Might as Well Face It, My Loved One Could Be Addicted to Drugs!

The prevalence and sheer number of prescriptions written by doctors for highly addictive opioids in the US is alarming.  Without knowing the behavioral health history of their boomer or older adult patients the distribution of painkillers such as Oxycontin, Demerol and Percocet for toothaches to post-surgical pain management is happening at such an alarming rate that even the Centers for Medicare and Medicaid, as well as state governments are doing their best to shift this troubling trend.

I am not declaring that pain management is not a legitimate course of medical care. Nor am I denouncing or saying that there is no value in this category of drugs; I simply believe that one should be knowledgeable about the fact that these are narcotics and that those who care for loved ones prone to addictive behavior may want to avoid them, if at all possible.  Unfortunately for many of American caregivers, they do not find out about a loved one’s dependence on these medications until it is often too late.  After all, when a physician is seeing 30 patients a day, it takes only 5 minutes to tell a patient yes where it could take more than 30 minutes to say the word no.

Up until now, addiction treatment and counseling have not been included in the categories of palliative and managed care, but in light of the alarming rise in addiction to prescribed Opioids I believe they should be.  I asked my friend and colleague, Dr. Barbara Krantz, for her expert opinion on the subject.  Her reply was “Absolutely! We are speaking of a chronic disease with relapse potential”.  Dr. Krantz, D.O., FASAM, MS, MRO, is the Director of Addiction Medicine at the Caron Renaissance/Ocean Drive treatment facility in South Florida.  She is also a Diplomate of the American Board of Addiction Medicine.

It is more important now than ever before for caregivers to know what is being prescribed to their loved ones and what potential problems may arise. Caregivers should always ask if there is an alternative   non-addictive medication that can be prescribed prior to an opioid. At the very least, the concept of integrative and holistic care can be explained to them as well.  In some instances the use of an opioid is called for, in which case the lowest possible dose should be administered at first, until an appropriate level of pain relief is established.  This is much easier on the patient and the caregiver in the long run. 

Please note that those who are in recovery from addiction to alcohol or prescription drugs should have these medications monitored closely.  Many will do this of their own accord.  However, many will be “off to the races” and never look back.  Another troubling notion is that these drugs may be accessible to tempt family caregivers, children or other household members who may be prone to “experiment” or already have an addiction problem.

Fentanyl, oxycodone, oxymorphone, hydrocodone, hydromorphone and buprenorphine are just some of the generic names of commonly prescribed drugs that may lead to addiction, causing so many of our loved ones to become “accidental addicts”.  Your loved one  may develop a tolerance over time, wanting to take them more often or in higher doses.  Not everyone who takes opioids will become addicted to them.  Many people are able to take them as directed, even recreationally, and stop without consequence.

You may see no signs of addiction until after your loved one is taken off the drug.  You may want to consult your doctor about how to lower a drug’s dosage over a period of time to allow the body to wean itself off of the medication completely.

If addicted, when the prescription runs out your loved one may exhibit any number of symptoms, which vary according to each individual.  Irritability, weight loss, mood swings, headaches, changes in normal behavior, isolation, etc. could be a legitimate cause for concern.  If addiction is the culprit, detoxification treatment may be called for.  Even then, a true addict may relapse, continuing to crave the drug and its effects.  In extreme cases, an addict will find a way to acquire the drug, going to extraordinary lengths to do so.

I am unwavering in the opinion that, in order to achieve the best outcomes for those aging into their senior years, the integration of behavioral health must be included in general clinical practice.  I still like to think that “an ounce of prevention is worth a pound of cure”!