Yet some people are at risk for abusing pain medications or becoming addicted to them. This is especially true for those with a personal or family history of alcoholism or other drug addiction.

The problem is most acute with opioid medications such as codeine, oxycodone (OxyContin), meperidine (Demerol), and hydromorphone (Dilaudid). These have pain-relieving powers similar to morphine and other drugs created from opium, a plant extract. Opioids, however, are synthetic--produced in a laboratory rather than derived from plants.

"In our treatment programs, we see a regular influx of people with chronic pain problems and addiction to opioid medications," says Dr. Marvin Seppala, chief medical officer for the Hazelden Foundation. Seppala is a coauthor of a new book, "Pain-Free Living for Drug-Free People: A Guide to Pain Management in Recovery" (Hazelden, 2005), written with Dr. David Martin and Joseph Moriarity.

Opioid use can become addictive for at least two reasons, Seppala says. First, the relief of physical pain is reinforcing in itself. This naturally leads some people to crave opioids for non-medical uses. In fact, opioid medications imitate the action of endorphins and enkephalins--pain-killing chemicals that occur naturally in the human body. Opioids, endorphins and enkephalins bind to many of the same cells in the brain and spinal cord. These cells are key parts of the "pleasure pathway" that is activated when someone becomes addicted to drugs.

Second, relief of emotional pain is also self-reinforcing. "Someone who has had experience of childhood abuse or other emotional trauma--even with no family history of addiction--is at high risk for addiction once they get put on pain medication," Seppala says.

There are ways to greatly reduce such risks. Seppala emphasizes the following strategies. While especially important to people in recovery from alcohol and other drug addiction, they are useful for anyone.

Consider medications other than opioids to treat pain. Opioids are not the only medications for treating pain. Others to try first include non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin. These are available in over-the-counter and prescription forms. In addition, certain medications for depression and seizure disorders also have pain-relieving properties.

Draw on a full range of pain treatments. The expanding field of complementary and alternative medicine opens up possibilities for pain management that go beyond medication. Examples are acupuncture, acupressure, biofeedback, chiropractic treatment, osteopathic medicine, massage therapy, meditation, prayer, yoga, and traditional Chinese medicine.

Make specific agreements about use of opioid medications. If you do get a prescription for opioids, enter into an open and honest agreement with your doctor about how you'll use them. For example, consider signing a written contract that specifies that you will:

• Get prescriptions for opioids from only one doctor.
• Use only one pharmacy to fill those prescriptions.
• Refuse to sell or share your medications. 
• Provide your full medical record to the prescribing doctor, including any history of addiction.
• Keep your doctor informed of all medications that you take, along with their side effects.
• Be willing to try non-drug treatments for pain.
• Authorize your doctor to share information about your treatment with other professionals, such as pain specialists, pharmacists, and emergency room staff. 
• Submit to random urine or blood tests as requested by your doctor.
• Share your pain treatment plan with key people in your life, such as your spouse, other family members, therapist, and fellow members of supports groups such as Alcoholics Anonymous.

--Published August 8, 2005