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Tapering Opioid User

There’s an experiment I like to do with audiences when I am presenting on the use/misuse of opioids for chronic pain. I ask them to hold their breath…for a while. Then I ask them what they are thinking. The answer is, of course, “when can I take a breath?”

In those moments when people are holding their breath, they mostly think…“When is this guy going to tell us to stop?” Breathing is inherent to living. When it is taken away, nothing else matters except getting to that next breath.

That’s how it is for an opioid-addicted patient. An opioid-addicted patient goes through a daily cycle of being OK and then withdrawing and focusing on getting the next dose. Like needing to breathe. The withdrawal timeline depends on the type of opioid they are on, short-acting or long-acting

While the opioid is at their brain’s set point, they are not craving. But when in withdrawal and if they can’t get the opioid, that’s a whole other problem. They may seek street drugs, or pay a friend a “visit” and case their medicine cabinet, or drink a bottle of booze to help stave off the cravings.

Now imagine being such an individual and you are tapering off the medication, You know the next dose may be a long way off and it won’t be what you are used to. That is the person with a hijacked brain: the injured worker who can think of nothing else except getting something to fill his need for the drug.

The symptoms he may experience include:

  • Early withdrawal symptoms of anxiety and agitation, sweating and rapid heart rate, muscle aches, trouble sleeping and being heavily focused on not having the drug.
  • Late-stage withdrawal symptoms of nausea, vomiting, cramping, goosebumps, depression and more significant drug craving.

An addict’s brain has an increasing dysregulation of brain reward systems, meaning there are decreases in the reward function. Withdrawing from the drug raises thresholds for brain stimulation reward. Decreases in dopamine and serotonin may occur along with increases in brain stress neurotransmitters. The result is a change in the happiness set point.

The set point of happiness is predetermined by things such as heredity and personality traits and stays relatively constant throughout our lives. Our level of happiness may change in response to various life events, but it typically returns to its baseline level. But addiction can change the set point, causing people to feel unhappy unless they are using the drug. Using of the drug becomes a survival need for the injured worker. The effect of withdrawal is both physical and psychological.

Addicts represent about 5-10 percent of the injured workers we see, one of the lowest categories. Treating them successfully requires a combination of closely monitored medication and psychological intervention.

IMCS – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. IMCS makes intervention efficient with a national network of 1,000+ psychologists and psychiatrists in all 50 states.