It starts from the very moment of amputation when most patients are given a PCA (patient-controlled analgesia) pump so that when they wake up from the deep sleep of anesthesia they can control their own level of pain.
What am I talking about? The possibility of becoming a prescription-drug abuser or addict.
What Is Drug Abuse and Addiction?
Drug abuse refers to the use of a drug for purposes for which it was not intended or using a drug in excessive quantities.
Drug addiction is a state of physical or psychological dependence on a drug and is characterized by compulsive, at times uncontrollable, drug craving, seeking, and use that persist even in the face of extremely negative consequences. Physical addiction is characterized by needing more and more of the drug to achieve the same effect (tolerance) and withdrawal symptoms that disappear when further medication is taken.
All sorts of drugs can be abused, including illegal drugs (such as heroin or cannabis), prescription medicines (such as tranquilizers or painkillers), and other medicines that can be purchased off of the supermarket shelf (such as cough mixtures or herbal remedies).
The Risk for Amputees
It is estimated that 4.7 million adults abuse prescription drugs each year, many of whom become addicted. Though amputees do not necessarily stand out as the greatest abusers, the amount of prescription drugs given to new amputees to control their preoperative and postoperative pain greatly increases their chances of becoming abusers or addicts. And we haven't even counted all of the other medications the new amputee might already be taking.
As an amputee, you will probably be taking many different drugs, not just for pain but also for sleep, nervousness, depression, etc. That's a lot of drugs, and, believe me, it is very easy to fall into the trap of abuse and even addiction.
The medical community once wrongly believed that giving pain-control medication to patients would automatically lead to addiction. As a result, many patients suffered unnecessarily. Fortunately, it is now understood that if a patient is in pain and is taking his or her medication as prescribed, the possibility of becoming addicted is almost nonexistent. Note the words “as prescribed.”
Dealing With Pain
For those amputees who suffer from chronic nonmalignant pain, opioid drugs are commonly prescribed because of their effective analgesic, or pain-relieving, properties.
Among the compounds that fall within the opioid class – sometimes referred to as narcotics – are morphine, codeine, and related medications. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other opioids that can be prescribed to alleviate pain include oxycodone (OxyContin is an oral, controlled-release form of the drug), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), and meperidine (Demerol), which is used less often because of side-effects.
Contrary to common fears, numerous studies have shown that addiction is extremely rare in pain patients taking opioid drugs, even those with a history of drug abuse or addiction. Patients with chronic nonmalignant pain will develop a physical dependence on opioid drugs, but this is not the same thing as addiction, which is an aberrant psychological state.
Unrelieved pain has many negative health consequences, including but not limited to:
- Increased stress, metabolic rate, blood clotting and water retention
- Delayed healing
- Hormonal imbalances
- Impaired immune system and gastrointestinal functioning
- Decreased mobility
- Problems with appetite and sleep
- Needless suffering.
Chronic nonmalignant pain also causes many emotional/psychological problems, including low self-esteem, powerlessness, hopelessness and depression.
Because pain control is so important in helping people avoid these negative consequences, it is important that patients not be overly fearful of becoming addicted as long as they take their medications as prescribed.
The medical community once wrongly believed that giving pain-control medication to patients would automatically lead to addiction. As a result, many patients suffered unnecessarily. Fortunately, it is now understood that if a patient is in pain and is taking his or her medication as prescribed, the possibility of becoming addicted is almost nonexistent. Note the words “as prescribed.” If you follow your healthcare providers' instructions, you should have no problems or worries. If you do not, watch out!
It Can Happen to Anyone
I am trained in both medicine and psychology, and I myself came very close to becoming addicted to pain medication after my own amputation surgery!
I took a lot of pain medication, including OxyContin and Vicodin. I spent weeks trying to get rid of my postoperative pain, and these medications did help me. The biggest problem I had, however, was trying to face the reality that I no longer had a leg and my belief at the time that I would not be independent anymore. I spent months lying on the couch feeling sorry for myself, and as long as I took these drugs, I did not have to face reality. I was happy living in a world of denial and enjoying the euphoria caused by these drugs.
Once I stopped taking the medication, I thought that my problems would end, but they were just starting. I now had to face the reality of my limb loss. It was a good thing, however, because I was then able to really begin healing. Today, I run an organization called M-STAR (Michigan Society To Advance Rehabilitation), and I have had the opportunity to help hundreds of amputees around the world.
Please don't let yourself get caught in the trap of abuse or addiction. If you are abusing drugs, please take your first step toward healing today.
What Causes Drug Abuse and Addiction?
This depends on the nature of the drug being abused, the person taking the drug, and the circumstances under which it is taken. Some medications – for example, certain sleeping pills or painkillers– are physically addictive. They have a specific effect on the body that leads to tolerance and withdrawal symptoms. Others may lead to a psychological addiction if people have a craving for the effect that the drug causes.
There has been some speculation that some people may be more prone to drug abuse and addiction than others. Research is being done to learn whether there may even be genes that predispose certain people to addiction. Social circumstances are also important factors in drug abuse. Peer pressure, emotional distress, and low self-esteem can all lead individuals to abuse drugs. Ease of access to drugs is another important influence.
People abuse drugs for a reason. Understanding what the person's motivation is helps to explain why that person is abusing drugs.
Though prescription medications, such as pain relievers, tranquilizers, stimulants and sedatives, are very useful treatment tools, sometimes people do not take them as directed, and, as a result, they may become addicted. Pain relievers, for example, make surgery possible and enable many individuals with chronic pain to lead productive lives. While most people who take these medications use them responsibly, the inappropriate or nonmedical use of them is a serious public health concern.
Patients, healthcare professionals, and pharmacists all have roles in preventing the misuse of and addiction to prescription medications. When a doctor prescribes a pain relief medication, central nervous system (CNS) depressant or stimulant, the patient should follow the directions for use carefully, learn what effects the medication could have, and determine any potential interactions with other medications. The patient should read all of the information provided by the pharmacist. Physicians and other healthcare providers should screen for any type of substance abuse during routine history-taking, with questions about which prescription drugs and over-the-counter medicines the patient is taking and why. Providers should note any rapid increases in the amount of a medication needed or frequent requests for refills before the quantity prescribed should have been used; these may be indicators of abuse.
Commonly Abused Prescription Medications
While many prescription medications can be abused or misused, opioids, CNS depressants and stimulants are the most commonly abused.
Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can effectively change the way a person experiences pain.
In addition, opioid medications can affect regions of the brain that determine what we perceive as pleasure, resulting in the initial euphoria that many opioids produce. They can also produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could even cause severe respiratory depression or death.
Opioids may interact with other medications and are, therefore, only safe to use with other medications under a physician's supervision. Typically, they should not be used with substances such as alcohol, antihistamines, barbiturates or benzodiazepines. Since these substances slow breathing, their combined effects could lead to life threatening respiratory depression.
Long-term use can also lead to physical dependence. The body adapts to the presence of the substance, and withdrawal symptoms occur if use is reduced abruptly. This can also include tolerance, which means that higher doses of a medication must be taken to obtain the same initial effects. Note that physical dependence is not the same as addiction; physical dependence can occur even with appropriate long-term use of opioid and other medications.
Individuals taking prescribed opioid medications should not only be given these medications under appropriate medical supervision but should also be medically supervised when stopping their use in order to reduce or avoid withdrawal symptoms. Symptoms of withdrawal can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and involuntary leg movements.
Warning Signs of Drug Abuse or Addiction
Many signs indicate that an individual might have a drug or alcohol addiction. The following drug addiction signs are cues to look for in yourself or others. Be aware that possessing several of these signs does not always mean that a drug addiction is present, but if one is suspected, be supportive of the individual in his or her road to recovery.
Drug Addiction Signs
- Increase or decrease in appetite, changes in eating habits, unexplained weight loss or gain
- Smell of substance on breath, body or clothes
- Extreme hyperactivity; excessive talkativeness
- Change in activities; loss of interest in things that were important before
- Changes in habits at home; loss of interest in family and family activities
- Difficulty in paying attention; forgetfulness
- Lack of motivation, energy, self-esteem, or discipline; bored; “I don't care” attitude
- Defensiveness, temper tantrums, resentful behavior (everything's a hassle)
- Unexplained moodiness, irritability or nervousness; violent temper or bizarre behavior
- Unexplained silliness or giddiness
- Paranoia, suspiciousness
- Excessive need for privacy; keeps door locked or closed, won't let people in
- Secretive or suspicious behavior
- Car accidents, “fender benders,” household accidents
- Change in personal grooming habits
- Doctor shopping – several appointments with different doctors to stock up on medication
How Do I Know If I Have a Problem?
You have a problem if you keep craving and using a drug even if it's causing trouble for you. The trouble may be with your health, with money, with work or school, or with your relationships with family or friends. Your friends and family may be aware you're having a problem before you realize it because they see changes in your behavior.
What Other Problems Might I Experience?
When you abuse any medication, you risk the possibility of doing irreparable damage to yourself, your family, and your relationship to them. If you abuse certain medications, for example, they will alter your ability to balance properly, and you could fall and hurt yourself. Some could also cause you to miss physical therapy and/or doctor appointments, thereby hindering your healing process.
It is important to note that even if you take some of these medications exactly as your healthcare provider instructs, you may still experience some of these problems and unwanted reactions. If this happens, contact your healthcare provider at once so that he or she can change your medication or the dosage.
Can Addiction Be Treated?
Yes, but addiction is a chronic, relapsing disease. It may take a number of attempts before you can remain free of drugs or alcohol.
Why Should I Quit?
Breaking your addiction is the only way to stop the problems drugs are causing in your life. It may not be easy to quit, but your efforts will be rewarded by better health, better relationships with the people in your life, and a sense of accomplishment that only living drug-free can give you. As you think about quitting, you may want to make a list of your reasons for wanting to quit.
How Do I Stop?
The first step in breaking addiction is realizing that you control your own behavior. You can't control how the people around you act, but you can control how you react. It's the only real control you have in your life. So use it. The following are the first steps to breaking your addiction:
1. Commit to quitting. Once you decide to quit, make plans to be sure you really do it.
2. Get help from your doctor. He or she can be your biggest ally, even if you're trying to quit a drug he or she prescribed. Your doctor may be able to prescribe medicine that makes you less likely to crave the addictive drug. Talking with your doctor or a counselor about your problems and your drug use can be helpful too.
3. Get support. Contact one of the local organizations that provide assistance for substance abuse or addiction. Look up their contact information in the Yellow Pages or call your local health department for a list. For referrals to treatment programs, you may also call 800/662-HELP or visit the Substance Abuse & Mental Health Services Administration online at http://findtreatment.samhsa.gov.
These groups are dedicated to helping people who have addictions. They want you to succeed, and they will give you the tools and support you will need to quit using these drugs and move on with your life. Ask your family and friends for support too.
I wish you well on your journey.
Note: This article is intended for educational purposes only. For specific advice about appropriate drugs for your condition, potential side-effects/interactions, or drug abuse and addiction, you should contact a doctor and/or a mental health professional.
National Institute on Drug Abuse
Schaffer Library of Drug Policy
About the Author
Saul Morris, PhD, is a below-knee amputee and veteran naval commander, who is educated in both psychology and medicine. The founder and director of M-STAR (Michigan Society To Advance Rehabilitation), an organization that provides amputee peer counseling to new amputees, he also spends an enormous amount of time educating the medical profession about the value of amputee peer counseling and the psychology of amputation.