Question about addiction development

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I have read here a lot of the posts on addiction and have found them to be helpful. Now I have some questions about the development of addiction.

Last year I was involved in a auto accident (rear ended on the highway). I was off from work for a few months,but have returned. I am still doing PT, seeing a couple of specialists including a doc for pain management. At this time i feel that the current meds prescribed are very effective. The problem is that i am worried about becoming addicted to these meds. Currently i am prescribed Duragesic,Darvocet and Opana. Duragesic is the only one that is used as prescribed, the others i attempt to use an OTC anti-inflammatory first and if ineffective then use the others. I am very worried about becoming addicted to these meds. From what i understand about addiction it often begins as a pain relief measure and develops into a physical need. The physical need for them is something i would like to avoid.

My questions......

What were some of the first s/s when you knew your medication use was no longer therapeutic??

I have always thought the impaired nurse was one who obviously (slurred speech, confusion,sleeping) has taken a substance and it affects judgement. What about prescribed meds without these symptoms??

Thanks in advance for any info you can provide

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I remember early in my recovery from addiction (over 15 years ago) being told by a friend in recovery that the litmus test she used when being prescribed narcotic pain meds for legitimate use (after surgery for instance) was that when she found herself questioning if she needed the med or wanted it, she thew away the meds and went to nonprescription OC meds. When I had major surgery three years into recovery (mastectomy with TRAM flap reconstruction) I did that also. I've been told that if narcotics are used for real pain and as prescribed, addiction doesn't happen. There may be a brief time when weaning off the meds is uncomfortable but that is because of physiologic dependence, not addiction. By all means discuss this with your doctor and good luck.

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MIchigoose I really appreciate your input. I understand your recommendation about talking to doc but heres the prob. I am a registered nurse, although i have legitimate pain I am uncomfortable with the way this guy hands out meds as if they were tic tacs. Do i have pain??...Yes. Although i dont consider taking the meds as he prescribes because i think is a recipe for disaster. I havent had a prob with meds....but think its real easy to get one. I think i am predisposed to this type of thing as i have family members who are/were addicts. See my prob?? I feel the need to be ever vigilante or there but for the grace of God go i

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lylenrn, Yes, I see your problem. You are right, your are at risk due to your family history. Is "this guy" your primary physician or a specialist? If a specialist, talk right now with your primary about this. If "this guy" is your primary, consider seeking a second opinion. Doctors who are not familiar with dealing with addiction issues just "don't get it" and are not good for pain patients with addiction or at risk for addiction (like you are). I personally wouldn't consider using a doctor who was not used to dealing with these kinds of patients and who didn't know of my history of alcohol & drug use and my 18 years clean and sober.

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Specializes in Med/Surg/Ortho, Oncology, PACU.

There is a low rate of addiction with use of narcotics. Surprisingly, I was taught in my pain management nursing class that that rate of addiction to narcs (when used correctly for pain) is even LOWER in recovering addicts who are actually working their recovery.

One sign that you may be abusing your narc (but not always a sign you are addicted) is using the med for "feeling good" or for any other reason other than that you are in pain and are using it for that pain. If you notice that you feel the need to do this, it's best to stop and call your physician for a non-narcotic solution.

That's the best advice I can offer. I have never been big on pain meds myself, (I know with alcohol, it kinda ran along the same lines for me. I went from drinking 1-3 cocktails socially every few months to socialize or for get-togethers. For years. Then it became a "reward" for my week of hard work. Or my "medicine" for sleep, or anxiety, or sadness. Then it was my "reward" for simply dealing with life! Then I couldn't picture the point in going out with friends or having a weekend without it.)

I would imagine it's the same with narcs or anything else. So if anyone with other drugs-of-choice has anything more helpful to add on or correct, that'd be great!

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Specializes in ICU, psych, corrections.

I was first prescribed vicodin in my 20's for my menstrual cramps. I have severe dysmenorrhea and would be laid up for about a day each month, even with the pain meds. That went on for about 7 or 8 years and a bottle of 30 would last me an entire year. Then, in my early 30's, I had back to back oral surgeries and was on 7.5mg vicodins each time. After my 3rd surgery, I found myself calling in a refill after about a week, even though reflecting back, my pain probably wasn't as severe as I thought it was. We were going through some financial problems, I hated my job (I was working in a very stressful ICU), and were in and out of court with my husband's ex wife, who had been trying to get custody of their kids. It was the perfect storm, I guess you could say. At the same time, I had also been taking tramadol for my rheumatoid arthritis (don't let anyone tell you that stuff is "non-narcotic"). So when I ran out of the vicodin after my oral surgeries and had no more left, I starting abusing my tramadol. If I took 4 instead of 2, I would get the same buzz I did from the vicodin. Then, my tolerance developed and I found myself with a 20-a-day habit with the tramadol.

My doctors ended up giving me Norco down the road and I found myself with a 40-50 pills a day habit by the time I was at "rock bottom". I wouldn't have been able to tell you when I crossed that line from taking them for therapeutic reasons and the addiction when it happened, but looking back, I think it was when my pain scale became warped. I lost focus of what a "7" truly was or what a "3" was. Now, when I think about how much pain I am in, I compare it to how much I think having my arm ripped off while I am still conscious would hurt. Most of the time, it's about a 4 or 5. And that's a manageable number for me. In the past, everything warranted a pill....everything. Ibuprofen really works....who knew? :p And when I arthritis gets really bad, I do have Celebrex.

As for the symptoms of the impaired nurse....for the first 2 years I was abusing my pain meds, I was "super nurse". I was the Martha Stewart of the ICU. Totally OCD and on top of things. I was the nurse whose charting was finished 10 minutes after my assessment (my coworkers would chart hours later) and had everything labeled, organized and color coded...lol. I never slowed down and had glowing reports on my technical abilities. My ability to handle stress, however, wasn't so great and I admit that I wasn't the best co-worker. I was very emotionally labile and broke down quite easily when my "feelings were hurt". But that was with or without drugs or alcohol :) It wasn't until about a month before I was found unconscious in my unit that my charting got sloppy, my meds were being given late, and I was falling asleep while at the nurse's station. So I imagine a nurse can go on for quite a while, using without being flagged.

I don't know if that is what you were asking but so glad you asked. Such a great question! Because with the increased use of pain medication these days, it's important to be aware of the signs and when that line is being crossed. It seems to me that some patients who might otherwise never have a problem with addiction are ending up with one because of the liberal use of pain meds. Again, that's just one person's observation who had pain meds thrown at her for a condition that is NOT best treated with narcotic pain meds. I wish I had been more educated about cross addiction and the actual biochemistry behind the disease of addiction/alcoholism. I was so darn focused on not becoming an alcoholic like my dad, I didn't even think about becoming addicted to my pain meds. I felt because they were prescribed, it was okay and by the time I knew it wasn't "okay", I was so far gone in my disease, the denial was overwhelming. I'm doing much better on anti-inflammatories these days :D

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I knew i had come to the right place. I thank you all for your replies as well as for sharing your stories. When i have asked other people this question (even other nurses), they look at me as though i am crazy. Some still have the idea of docs as Gods. But to me this has always seemed a recipe for misuse down the road. My injury was bad and requires treatment but i have always questioned this combination of meds.

Michig...i dont think it would be very useful to discuss this matter with my PCP. He referred me to the pain managment doc and thinks hes the best thing since sliced bread. I will try going for a second opinion though

again thanks all

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