Indeed, persistent pain, risk for substance abuse, depression and anxiety are frequently parts of one complex package that requires careful sorting out, says Peggy Compton, a registered nurse and an expert on pain and addiction at the University of California, Los Angeles. But sometimes doctors who are concerned patients might be addicted to their medications simply stop treating them, without addressing the problem. “The patient is very likely in pain,” says Compton. “But they’re being sent out without any pain management, without anybody treating their addiction.”
What’s the average person’s risk of getting hooked? “The answer is we don’t honestly know,” says David Oslin, M.D., a geriatric psychiatrist and addiction specialist at the University of Pennsylvania. “But the sense is that the vast majority take these drugs in a reasonable way.”
It’s important, he says, to understand that anyone who’s on opioid painkillers for more than a month or two may experience uncomfortable symptoms—cold sweats, cramping and the like—if the drug is abruptly withdrawn rather than tapered off. This physiological dependence doesn’t mean a patient is addicted (a term used to describe a problem that’s more psychosocial and often more chronic), so that a patient’s daily life comes to revolve around getting the drugs despite negative consequences.
Who’s the most likely to get into trouble with habit-forming medications? Those with a personal or family history of substance abuse or addiction, mood disorders and childhood sexual abuse.
Full-blown addiction with the associated behaviors—going from doctor to doctor to get more medication, “losing” prescriptions and repeatedly pleading for early refills—probably occurs in at most 5 percent of patients taking the opioid painkillers chronically, says Oslin. A larger group occupies a gray area, taking opiates as prescribed, not getting relief, but very much attached to continuing the drugs rather than trying a different tack. “Are they addicted? In some sense, yes,” says Oslin.
Benzos, after all these years
Another class of prescription drugs that’s proved problematic, especially for older people, is benzodiazepines. Sometimes called benzos or “minor tranquilizers,” these drugs include Valium, Xanax, Klonopin and Ativan and are prescribed for anxiety, panic attacks and sleep disorders. The trend in the use of these drugs is quite different from that of narcotic painkillers. After widespread use in the ’60s, ’70s and ’80s, concern about abuse and dependency drove doctors to push for limiting benzodiazepines to short-term prescriptions. Even so, these pills remain a medical mainstay, with 10 percent to as many as 20 percent of older people reporting taking a benzodiazepine.
In research published in the Journal of General Internal Medicine in 2007, psychologist Joan M. Cook conducted interviews with 50 older patients in Philadelphia primary care practices who were routinely taking benzodiazepines, in some cases daily and for many years. Now an assistant professor in the psychiatry department at Yale University, Cook found the patients felt reliant on the pills, and some expressed a deep reluctance to try going off of them. “I see no reason why I should put myself through hell,” one patient told Cook. “If it makes me feel better, I’m gonna do it … We don’t have that long to live, and we might as well enjoy ourselves while we’re here.”
Feeling better is precisely the point, of course, even though getting off the drugs can be tough at first as anxiety symptoms rebound. In fact, increased well-being is the likely outcome, says Cook. As people get older, the same dose of a benzodiazepine packs more power and can slow mental functioning, cause excessive sedation and lead to falls or other accidents. As one of Cook’s subjects told her: “My head always feels foggy.”