Pain Medication Addiction - Specialists and Information

Painkiller dependence (also known as painkiller addiction) refers to a dependence on medications used to treat pain. Known as analgesics in medical terminology, experts divide this group of medications into three categories:

• Opioid analgesics
• Non-opioid analgesics
• Cannabinoids

In Germany, opioids and non-opioid analgesics are the most common. Examples of non-opioid analgesics include:

• Ibuprofen
• Paracetamol
• ASA (acetylsalicylic acid) or
• Diclofenac

They are available over the counter (in low doses) at pharmacies. Opioid pain relievers, which require a prescription and are in some cases subject to the Narcotics Act, include:

• Morphine
• Tramadol
• Oxycodone
• Tilidine and
• Fentanyl

Fentanyl has a pain-relieving effect that is up to 100 times stronger than that of morphine. @

Ibuprofen primarily blocks enzymatic activity. Opioid pain relievers, on the other hand, bind to specific receptors in the central nervous system, thereby influencing the chemical balance in the brain.

In addition to their pain-relieving properties, opioids also have psychoactive effects and induce euphoria. This increases their addictive potential and thus the risk of abuse.

About 16 million Germans regularly use over-the-counter painkillers. But the number of prescription medications is also rising: between 2006 and 2015, the amount of opioids prescribed increased by about one-third.

About 1.9 million people in Germany are addicted to medications. In addition to painkiller addiction, dependence on benzodiazepines (sleeping pills) also plays a major role in our society.

Painkiller addiction usually develops gradually and often goes unnoticed until it is already too late. When people stop taking the medication in question, they experience physical and/or psychological withdrawal symptoms. Another cause of addiction—or rather, a contributing factor—is the misuse of a medication.

In terms of symptoms, two types of painkiller addiction can be distinguished:

1. If someone is dependent on mild painkillers such as ibuprofen, serious physical symptoms usually do not occur. The addiction is more likely to manifest as psychological dependence. Those affected are convinced that they cannot tolerate the pain without the medication or that the pain will return immediately. For this reason, they continue to take the medication—without a medical indication.
2. Addiction to opioids, on the other hand, manifests itself through various serious psychological and physical symptoms. For example, those affected develop physical withdrawal symptoms when they reduce their 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:

• cramps,
• headaches
• Tremors, and
• sweating

Psychological withdrawal symptoms also occur. They manifest as follows:

• Depressive moods
• Sleep disturbances
• Hallucinations or
• Feelings of anxiety and panic

People who want to stop taking painkillers or begin withdrawal should therefore do so under medical supervision.

Drug dependence can also be recognized by the fact that taking the medication becomes increasingly central to one’s life. Even the thought of having to go without the medication for a single dose causes anxiety and panic in those affected.

Addicts often increase their daily dose on their own or seek out a doctor who will prescribe a higher dose. They downplay physical and psychological side effects so they don’t have to stop taking the pills.

In most cases, people addicted to painkillers do not admit to their addiction for a long time. The addiction continues to progress and can eventually only be managed through withdrawal.

Morphine is the strongest known natural painkiller used to treat cancer-related pain. @ Sherry Young / AdobeStock

The cause of painkiller addiction is the long-term use of prescription opioids. Taking a painkiller like ibuprofen or acetaminophen every now and then will not make you addicted.

The situation is different with oxycodone or fentanyl: these medications can lead to dependence even at low doses with long-term use.

To minimize the impact of painkillers on the brain, patients should take them only for a short time and at the lowest possible dose. Otherwise, the brain classifies the pain-relieving effect and the euphoric feelings as a reward.

This, in turn, leads to what is known as “addiction memory,” which repeatedly craves this reward. If the reward is not received, the body and mind 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 to achieve the desired effect.

A tolerance effect can also occur with harmless pain relievers and active ingredients such as ibuprofen, acetaminophen, or aspirin. At some point, the medications no longer produce the same effect: While one tablet may initially be enough to relieve the pain, several are needed later on.

Another problem—especially with headaches—arises when the pain worsens despite taking the medication. The cause is often a so-called “medication-induced” headache, which those affected confuse with the actual headache. In addition, many of the medications mentioned can cause side effects.

According to the WHO, there are six criteria for assessing and diagnosing painkiller dependence:

• A strong desire or compulsion to use the medication
• Reduced ability to control when to start, how much to take, and/or when to stop taking the medication
• Physical withdrawal symptoms
• Development of tolerance/diminished effect or increased dosage
• Increased time spent obtaining the drug
• Continued use despite adverse consequences
• When making a diagnosis, doctors face the challenge that the symptoms of medication dependence do not appear until the person reduces their usual dose. It is only then that the body reacts with withdrawal symptoms, which serve as a clear indication.

In addition, many side effects resemble the very problems that led individuals to start taking the medication in the first place.

Withdrawal is an effective way to overcome painkiller dependence. Treatment for opioid addiction should not be undertaken without the supervision of a doctor, as withdrawal symptoms can be extremely distressing. Therefore, individuals with addiction should undergo withdrawal at a specialized addiction treatment center.

The goal is holistic treatment. Physical withdrawal begins with tapering off the medication. Doctors gradually reduce the dose, thereby limiting the severity of withdrawal symptoms. 

This gives the body and mind time to adjust. Those affected often take advantage of psychotherapy services. They address the causes of their addiction and develop new coping strategies.

Oxycodone is a pain-relieving, anxiolytic, and psychotropic active ingredient used to treat moderate to severe pain. @ Gabriel Cassan / AdobeStock

Since addiction often goes unnoticed, painkiller dependence is usually a slow and insidious process. With therapeutic help, recovery is generally possible. It is important for those affected and their loved ones not to delay therapy—including, if necessary, treatment at a clinic—for too long. Recovery is faster and easier when the addiction has not yet progressed too far.

Both prescription and over-the-counter painkillers can be addictive. While non-opioid medications such as acetaminophen cause only psychological dependence, opioid medications can lead to physical withdrawal symptoms. 

Diagnosing painkiller addiction is difficult. Doctors often do not recognize the symptoms of addiction until it is already too late. At that point, detoxification is usually the only effective treatment.