How to use prescription painkillers without getting hooked

Michele Braa-Heidner, 47, started taking prescription painkillers in 1995, when she had her wisdom teeth removed.

Soon after, she developed a painful spinal condition for which she needed several surgeries - and more medications. The drugs relieved the pain and "made me feel really good," she says. Soon, she found that she couldn't get through the day without them. "You're almost chasing that first high, (but) you never get it anymore unless you take a huge amount," she says.

Prescription drug abuse has long been a problem for everyday Americans as well as pill-popping celebrities. About 48 million people, or 20 percent of Americans over age 12, have taken prescription medications - often, the painkillers called opioids - for nonmedical reasons, according to the National Institute on Drug Abuse, and seniors are particularly vulnerable since they often juggle many medications.

Those prescription opioids cause more drug overdose deaths than heroin and cocaine combined, according to the Drug Enforcement Administration. Meantime, painkiller-related admissions to state-licensed treatment centers are on the rise.

But while the stories of current and former prescription opioid addicts are frightening, chronic pain experts note that addiction is relatively rare and that these drugs do offer benefits when they're properly prescribed and used. And there's certainly a need for them.

More than a quarter of Americans age 20 or older - more than 76 million people - say they've experienced pain that lasted longer than 24 hours, according to the American Pain Foundation, and 42 percent of those sufferers have endured pain lasting longer than a year. For many of these people, prescription opioids like the oxycodone (commonly sold as OxyContin) and hydrocodone (sold most popularly as Vicodin) used by Braa-Heidner, as well as meperidine (sold as Demerol) and others, are very helpful.

"I think the fear can be a huge barrier to proper pain control," says Paul Christo, director of the multidisciplinary pain fellowship program at Johns Hopkins University School of Medicine in Baltimore.

So how should you approach using a pain medication to get the relief you need without getting hooked?

First, experts say it's best to stick with one doctor to coordinate your care; that way, she will keep tabs on all the pain medications you're taking. She may also be looking for signs of abuse. Pain specialists can monitor pill use and do urine drug testing to ward off addiction in their patients. They may also require patients to sign treatment agreements that give the doctor permission to take certain steps if he or she suspects addiction - including talking to family members, says Howard Heit, a pain management and addiction medicine specialist based in Fairfax, Virginia.

And there are other systemic measures in place to help curb abuse. Many states have passed legislation to start prescription drug monitoring programs to keep tabs on when, where and for whom controlled substances, including opioids, are dispensed.

Meantime, after being prompted by the U.S. Food and Drug Administration, drug companies are trying to do their part to ease the problem by reformulating drugs to make them more difficult to abuse.

If your pain isn't improving, talk to your physician. It's a bad idea to take medications that haven't been prescribed for you, so don't be tempted to use pills intended for a friend or relative. Instead, see if a different medication or dosing schedule might make things better, and be sure to consider alternative ways of managing pain that might work instead of or in tandem with powerful opioids.

Experts say that injections of steroids or other medications, nerve blocks that interrupt pain signals, physical therapy and psychological interventions such as cognitive behavioral therapy, biofeedback and guided imagery, as well as other relaxation techniques can all be beneficial.

Acupuncture is another option. It's thought to ease pain by raising the level of endorphins - the body's natural pain relieversy, Christo says. "They are released when the body experiences pain, when you sprain your ankle, cut your finger - in response to injury."

And while it may sound counterintuitive, people with chronic pain should try to get exercise, both for the same health reasons as everyone else and, specifically, to avoid muscle atrophy. A 2005 study published in the Annals of Internal Medicine found that a supervised, individually tailored exercise program may help both ease pain and improve function. A physical therapist or personal trainer can help.

If you are using prescription opioids, be aware of the different states that your body may experience. Tolerance occurs when the body adjusts to one dosage and needs increasingly more medication over time to achieve the same result. (This also applies to side effects, so if opioids make you itch, for instance, that feeling may go away as your body adjusts.) People should not be overly concerned about developing tolerance to pain medications, because it's a part of taking the drugs, experts say.

Users can also experience physical dependence, causing withdrawal symptoms such as diarrhea, perspiration and abdominal cramping when they abruptly stop taking the medication. It can occur after as few as two days of continuous use; to reduce symptoms, physicians can help you taper off the dosage, says Christo.

Addiction is far more serious. It involves compulsive use of the drug, continued use despite harm to a person or loved ones, and cravings for the substance. Not everyone who takes the medicine will get hooked, even with years of use, and there's no sure way to predict who will.

The hallmarks of addiction are an inability to keep up with work, school or family matters as a result of drug abuse, and an inability (or refusal) to stop despite those consequences, says Scott Fishman, professor and chief of pain medicine at the University of California-Davis School of Medicine.

As for Braa-Heidner, she's stopped using the drugs that got her in trouble. She soon plans to start, with the help of her psychiatrist, slowly tapering off Suboxone. The drug "has helped me in regards to normalizing my life and getting me out of the ups and downs of taking pain meds every four hours, so I am grateful for that," she says. "I'm feeling quite good about my life right now, and I'm looking forward to succeeding at healing myself and getting off of Suboxone."