I stress the importance of non-medication approaches to all of my opioid-dependent clients. For once the detox and maintenance phases of treatment are addressed via methadone maintenance, Suboxone or any other medication-assisted strategy, the hard work of relapse prevention, developing long-term coping skills and rallying support from significant others who don’t use drugs with abuse potential, will be integral keys to sustained success. I encourage clients to take the issue of surrounding themselves with a support structure seriously, because lack of encouragement is a huge reason why prolonged abstinence is difficult to achieve. Emotional swings, glorifying the euphoria derived from opioid use and physical cravings are commonplace in early recovery.

As important as detox, maintenance drug treatment and social supports are to    a patient’s possible success in overcoming their drug woes, all of these are “after the fact,” in that personal, professional and social damage was done, and the above interventions were utilized to help the individual begin the process of recovery pursuant to getting their lives back on track. None of these interventions address the issue of cause and how things went awry for the drug user in the first place. It is prevention that’s key – prevention that begins by explaining to patients who have been prescribed pain medication (the most common path to the start of opioid use is pain) why some people become addicted to opioids, and teach them the early warning signs of possible trouble going forward. The issue of dependence and addiction should be discussed with every pain patient placed on opioid medications, and this is done far too infrequently by prescribers.

The main reason why we have all but failed in our drug prevention efforts is that the messaging has been all wrong. Remember the campaign ad “Just say NO to drugs?” This failed miserably because its motivational message was fear-driven or a scare tactic, so to speak. Fear may be an initial motivator, but it rarely sustains people to stay a course of action indefinitely. Then along came an ad showing an actual egg frying in a pan with the tagline – “This is your brain on drugs.” This of course failed too because the implied message was that all of our brains must be similar when it comes to using drugs with abuse potential. This is patently false because with any particular drug in the opioid class for example, some people can feel a sense of joy and happiness from the drug, while others will not feel any joy or happiness at all. This is an important point which leads us to what questions you should be asking if you’re working with a pain patient who has been prescribed opioids. Here are 2 key questions:

  1. So you’ve been prescribed an opioid to help with pain management, what are you expecting from the drug? If the patient states their expectation is that the drug will alleviate the pain they’re experiencing and help take their mind off of it, that’s what you want to hear, because in all likelihood this patient will decrease the frequency of use and eventually discontinue when he or she realizes the pain is manageable enough without the drug. On the other hand if the person mentions they’re seeking pain relief and they want to feel “good,” (I hear this often) that’s not what you want to hear, so move on to question two.
  2. How does the drug make you feel? If the answer is the drug takes their mind off the pain and has them feeling great, happy and energized, it is very important to explain that they may be genetically susceptible to abuse or even worse, addiction. Why? Because if they keep triggering the pleasure principle, they’ll eventually succumb to cravings which will give rise to continuing and escalating use. Opioids only dull the sensation of pain; they don’t fix it or “cure” it – which is why most people discontinue them once their pain is either manageable or resolved. In this patient’s case, understanding that it’s the euphoria that’s luring them in can help them stop the drug before it tightens its grip and owns them.

If someone understands that a genetic basis exists for any addiction, he or she can use that information to determine whether or not they may be at risk. Most folks know their family history – at least to some extent. They may not know or even want to know the gory details, but often have heard about concerns and troubles from family members. This can serve as an impetus to be vigilant about their personal risk factors. It is one thing to fall prey to opioid abuse because of not knowing the warning signals; but another to be well informed and succumb anyway. I have found that when well-intended people understand their own risk factors, they’ll reach the conclusion that it’s in their best interest to change their behavior by significantly curtailing or discontinuing their opioid use – before it’s controlling them.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.