Prescription for Addiction

Pain killers that contain opioids can cause addiction after taking them for just three weeks. What makes this tendency so fatal is that since the year 2000, doctors in the US have been prescribing increasing amounts of these drugs for relatively minor pain. The number of people who have become addicted to opioids since then has risen drastically. It’s caused an epidemic of drug addiction that has affected whole regions of the US, including broad cross sections of society. Judith Burggrabe speaks with Prof. Dr. Michael Müller of the Institute of Pharmaceutical Sciences of the University of Freiburg about the dangers of drugs that contain opioids.

The graded guidelines for prescribing some medicines created by the World Health Organization (WHO) offer some protection. Photo: Alexander Raths/stock.adobe.com

Mr. Müller, would a similar addiction crisis like the one in the US be possible in Germany?

Michael Müller: Yes, but to a much lesser degree. The risk of becoming addicted to pain killers exists in Germany as well, especially because certain opioid-containing medications are being increasingly prescribed. I don’t think that the situation will become as drastic as it has in the US, where drug overdoses, including of some opioids, have in the meantime become the most common cause of death among people under fifty. Yet the risk cannot be underestimated.

What ingredient makes the drugs become addictive so rapidly?

Primarily oxycodone, but it’s true of many opioids. Oxycodone was developed at the beginning of the 20^th Century in Germany, and was used to treat pain during World War Two. At the start of the 1990s, oxycodone was banned in Germany because of its high potential to cause addiction. But a few years later a new formulation of it was brought back onto the market. The same happened in the US, where it was additionally marketed very aggressively. And not without reason, because as a pain killer, it is a very effective therapeutic tool when used correctly, just like the synthetic opioid fentanyl, which is used for anesthesia among other things.

How could the situation in the US get so out of hand?

In the US, the predominant views on how to treat pain vary greatly from those in Germany. There, modern medicine is seen as promising healing – which makes it possible to be fully pain free. We’ve got a different approach in Germany. The church, for example, has for centuries spread the word that we share in the sufferings of Christ though our pain. Besides, the concern about addiction among doctors as well as patients was and is still great. This attitude even led to under-provision of the drugs in Germany, especially of pain killers, a few decades ago.

Michael Müller warns of the high potential to cause addiction: “There’s a risk of becoming dependent on pain killers in Germany as well, especially because certain opioid-based medications are increasingly being prescribed.” Photo: Thomas Kunz

How can the general public protect themselves?

Patients have to rely on the advice of their pharmacists in this case. If the pharmacist fails to call a halt to things after two or three weeks, it’s possible that the patient could become drug dependent. The graded guidelines for prescribing some medicines created by the World Health Organization (WHO) offer some protection. Drugs containing opioids should not be prescribed at all for simple back pain or after dental treatment.

What can be done, then? Provide better information for doctors?

I hold, for example, informational lectures within the university community and in the general public about the risks of the new synthetic substances. Especially young people are threatened, because they like to try things and test their limits. Patients have a different viewpoint. They want to be pain free. That’s why they should be warned about the high risk of addiction.

So addiction should be considered a possible side-effect?

Exactly. Just as they warn of particular interactions between drugs on package inserts, they should also take up the topic of drug dependence as a side-effect. Doctors, pharmacists, and patients should be fully aware of this.

How can the problem be solved?

We won’t control it using solely pharmacological tools. Tougher laws won’t do it either. It’s a societal problem. Opioids as a type of drug have come to be present in mainstream society. That’s why it’s important to address the problem openly and transparently and then accept and approach it as a societal challenge.