Accidental addiction: Just one pill too many
All addiction is accidental, explained Dr. Zoe Weinstein, director of the Inpatient Addiction Medicine Consult Service at Boston Medical Center, home of the Grayken Center for Addiction Medicine. “No one intends to become physically dependent on a substance, and then have cravings, compulsive use and negative consequences in his or her life.”
But the dependence can sneak up on you. Some drugs affect what’s called the brain’s reward system, which releases a chemical called dopamine. This system controls the sensation of pleasure and motivation, and compels a person to repeat certain behaviors that bring gratification, such as eating a satisfying meal or spending time with family and friends. Overstimulation of the system, however, causes a “high” that can induce an individual to take the drug again and again.
With repeated use of the drug, the brain eventually stops responding to the flood of dopamine and no longer produces the intense original high. In turn, that causes the individual to take more of the drug to retrieve that initial pleasure. That’s how substance use and addiction take hold. The desire for a better high can be persistent, which raises a challenge to recovery. Because of changes that have occurred in the brain, some people relapse and return to drug use even after years of abstinence.
Certain medications are more apt to produce these results. Controlled substances such as opioids, amphetamines and barbiturates, have a higher risk of causing physical dependence and addiction, said Weinstein. These drugs are commonly used for the treatment of pain, attention deficit hyperactivity disorder, anxiety and panic attacks.
Although controlled substances are most likely to cause physical dependence, certain over-the-counter drugs have misuse potential as well, explained Weinstein. For instance, cough or cold medications contain ingredients that may produce euphoria, or even hallucinations in quantities greater than the recommended dose. “These medications are more typically misused by teens,” she said.
Some people may be of higher risk for addiction, especially when using opioids for pain. The Opioid Risk Tool was developed to help assess characteristics that might lead to addiction. The risk factors cited are family and personal history of substance use disorder, the existence of psychological disease, such as depression or schizophrenia, and age between 16 and 45 years. Females who suffered preadolescent sexual abuse may also be at risk.
Further complicating the issue is that some people might not even be aware they have a substance use problem. That’s why the Addiction Consult Service at BMC provides such a valuable service. The Service is designed to help patients who are hospitalized for other reasons but found to be addicted. The program initiates medication-assisted treatment for their addiction during hospitalization and then helps patients transition to outpatient treatment programs. Research has shown that the Inpatient Addiction Consult Service reduced emergency department visits by approximately 30 percent and readmission rates for high-risk patients by roughly 40 percent.
The crisis of substance use has taken its toll. In 2016, approximately 2,000 deaths in Massachusetts were attributed to unintentional or undetermined opioid-related overdose deaths, according to a report from the Massachusetts Department of Public Health. The socio-economic impact of use of illicit drugs costs the country $400 billion for health care, lost work productivity and crime, as determined by the National Institute on Drug Abuse.
In Massachusetts, measures have been taken by health professionals and the legislature to curb the epidemic. As an example, effective in March 2016, state law requires that initial opiate prescriptions be limited to a 7-day supply for outpatient users. Pharmacists dispensing such substances are required to keep an accurate record of the transaction, including name and address of the purchaser, as well as the strength and quantity of dosage dispensed. Doctors and dentists are advised to screen and counsel all patients about the risk of addiction and dependence with any controlled substance. “Providers must continuously weigh the risk and benefit of prescribing any substance with risk [potential], and should be able to identify and treat addiction if and when it develops,” Weinstein said.
The $25 million gift from the Grayken family will help advance BMC’s mission to continue the Addiction Consult Service and other programs designed to curb the opioid epidemic in Boston. The BMC Grayken Center for Addiction Medicine will play a key national role in research, treatment, training and prevention of substance use disorder.