Substance Abuse Problems: Tolerance, Dependence, and Addiction

When you’re in pain, relief is often the only thing you can think about, and the fastest way to get that relief is often through the use of opioid-based painkillers. Indeed, during the 1990s, painkillers were viewed as one of those “magic bullets,” helping millions of people finally break free from the prison that pain can create. But, as we’ve learned time and again, there really is no such thing as a “magic bullet” in medicine, which is certainly true of opioids. In this case, the price for pain relief can be costly if a substance use disorder develops.

At Comprehensive Pain Management, our team of pain management specialists understands the risks that come with using opioids as a pain reliever, and we work diligently to mitigate these risks. Opioid-based painkillers can still play a valuable role in helping to relieve pain, but only if we help our patients avoid the slippery slope of increasing tolerance, addiction, and dependence.

To help you better understand why opioids can only be used judiciously and under strict oversight, here’s a look at what happens to your body when opioids are introduced and why they pose such a threat.

Increasing tolerance

One of the more eye-opening stats when it comes to opioid use disorders is that 21-29% of patients who are prescribed opioids for chronic pain end up misusing them. One of the reasons why this occurs is that your body develops an increasing tolerance toward the medication the longer you take them.

What this means in terms of pain relief is that you end up needing to take more of your medication in order to achieve the same degree of relief you felt when you first started. It starts off slowly, at first. Perhaps you take a pill an hour earlier than you’re supposed to or you pop two because you’re having a bad spell. Unfortunately, by responding to the increasing tolerance with more medication, you only exacerbate the problem, building your tolerance even more.

The beginnings of addiction

At the same time as your body builds up a tolerance toward your painkiller, your brain’s activity is altered by the opioids. The cells in your brain are equipped with opioid receptors, which is why the painkillers are so effective in the first place. When you take your medication, the receptors in your brain respond quickly, which brings you much-needed relief.

Over time, however, your brain can form new neural pathways that are designed to receive more of the drug, in effect rewiring your brain for drug use. This alteration of your brain’s chemistry also suppresses your natural endorphins, which means you’re reliant on the opioids for pain relief, and much more.

With your brain rewired, you experience uncontrollable urges for more opioids and the more you comply, the deeper into the problem you get. All too soon, you’re unable to stop as your brain takes over — and this can happen to even the most strong-willed among us as the brain is a powerful force.

Enter dependence

With increased tolerance comes increased opioid use. With increased opioid use, comes addiction. Not far behind, or at the same time, your body forms a physical dependence upon the drug, which is separate from what’s happening in your brain. With dependence, your body goes through withdrawal when the substance is taken away, and the withdrawal symptoms from opioids can be especially difficult and range from flu-like symptoms to severe body aches.

Stopping the cycle

Our goal here at Comprehensive Pain Management is to closely monitor our patients so that they don’t enter into the vicious cycle that tolerance, addiction, and dependence can create. To do this, we offer medication management services that we operate under the guidelines the Department of Health sets forth. We understand that opioids can still play a role in pain management, but we also want to avoid the bigger problems that come with a substance use disorder. Through vigilant oversight, we can achieve this goal while providing the pain relief you need.

If you have more questions about using opioids or medication management, please contact one of our offices in Attleboro or Franklin, Massachusetts, or South Kingstown or Warwick, Rhode Island.

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