Taking Prescription Opioid Painkillers as a Recovering Opiate User: Is It Safe?

Among scientists who study addiction, there is a lot of debate about the merits of total abstinence from substances of abuse.  The credo of self-help groups such as Narcotics Anonymous states that a person in recovery can never again take opiates without risking relapse, even if prescription opioid painkillers are prescribed by a doctor.  Other addiction experts say that when properly managed, a recovering opiate user can safely use prescription painkillers for a limited period of time.  Unpacking these mixed messages to arrive at a safe, healthy decision for yourself or a loved one can be a challenge.

Risks Associated with Taking Prescription Opioids Painkillers

To understand the risks associated with people in recovery taking prescription opioid medications, it is important to know the biological effects of opiate abuse.  When a person takes heroin, morphine, oxycodone, and related substances, the opiate molecules travel into the brain.  Once there, they bind to a specific type of receptors that live on brain cells.  These opiate receptors are responsible for the euphoric “high” feeling that people using opiates feel.

In addition to yielding feelings of euphoria and numbing, opiates rearrange the structure of brain cells.  Specifically, they lead to alterations in the brain’s reward pathway.  This causes the brain to need more and more of the drug to get the same pleasurable response.  Thus, over time, the person becomes physically and psychologically dependent on opiates.

Studies in rodents have found that after periods of abstaining from a drug, even a small amount of the substance can reactivate those reward pathways.  The result is a dramatic increase in drug craving and drug-seeking behaviors.  This is why treatment providers become concerned about prescribing prescription opioid painkillers to people in recovery.  Because the person’s reward pathway continues to be susceptible to the effects of opiates, it may be dangerous to take the prescription medications.

Alternative Pain Management Strategies

Of course, there are situations in which a person recovering from opiate dependence needs strategies to manage acute or chronic pain.  It is important to recognize that prescription opioid painkillers represent just one way of decreasing pain.  Other evidence-based pain management practices include:

• Non-opioid pain medications.  Certain types of pain arise in response to the body’s inflammatory response.  Post-operative pain, trauma, infection, or arthritis may trigger this type of pain response.  Non-narcotic pain medications such as NSAIDs (e.g., ibuprofen, naproxen) or corticosteroids may be sufficient to manage this pain.
• Muscle relaxants.  For chronic muscle pain, medications that relax muscles may be the best pain relief strategy.  For example, Valium, Soma, or Norflex are commonly prescribed to treat muscle pain.
• Local anaesthetics or topical analgesics.  For pain that occurs in a specific area, local anaesthetics or topical analgesics may be more appropriate than prescription narcotics.  For example, a lidocaine patch or gel may provide local pain relief.
• Acupuncture.  Millions of people have found pain relief through alternative medicine practices such as acupuncture.  Acupuncture targeting specific body areas can help alleviate chronic pain.
• Biofeedback.  During a biofeedback session, small electrodes are attached to the skin.  By viewing a monitor that indicates your heart rate, skin sweating, and other responses, your brain can actually begin to control involuntary body responses.  After a few biofeedback sessions, many people discover how to manage their own chronic pain.
• Mindfulness meditation.  Mindfulness techniques are a way of centering and calming the mind, allowing a person to attend to the current moment.  Proponents of mindfulness meditation often say that they feel the pain washing over them without it taking power over their lives.  Learning mindfulness meditation from a therapist often helps pain patients reclaim their lives.

There are certainly risks associated with recovering opiate users taking prescription opioid painkillers.  Exploring alternative pain management techniques represents a healthy, safe choice for many patients.