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Do you have a legitimate need for opioids but wonder if you might use them for more than just pain management? Or, does someone you love use opioids for legitimate reasons but you wonder if they might take more than they should?

Well, unfortunately, it’s nearly impossible to see the line that separates abuse from addiction as you pass it, and once addicted, responsible opioid use becomes almost impossible.*

Fortunately, you don’t jump straight from use to addiction. The normal progression goes from:

  1. Legitimate Use, Novel Experimentation

to -->

  1.  Misuse, Increasing Opioid Abuse

to -->

  1.  Opioid Addiction

So, though it's hard to see the line that separates abuse from addiction as you pass it, since abuse is defined by behaviors rather than by brain changes, abuse is much easier to recognize - so long as you know what to look-out for!

*Addiction is characterized by progressive changes to brain function and structure that lead to compulsive use and hijacked memory and motivation systems. Though you can often look back and remember when behaviors became compulsive, it’s very difficult to self-observe this in real time. This inability to self-recognize addiction helps to explain addiction denial.

Opioid Abuse Self-Test

Are you starting to behave in ways that indicate opioid abuse/misuse – are you starting down that dangerous path to addiction? To check yourself, read the list below of 15 indicators that warn of potential opioid misuse.1

  1. In the past month, have you visited the emergency room one or more times?
  2. In the past 30 days, have you ever felt worried about your opioid use and the way you take these medications?
  3. Over the past month, have you had to use more medication that you are prescribed?
  4. Over the past month, have you used your pain medication for reasons other than for what it is prescribed – for example, to boost mood, handle difficult situations or get a good night’s rest?
  5. In the past month, have you ever asked to borrow pain medication from another person?
  6. In the past month, have you ever taken another person’s pain medications?
  7. Over the past month, have you been in more arguments than normal?
  8. Over the past 30 days, have you had a more difficult time than normal controlling your temper?
  9. Over the past 30 days, has anyone you know expressed concern about your use of opioids or about the way they affect you?
  10. Over the past month, have you spent a lot of time thinking about opioids (getting enough, when to take them, etc.)
  11. Over the past 30 days, have you had more trouble with memory problems or with clear thinking?
  12. Have you ever thought seriously about hurting yourself over the past 30 days?
  13. Within the last 30 days, has anyone complained about your failure to meet responsibilities at work, school or home.
  14. Over the past month, did you ever get opioids from any person other than your prescribing doctor (E.R. doctor, friend, family member, street, dentist, etc.)
  15. Over the past month, have you used your medications differently from how they are prescribed to you (different schedule or dosing)?

Scoring

The more yes answers you tally the greater the likelihood that you misuse your medication and the greater the risk of opioid addiction.

  • A strong yes answer to 3 more of the preceding 15 questions is strongly indicative of an opioid misuse problem.

Beyond this list above, additional signs of opioid misuse include:

  • Ever altering the route of administration (crushing a pill to snort or inject, for example)
  • Arguing with your doctor about a need for stronger prescriptions
  • Deteriorating social functioning

Be especially careful to avoid opioid misuse if:

  • You have any family history of drug or alcohol addiction
  • You have any personal history of drug or alcohol abuse or addiction
  • You have any current mental illness
  • You have a history of preadolescent sexual abuse

How to Respond to Misuse

Realizing that you abuse your opioid medications before you develop an addiction is fortunate – think of it as like waking up in a canoe drifting steadily down river toward a waterfall:

  • If you take action soon enough you have an excellent chance to make it safely to shore.
  • If you decide to do nothing, you’ll continue to drift – picking up speed as you go – until you fall over the lip of the falls…and from there, you can’t ever go back.

So if you realize that you abuse your meds, you may still have an opportunity to save the situation before you fall into addiction – and remember, moving from abuse to responsible use is easy, pulling back from addiction is incredibly hard (some people can never manage this feat).

What to do…

Talk to your doctor about your concerns. If it helps frame the discussion, you can print off the list of 15 indicators to show him or her which warning signs you’re most worried about.

  • Although you might feel awkward to admit abuse worries, your willingness to discuss the situation proves your responsible intentions.

Based on your situation, your doctor may:

  • Suggest trying a different combination of medications (for example, a lower dose of opioids combined with additional non-reinforcing medications).
  • Suggest that you taper off opioids and move to alternate forms of pain management.
  • Suggest you meet with a specialist or get involved with a pain clinic, for more comprehensive treatment options.
  • Suggest continuing with opioids while employing control strategies that limit your access, such as having a person you trust handle your medication, bringing your medication for pill counts at all visits or making an agreement to use urine samples as a way to ensure instruction compliance.
References
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Page last updated Apr 07, 2015

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