Opioid pain relievers have a very high potential for abuse, and can be very dangerous if taken beyond recommended doses, or for purposes other then their intended use. However, they can also be extremely useful in controlling otherwise unbearable pain, and allowing someone with chronic pain or recovering from extensive surgery to function.
The challenge then, is what do we do when someone prone to abusing or developing dependence on these drugs has a legitimate, medically supervised use for them, as part of their medical care. While we can not totally mitigate the risks of these substances, there are important guidelines for how to encourage responsible use, as well as some alternative methods of pain relief that can also be explored.
Medically responsible supervision and limited use to avoid abuse
Some drugs are more prone to abuse then others, and so it might be necessary to choose a drug with a lower potential for abuse. The World Health Organization (WHO) has created the helpful concept of a "pain ladder," with mild, non-opioid painkillers at the bottom (some so mild and safe as to available over-the counter), weak opioids in the middle, and stronger painkillers at the top.
Based on the level of pain experienced, you should start at a relatively low place on the ladder, moving up or increasing dosage only if pain relief does not come. The key is to be careful and conservative, trying to use the minimum level of medication that will bring relief.
For the addict, this requires a very important shift in the focus of how painkillers are understood, used with a newfound sense of carefulness and cautiousness. To help with patient-doctor communication in deciding how much pain there is and how it should be managed, a numeric scale of pain, such as the 1-10 scale approved by the Joint Commission of Accreditation of Health Care Organizations, should be used.
If misuse is suspected, doctors can check by requesting patients bring in all medication to see how many are left and that they are all coming from approved sources. In addition, one physician should be handling all prescriptions and overseeing the pain management process, so that you can be more carefully observed to ensure a safe level of use.
For the patient receiving the medication, it is vitally important that the use of the drug remain within the boundaries set by the physician. The doctor should set careful limits in terms of both dosage and intended use, with the goal of making pain more manageable.
If you find yourself either taking more then prescribed, or to "take the edge off" tensions unrelated to the physical pain, that is misuse that is extremely dangerous and can lead to addiction.
Alternative methods of pain relief
Sometimes, a doctor may decide that the risk of developing an addiction is too great. In that case, there are a number of safer alternatives, other ways to relieve pain. Physical therapy can help to deal with moving, exercising, and physical positions that can help to lessen the impact of chronic pain.
Acupuncture and massage can be other methods that may lessen the impact of pain. Also, a psychologist can help deal with pain-related behaviors and thoughts, helping to deal with your responses to pain in healthier ways that do not limit your life.
If you are experiencing pain, talk openly with a doctor about it, as well as your experience with addiction and your concerns. Work together to find an acceptable treatment that can both lessen the pain, and not lead to a relapse of addictive behavior.