By Addy Hatch, College of Nursing

How do people with chronic pain move from appropriate use of opioids to addiction? And what prompts them to seek addiction treatment?

As the United States grapples with rising opioid addiction and overdose death rates, the answers to those questions are critical. Yet they’re not well understood.

Three researchers at the Washington State University College of Nursing studied those transitions and are publishing their findings this month in the journal Nursing Research, under the title “Opioid Initiation to Substance Use Treatment: ‘They Just Want to Feel Normal.’” The researchers include Assistant Professor Marian Wilson, Associate Professor Michele R. Shaw, and Research Associate Mary Lee A. Roberts.

Few studies detail how people with chronic pain transition from appropriate use of opioids to the recognition that they have an addiction, noted Wilson, the study’s lead investigator. Wilson recalls being taught in her previous role as an oncology nurse that people who use opioids for cancer pain cannot become addicted, a notion that is now disputed.

The researchers interviewed 10 adults in the Spokane area diagnosed with chronic pain who were receiving outpatient medication-assisted treatment for opioid addiction (more formally referred to as “opioid use disorder” within the medical field).

In most cases, the study participants began using opioids via a legitimate prescription for pain caused by injury in an accident, or for a medical condition such as infection, childbirth or a birth defect. Two participants reported that they began taking illegal opioids to self-medicate their pain.

The study participants unanimously agreed that they did not receive much information regarding non-opioid therapies to help ease their pain. Some reported being surprised by the high dose of opioids they received for relatively minor pain conditions.

In all cases, psychological and physical craving for opioids set in, then “a gradual shift whereby participants began to realize they were now addicted to opioids,” the study reported. This “transition into dependency” often involved stealing or lying to get more opioids, and “often resulted in devastating consequences regularly described by participants as losing everything that was important to them.”

Eventually, the subjects reached a point where they decided they couldn’t sustain that lifestyle and wanted to return to a more “normal” life. Often the subjects made several failed attempts at stopping opioids before entering medication-assisted treatment — an outpatient clinic where daily opioids, such as methadone, were prescribed to curb their drug cravings.

The study participants relayed that in many cases, their healthcare providers had opportunities to help them identify their addiction and successfully transition into treatment. However, most participants said they felt judged by healthcare providers, who didn’t believe their medical complaints or didn’t take their pain complaints seriously. Often, their “most challenging relationships” were with healthcare workers, according to the study report.

The study findings indicate that nurses and other healthcare workers can play an important role in addressing the nation’s opioid crisis by providing compassionate, nonjudgmental care.

“Healthcare professionals should recognize that pain can be a driving force that may lead some people to use and, eventually, misuse opioids,” Wilson said. “Appropriate pain management that includes non-opioid options is essential, along with recognition that undertreated physical and emotional pain may put someone at risk for opioid addiction. Medication-assisted treatment programs can serve as a lifeline to people who find themselves with the challenging combination of pain and addiction.”

 

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