and fentanyl act on brain receptors, heroin has the same effect. Addicts jump to heroin because it’s cheaper and easier to get. Dr. Jerry said just as the federal government began cracking down on prescription opioids, heroin began coming into the country through Mexico. 

But with heroin, “you really don’t know what you’re getting. It’s often mixed with fentanyl, for instance, which is many times more potent than heroin. You’re really playing Russian Roulette on the streets when you’re using heroin.”

It’s our attitude about pain that Dr. Jerry believes needs to change.

“This idea in our culture, inside and outside hospitals, that we should somehow be pain free. I think the older we get, the more we realize we’re going to wake up every morning with a certain amount of pain, and that’s just the way life is. We can’t be pain free. This developed perception that this should be the goal – that we should be physically pain free with narcotics, and emotionally pain free with benzodiazepines and other meds like that – it’s just not realistic. It’s unhealthy. And I think it’s ultimately what’s driving the current epidemic.”

Marks has been in active recovery for more than eleven years now. In addition to his job as a senior account director for a west side financial services company, he’s served in leadership positions with several organizations including Recovery Resources, and the Education and Prevention Subcommitee under the U.S. Attorney’s Task Force.  Marks said no one should believe this epidemic doesn’t affect them.

“It’s tough to look this in the face. We want to do what we’re comfortable with, and think ‘that person chose to do that, it’s their fault, forget about them. No! If we forget about them, they’ll break into your house and steal your TV (to pay for the drugs), or overdose and end up in the ER three times. It’ll cost taxpayers, or they’ll solicit your kids and get them addicted. It’s pervasive.”

Dr. Jerry add that a barrier to treating addiction is the stigma, and the attitude among many people that it’s a character flaw.

“This is a disease like any other in medicine. It’s well documented, well researched. We have functional neuroimaging to prove that something different is going on in the brain of an addict versus someone who is not afflicted with addiction. It’s a very real, very organic disease just like any other.”

Think you know someone who's addicted to heroin or painkillers? Think again. On Thursday, NewsChannel 5 Anchor Lee Jordan shows how you can spot the signs of heroin addiction and possibly save someone's life.