An addiction to painkillers (also known as painkiller addiction ) is a dependence on medication for pain. Experts divide this group of drugs into three categories, known as analgesics:
- Opioid analgesics
- Non-opioid analgesics
- Cannabinoids
In Germany, opioids and non-opioid analgesics play a particularly important role. Non-opioid analgesics include, for example
- Ibuprofen
- paracetamol
- ASS (acetylsalicylic acid) or
- diclofenac
They are available (in low doses) over the counter from pharmacies. Opioid painkillers, which require a prescription and are partly subject to the Narcotics Act, include
- Morphine
- tramadol
- oxycodone
- Tilidine and
- fentanyl
Fentanyl has an analgesic effect that is up to 100 times stronger than that of morphine. @ Joaquin Corbalan / AdobeStock
Ibuprofen mainly blocks enzyme activity, while opioid painkillers bind to certain receptors in the central nervous system and thus influence the chemical balance in the brain.
In addition to their analgesic properties, opioids also have a psychoactive effect and cause euphoric effects. This increases the potential for addiction and therefore the risk of abuse.
Around 16 million Germans regularly use over-the-counter painkillers. However, the number of prescription drugs is also increasing: In the case of opioids, the amount prescribed rose by around a third between 2006 and 2015.
Around 1.9 million people in Germany are addicted to medication. In addition to painkiller addiction, addiction to benzodiazepines (sleeping pills) also plays a major role in our society.
An addiction to painkillers usually develops gradually and only becomes apparent when it is already too late. When the medication in question is discontinued, those affected develop physical and/or psychological withdrawal symptoms. Another cause of addiction - or a reinforcing factor - is the misuse of a medication.
In terms of symptoms, a distinction can be made between two types of painkiller addiction:
- If someone is addicted to mild painkillers such as ibuprofen, there are usually no serious physical symptoms. The addiction manifests itself more as a psychological dependency. Those affected are convinced that they cannot bear the pain without the medication or that the pain will return immediately. For this reason, they continue to take the corresponding preparations - without medical indication.
- Addiction to opiates, on the other hand, manifests itself in various serious psychological and physical symptoms. For example, those affected develop physical withdrawal symptoms when they reduce the dose. People who take strong opioids usually suffer from psychological and physical dependence after just a few weeks or even days.
Physical withdrawal symptoms can include
Psychological withdrawal symptoms also occur. They manifest themselves as follows:
Those affected who want to stop taking painkillers or start withdrawal should therefore do so under medical supervision.
An addiction to medication can also be recognized by the fact that taking the medication becomes more and more central. Even the thought of having to stop taking them leads to anxiety and panic in those affected.
Addicts often increase the daily dose on their own authority or seek out a doctor who prescribes a higher dose. They minimize physical and psychological side effects in order to avoid having to stop taking the pills.
In most cases, painkiller addicts do not admit their addiction for a long time. The addiction progresses further and further and can then only be controlled with withdrawal.
Morphine is the strongest known natural painkiller used for the treatment of tumor-related pain. @ Sherry Young / AdobeStock
The cause of painkiller addiction is the long-term use of prescription opioids. Taking a painkiller such as ibuprofen or paracetamol once in a while does not make you addicted.
The situation is different with oxycodone or fentanyl: These preparations are addictive, even at low doses, when used long-term.
In order to minimize the impact of painkillers on the brain, patients should only take them for a short time and in the lowest possible dosage. Otherwise the brain classifies the analgesic effect and the euphoric feelings as a reward.
This in turn leads to the so-called "addiction memory", which repeatedly demands this reward. If this does not happen, the body and psyche react with withdrawal symptoms. If, on the other hand, the brain becomes accustomed to the reward, those affected feel the need to take higher doses in order to obtain the desired effect.
A habituation effect can also occur with harmless painkillers and active ingredients such as ibuprofen, paracetamol or ASA. At some point, the drugs no longer have the same effect: While one tablet is enough to relieve the pain at the beginning, several tablets are needed later on.
Another problem - especially with headaches - occurs when the pain worsens despite taking the medication. The cause is often a so-called "drug-induced" headache, which those affected confuse with the actual headache. In addition, many of the medications mentioned can trigger side effects.
According to the WHO, there are six criteria for investigating and diagnosing painkiller dependence:
- Strong desire or compulsion to use
- Reduced ability to control the start, amount and/or cessation of use
- Physical withdrawal symptoms
- Development of tolerance/loss of effect or increase in dose
- Increased time required for procurement
- Continuation of consumption despite consequential damage
- When making a diagnosis, doctors have the problem that the symptoms of drug dependence only appear when those affected reduce their usual dose. Only then does the body react with withdrawal symptoms as a clear indication.
In addition, many side effects look exactly like the problems that caused the person to start taking medication in the first place.
Withdrawal is the best way to overcome an addiction to painkillers. Treatment for opioid addiction should not be undertaken without a supervising doctor, as the withdrawal symptoms can be very distressing. For this reason, addicts should undergo withdrawal in a special addiction clinic.
The aim is holistic treatment. Physical withdrawal begins with phasing out the medication. The doctors gradually reduce the dose and thus limit the severity of the withdrawal symptoms.
This gives the body and psyche time to get used to it. Those affected often accept psychotherapeutic offers. They deal with the causes of their addiction and develop new coping strategies.
Oxycodone is a pain-relieving, anxiolytic and psychotropic agent that is used to treat moderate to severe pain @ Gabriel Cassan / AdobeStock
As the addiction often goes unnoticed, painkiller addiction is usually aslow and insidious process. With therapeutic help, it is usually possible to overcome it. It is important for those affected and their relatives not to delay treatment for too long- in a clinic if necessary. Recovery is quicker and easier if the addiction is not yet so advanced.
Both prescription and over-the-counter painkillers can be addictive. While non-opioid drugs such as paracetamol only cause psychological dependence, physical withdrawal symptoms are possible with opioid preparations.
The diagnosis of painkiller addiction is difficult. Doctors often only recognize the symptoms of addiction when it is already too late. At this point, withdrawal is usually the only remedy.