Abuse of pain relievers, also known as opioid abuse, is a significant public health concern worldwide.
The National Library of Medicine, an official website of the United States government, defines it as prescription drug misuse – taking painkillers in a way that is different from what the doctor prescribed.
Painkillers, also called analgesics, are used to treat pain or manage a lifelong painful condition and can be bought over the counter or with a doctor’s prescription.
However, studies have shown that painkillers, including prescription opioids like oxycodone, hydrocodone, codeine, and morphine, sedatives, tranquilisers, and stimulants, as well as illicit opioids like heroin, are highly addictive substances that can lead to devastating consequences when misused.
One of the main reasons for the abuse of painkillers is their powerful ability to relieve pain and induce feelings of euphoria. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain, according to the National Institute on Drug Abuse.
“People misuse prescription opioids by taking the medicine in a way or dose other than prescribed, taking someone else’s prescription medicine, and taking the medicine for the effect it causes to get high.
“When misusing a prescription opioid, a person can swallow the medicine in its normal form. Sometimes people crush pills or open capsules, dissolve the powder in water, and inject the liquid into a vein. Some also snort the powder,” the NIDA added.
A report published online by the American Psychiatric Association noted that nearly one in 10 people said they had taken an opioid or prescription painkiller without a prescription.
It also revealed that five per cent of US adults admitted to having abused or have been addicted to opioids or prescription painkillers, up from one per cent in 2017.
Data provided by the World Health Organisation show that approximately 0.4 per cent of the Nigerian population aged between 15 and 64 are reckoned to be high-risk drug users.
A 2018 estimate given by the United Nations Office on Drugs and Crime said 4.6 million Nigerians used pharmaceutical opioids, noting that one in five users was dependent.
Odyssey of pain
Many abusers of painkillers navigate through and negotiate with two physical sensations on both ends of the spectrum: pain and pleasure.
“Humans are hardwired to avoid and escape pain. It’s there to help us survive, signalling an imminent threat that we need to evade,” wrote Kim Armstrong in an article published by the Association for Psychological Science.
Many people resort to painkillers to gain relief from pain, but such substances can also make people feel very relaxed and “high” which makes such opioids highly addictive, leading to overdoses and deaths.
This pain could result from some injuries or surgical procedures which often cause more pain than others, especially orthopaedic and trauma procedures on the spine or extremities.
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage”.
Most pain scales use numbers from 0 to 10 to show levels of pain, ranging from 'no pain' to 'moderate pain' to 'worst pain possible.' However, some health experts say pain is subjective, and the patient's idea of pain may differ from that of the healthcare provider.
The IASP website mentioned that patients who have had surgery usually find pain ratings of four or less (mild-to-moderate pain intensity) acceptable, on average.
However, patients were more satisfied with their pain treatment if they had pain ratings of three or less. The experience of surgical pain varies among patients and is known to affect several biological, psychological, and social functions, which in turn affect the pain experience.
Dr. John Farrar, a pain specialist and director of the Biostatics Analysis Centre at the University of Pennsylvania, also said that the primary reason for developing the pain scales used today was to standardize them for research purposes, rather than for patients to report their pain in a clinical setting.
Assessing pain among hospitalized workers is crucial for proper pain management and for determining the appropriate pain treatment by healthcare providers.
A pharmacist in Lagos, Moyosore Odedeyi, expressed concern about the widespread misuse of painkillers and antipyretic drugs, particularly in Nigeria, in an interview with Sunday PUNCH. He explained that the process causing pain in humans can be divided into three phases: acute inflammation, immune response, and chronic inflammation. Painkillers help prevent these events by inhibiting the production of prostaglandins, which are compounds in the body with hormone-like effects.
Pain occurs due to acute inflammation, immune response, and chronic inflammation, while painkillers help stop these processes by blocking the production of prostaglandins, according to Healthline.
Odedeyi stated that when there is an injury or physiological pain, a protein called cyclooxygenase releases prostaglandins, causing pain and inflammation at the injury site. Painkillers like Aspirin, Ibuprofen, and Naproxen inhibit COX non-selectively, while others like Celecoxib, Etoricoxib, and Parecoxib selectively inhibit COX-2.
Painkillers like those mentioned above reduce the signs and symptoms of inflammation and have an anti-inflammatory effect. These drugs are also called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Paracetamol, a common over-the-counter painkiller, does not have strong anti-inflammatory action but is an excellent analgesic and antipyretic. It is often misused by artisans and unskilled workers with physically demanding jobs.
The pharmacist explained that most NSAIDs can be easily bought at pharmacies and drug vendors without a prescription. However, these drugs should not be used for a long time (no more than three days) as they can cause harmful effects like stomach irritation leading to bleeding, fluid retention, kidney failure, rash, and tinnitus.
They can also make peptic ulcers and asthma worse, and trigger allergic reactions in certain people. Overdosing on paracetamol can release toxic substances that harm the liver and kidneys.
Odedeyi emphasized that sickle cell patients should only take painkillers prescribed by their doctors. They have been found to misuse painkillers, including injectable pentazocine (commonly called Penta) and other narcotic painkillers, so they need to be cautious.
He said that the misuse of painkillers is a persistent problem that needs to be actively addressed to protect the well-being of society.
Rheumatic patients should also consider non-drug treatments like heat therapy, saunas, and Ayurvedic practices. Pregnant women should avoid NSAIDs as they can cause early closure of ductus arteriosus leading to lung problems and fetal death.
The use of painkillers for sleep and benzodiazepines like Diazepam (commonly known as sleeping tablets) in elderly patients should be discouraged to reduce dependency.
A move towards addiction
Findings by Sunday PUNCH explain that many people who misuse painkillers like codeine do not follow their doctor’s instructions or get them from pharmacists, but instead buy them from dishonest sellers in black markets.
Despite the government's restriction on the sale of codeine-containing products in 2018, many Nigerian youths still manage to access and use the substance to relieve stress and pain.
Apart from codeine, tramadol is another widely abused painkiller in Nigeria. First made in 1962 by a German pharmaceutical company, Grünenthal, the drug is used for treating pain.
According to DrugAbuse.com, tramadol was first sold internationally in 1977 under the trade name tramal, and many drug regulatory agencies adopted it as a moderately addictive opioid drug that provides moderate pain relief.
Tramadol is considered less potent than morphine and codeine and has been regulated by the National Agency for Food and Drug Administration and Control since 1995. However, prolonged use of tramadol has been linked to addiction and misuse.
With the global issue of prescription drug abuse in mind, the WHO is committed to ensuring that people with severe pain have access to effective pain relief drugs, including opioids.
The WHO recognizes the importance of expanding access to pain relief, but also acknowledges the need to balance this with concerns about the misuse and harm caused by opioids and other pain management medications.
A pharmacist named Richard Uhuaba mentioned that using painkillers for a long time could lead to physical dependence, tolerance, and addiction.
He explained that misusing opioids can lead to physical dependence, tolerance, and addiction, causing people to seek higher doses or turn to illegal sources of painkillers, which can lead to overdose and death.
He also pointed out that misusing painkillers can negatively impact relationships, productivity, and finances, and can burden healthcare systems and governments. He warned that without effective strategies, the situation could become a major issue.
He emphasized the need for tighter regulation of prescription opioids, better access to addiction treatment programs, and increased public awareness to prevent addiction and reduce the harmful effects of opioid abuse.
Also speaking with Sunday PUNCH, a community pharmacist, Williams Miebi, explained that despite strict regulation, drug abuse in the country remained alarming.
He mentioned that while painkillers like morphine are heavily regulated in Nigeria, there is still a significant addiction to drugs that have sedative effects among youths, such as Rohypnol.
He also observed that some youths resort to using over-the-counter cough syrups mixed with soft drinks, especially those involved in physically demanding jobs.
He emphasized that hard drug addiction often stems from emotional emptiness, particularly among individuals who have to engage in strenuous labor.
He added that addressing drug abuse in Nigeria requires going beyond mere law enforcement and focusing on addressing childhood abuse and neglect, which are often underlying causes of drug addiction.
Abusing painkillers, also known as opioid abuse, is a major public health concern worldwide. The National Library of Medicine defines it as using painkillers in a way different from the doctor's instructions.
“Most people who are drug addicts were abused or neglected as children and that’s why to curb drug abuse in Nigeria, we have to go deeper than the surface level of the National Drug Law Enforcement Agency just arresting people or clamping down on drug dealers. It’s a social ill that should start from the family,” he added.
