Use of certain drugs has become controversial in recent years in part because of the uptick in addiction and the widespread availability of cheap (and dangerous) “street drugs” masquerading as prescription lookalikes. People who become dependent or addicted are called mentally and emotionally weak and are often stigmatized, labeled socially deviant and worse. But they’re just people who need powerful medications, often to treat severe conditions like chronic pain.

The reality is that there are a number of factors that contribute to addiction, which is why doctors are increasingly sensitive to when they prescribe opioids and for how long. Some researchers believe that suffering from chronic pain may be more vulnerable.

The risks with using opioids to treat chronic pain include:

1) People can become “tolerant” of the drug, requiring higher doses for relief. 

While this does not itself lead to addiction, as the body becomes used to the presence of higher concentrations of a drug and dependent on it for dopamine stimulus that reduces pain sensitivity, cutting back drug use can cause an increase in pain and uncomfortable withdrawal symptoms that can cause people to resume use.

When prescription medications are unavailable, it’s the desire to resume use that can cause people to seek dangerous “street drugs” with unpredictable doses and which may even contain other substances designed to incite addiction.

2) Opioids stimulate dopamine release in a region of the brain associated with pleasure and reward. This can cause an inclination to increase dosage which can then lead to pleasure-seeking behavior.

3) With prolonged use, certain drugs can actually cause physical (neuroplastic) changes in the brain such as creating links between environmental or physical cues and opioid-induced pleasure  or memories, sometimes called “triggering” events. Studies have even shown that prolonged opioid use can remodel synapses, increasing the density of reward-seeking synapses in the brain that bias behavior toward reward and drug seeking. 

While it’s true that rates of addiction from opioids across all prescribed uses is pretty low – around 3.3% overall – it’s important to note that some indications have a higher risk. Among chronic pain users of opioids, a large study of 4.3 million non-cancer chronic pain patients found that nearly 30% show signs of psychologically aberrant, compulsive behaviors indicating misuse or abuse.

This landmark study examined how many people may be impacted, but it did not address exactly why chronic pain patients seem more vulnerable. The cause of addiction is widely studied but remains elusive and unique to the individual. It’s unclear whether chronic pain itself “rewires” the reward circuitry in the brain, making patients more vulnerable to addiction, or whether chronic pain patients are more frequently prescribed higher doses for longer periods, thereby increasing their risk – or both.

Meanwhile, pain professionals must be exceedingly careful to avoid doing more harm than good. What’s important to note is that drugs can affect individuals profoundly differently. In fact, not everyone experiences pain relief from opioids and not everyone becomes addicted while others can use them strictly as prescribed are more vulnerable.

The fact is that powerful drugs are sometimes required, and opioids used to treat acute and chronic pain are no exception. It’s also true that how people react to certain medications can be radically different. Not everyone who uses opioids becomes addicted and others who use them strictly as prescribed become vulnerable to dependency and addiction.

What both pain professionals and patients need is more options for treating chronic pain with fewer risks. Studies show that Nápreva’s active ingredient is not only effective for treating chronic pain, but it does so without side effects. It may even be effective for treating addiction itself.

For some people, Nápreva is extremely helpful, but there are varying degrees of benefit for others. We hope to invest in further studies to determine the potential for using Nápreva in combination with other medications to potentially allow reduced doses to be more effective or useful for longer periods of time.

Learn More:

Prevalence of problematic pharmaceutical opioid use in patients with chronic non-cancer pain: A systematic review and meta-analysis   https://onlinelibrary.wiley.com/doi/10.1111/add.16616

Veterans Administration Whole Health Library: https://www.va.gov/WHOLEHEALTHLIBRARY/tools/supplements-for-pain.asp