The limit of pain killers:

Fearing that her doctor would stop prescribing the medication if she told him that she had increased the dosage, she kept it a secret. She did not believe that she would be able to function without the pills. She began to change the numbers on the prescriptions so that she would get more pills, with more refills.

Over the next two years, she went from a physical dependence to a physical and psychological addiction. She had to continue to take this drug in increasing dosages in order to feel “normal.” She went from taking the medication, as prescribed, to a drug habit of 30 pills a day.

Folashade Aderemi, a 32-years-old banker usually have a hectic day. As a customer service officer, her job is very demanding and requires her to talk for longer hours to customers who need clarifications about the bank’s services. At the close of the day, she usually end up worn out but she soon found solace in Paracetamol Extra, which instantly relieves him of his aches but gradually, when the pain killer did not  achieve its desired results, he increased the dosage and soon, he started taking  15 pills at once.

Sylvia and Folashade’s experiences are replicated in Danjuma Bala a middle aged businessman who had over the years grown addicted to Velium 5, a sleeping pill which induces patients to sleep. According to Bala, “I started having sleep disorders about five years ago. I would come back from work and find it very difficult to sleep and when I eventually fall asleep, it would last for only about thirty minutes and then I would wake up again. I approached a pharmacist who prescribed Velium 5 for me, which worked like magic and since then I have been relying on the drug to induce me to sleep. Now, I can’t really sleep deeply on my own without some form of inducement.”

A great deal has been written about alcoholism and drug addiction over the last two decades. However, information regarding prescription drug abuse and addiction only seems to surface when someone famous has a problem and needs treatment or dies. For instance, the death of the king of pop, Michael Jackson further confirmed how prescription drugs can become addictive. Jackson was reported to have given up the ghost shortly after he was administered a dose of Demerol, a pain killer meant to relieve him of the pains from the injuries which he had sustained performing, where he had broken a vertebra and he had broken his leg from a fall on the stage, while rehearsing for his comeback concerts scheduled for 13th July.

Historically, prescription drug addiction has been the most underreported drug abuse problem in the nation. It is also the least understood. Addiction to and withdrawal from prescription drugs can be more dangerous than other substances because of the insidious nature of these drugs. According to an Abuja based pharmacist who spoke to Sunday Trust on an anonymous condition, “prescription drugs are basically called poisons because they have harmful effects on the human body. Prescription drugs like Diaxiphram, popularly   referred to as Valium, if properly used, can achieve its desired results, but if abused, it can be very fatal to the liver. People who take these kinds of drugs are usually hypertensive patients who have difficulties with sleeping.” On the difference between prescription and non-prescription drugs, he opined that non-prescription drugs are drugs commonly referred to as O.T.C. drugs (over the counter drugs) like paracetamol, panadol extra, dietary supplements, like blood capsules and other blood tonics which can be taken by anybody and they contain less poison. But as a pharmacist, I don’t just attend to  anybody who walks up to my shop demanding for drugs. I usually ask for the prescription notes by the doctor, but when they come for drugs like paracetamol and other OT.C drugs, I have no choice but to dispense them,” he said.

But in a chat with Sunday Trust, Mike Egwu, a pharmacist with Nisa  Specialist Hospital, Jabi, Abuja said that indiscriminate consumption of pain killer drugs is a very serious issue under the drug abuse syndrome by many Nigerians. According to him, “pharmacologically, drugs can be classified into two broad categories, which include narcotic and non-narcotic drugs. Under the non-narcotic drugs, there is what is referred to as NSAID which means non steroidal anti-inflammatory and examples are Paracetamol, Ibuprofen, Aspirin, Diclophenal, etc. These are conventional pain killers which could be used either orally, parentologically or through ingestion. Narcotic Drugs are widely abused drugs. They also act as pain killers. For instance, Codins, Morphine, Tramadol, Pentazocine, Optalidon, Dihydrocodine, Codorne, amongst others.”

He also attributed pseudo true/false feelings as one of the reasons why people abuse drugs. According to him, addiction to pain killer drugs can be in two forms which include physiological and psychological addictions. Physiological addiction, according to him, is a phenomenon when a person cannot do without taking a certain drug to the extent that without such drugs, the person would feel sickly. In his words, “Drug tolerance is basically the body’s ability to adapt to the presence of a drug. When narcotic substances are taken regularly for a length of time, the body does not respond to them any longer. Tolerance then becomes defined as a state of progressively decreased responsiveness to a drug as a result of which a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose.”

Dr. Kingsley Odika of the Holy Cross Hospital, Abuja, while describing the   difference between addiction to pain killers and alcoholism, told Sunday Trust that “Prescription drug addiction is no different from alcoholism or an addiction to any other substance. However, no one is prescribed alcohol or cocaine for medical reasons. People who suffer from chronic pain are in a very difficult position. Pain killers do relieve pain. For people who suffer from constant and chronic pain, narcotics may be necessary to allow them to have any quality of life. The downside is becoming physically dependent and risking the possibility of addiction.

While it is true that the drugs themselves are highly addictive, not everyone who takes pain killers becomes an addict. The statistics of those suffering from chronic pain who become addicted to these drugs are actually pretty low. However, this is not to say that those who suffer with chronic pain are not at increased risk of prescription drug addiction.”

Speaking further, he said “There is a difference between dependence and addiction. Dependence occurs when tolerance builds up and the body needs the drug in order to function. Withdrawal symptoms will begin if the drug is stopped abruptly. On the other hand, when a person is dependent on the regular use of a drug to satisfy physical, emotional, and psychological needs, they are addicted to that substance. Physical dependence exists as well, but the drug has become a way to cope with all kinds of uncomfortable feelings.

Many prescription drug addicts do begin by needing the drug prescribed to them for medical reasons. Somewhere along the line, however, the drug begins to take over their lives and becomes more important than anything else. Nothing will stop them from getting their drug of choice.

It may be difficult to understand how someone could let this happen. How could someone who is reasonably intelligent and sophisticated in regards to drug addiction become an addict? Addiction has nothing to do with intelligence. And addiction to prescription drugs is no different from any other substance abuse problem. Many people in the medical profession abuse prescription drugs.

Health care providers may have a slightly higher rate of addiction due to both the stressful nature of the work and their relatively easy access to supplies of narcotics. Clearly, the potential risks and dangers involved with taking narcotics are not unknown among health care providers. This, however, doesn’t stop someone from becoming an addict. Some 12-step members have described addiction as a disease of the emotions”

Another doctor at the Wuse General Hospital who spoke to Sunday Trust on the condition of anonymity explains the processes involved in withdrawing from addiction to pain killers. According to him, “When an individual becomes physically dependent on pain killers or benzodiazepines, he should not just suddenly stop taking them. Stopping suddenly can cause seizures and possibly even death. The risk of a seizure is actually quite high. Dependency might be dealt with by tapering off the medication. Some people have been successful using this approach. Addicts have often found tapering to be unsuccessful because their addiction is both physical as well as psychological. If tapering is done in patient, it has more of a chance of success.”

Withdrawal symptoms can be, and often are, difficult. Benzodiazepines, for example, are stored in the tissues and fat cells. Getting the drug out of your blood stream can take a long time. Drugs that go through the digestive tract are more quickly excreted.

Even when someone detoxes inpatient, the symptoms often feel unbearable. While the acute withdrawal symptoms generally last a couple of weeks, the prolonged withdrawal, called Post Acute Withdrawal Syndrome (PAWS) lingers. These symptoms have been known to last a year or longer.

In addition, the person who suffers from chronic pain may initially be in more pain than they were before they began to take pain killers. Pain killers and benzodiazepines repress the body’s natural production of dopamine and endorphins (the “pleasure centre of the brain”) and take over their function. After the drug is detoxed, it takes some time before the body’s natural pain receptors “wake up” and begin to function normally again.

What other options does someone who suffers from chronic pain have?  

The doctors responded thus “After becoming drug-free, this issue still needs to be addressed. Some people believe that they can never take prescription narcotics again and need to remain abstinent for life. Other methods of pain relief like meditation, breathing exercises, yoga, or biofeedback may provide some relief. For recovering addicts who need to be on narcotic pain killers, having someone else responsible for the medication may be a good idea.”

While reacting, NAFDAC’s regulatory officer for the FCT, Pharmacist Bolarinwa Yusuf described pain killers or analgesics as “drugs that are generally used when one is in pains or as a result of hard work that you have carried out or probably you are in one sickness or the other and the main reason why people normally abuse drugs, in this case, is when they just experience a particular pain in the body which may be due to a particular disease in the body that is not diagnosed. They feel that if they take a particular drug, the pain might go away so, abusing such drugs could either be a case of under dose or overdose. Maybe they have seen their friends using that particular drug whenever they are in pains and they might not know that they are not suffering from the same causes. What they are doing at that particular time is gross abuse of drugs. Common drugs that are easily abused are sleeping drugs, lexotan, traman, valium but it also has its own side effect.

So it is always good to visit your doctor who will examine you and, in his own professional judgement, will now know how to treat your ailment. These days when people have just slight headache, they go ahead and take paracetamol. When they find out that they are not sleeping, the next thing you see is that they go for lexotan, not knowing that the cause of that headache might be hypertension. When you take this kind of pain killers, it will just suppress the disease and the pain will remain. That is why we have cases of stroke and heart failure. People sleep and don’t wake up because, they take pain killers and the pain killers mast the problems. The disease remains untreated. So the general advice to the public is when you feel a particular pain in your body, just go straight to your, doctor who will give you a proper diagnosis.”