Pain-pill addiction: What's the risk?
Pain-pill addiction is a valid concern. But the risk is low if you take your medication exactly as directed.

You've been taking over-the-counter pain medications — but they're not helping. You'd like to try something stronger. You're also somewhat hesitant. What about all the people who've wound up fighting a pain-pill addiction? Might that happen to you?

The short answer: Probably not.

What is addiction?
Addiction is the inability to stop using a drug — whether it's legal or illicit — despite the fact that it causes harm. A prime example is cigarettes. Most smokers know that cigarettes damage their health. Many want to quit, but can't overcome the craving. That's addiction.

How do tolerance, physical dependence and addiction differ?
It's easy to confuse addiction with tolerance and physical dependence. But these are three distinct conditions.

Tolerance. Sometimes your body adapts to the ongoing presence of a drug. The initial dosage of a medication becomes less effective over time. You may need higher doses of the medication to achieve the same level of pain relief. This is called tolerance. It's normal — and not a sign of addiction. In some cases, tolerance can even be helpful. Side effects may disappear when your body becomes more used to the medication.
Physical dependence. When your body has adapted to the presence of a drug, you may experience withdrawal symptoms if you abruptly stop taking the drug. This is physical dependence. Many types of nonaddictive drugs — including corticosteroids and beta blockers — can cause physical dependence. If you gradually decrease the dosage under your doctor's direction, you can stop taking these medications without experiencing withdrawal symptoms.
Addiction. Addiction is a disease. If you're addicted to a drug, you'll use the drug despite serious or harmful consequences to your body, your relationships, your career or other parts of your life. You may not be able to recognize the situation yourself. Although addiction and physical dependence often occur together, you can have addiction without physical dependence. Likewise, you can have physical dependence without addiction.
Which pain medications are most addictive?
Opioids — sometimes called narcotics — are among the most addictive pain medications. Commonly prescribed opioids include:

Codeine
Fentanyl (Duragesic, others)
Hydrocodone (Vicodin, Lortab, others)
Hydromorphone (Dilaudid, others)
Meperidine (Demerol, others)
Morphine (MS Contin, Kadian, others)
Oxycodone (OxyContin, Percocet, others)
Propoxyphene (Darvon, others)
Who's at risk?
The tendency to develop an addiction seems to be inherited. If you have family members who abuse drugs or alcohol, you have a higher risk of the same problem. Anxiety, depression and loneliness also increase the risk. Past problems with substance abuse play a role as well. For example, a history of alcoholism increases the risk of problems with prescription pain medications — even if you're in recovery.

But most people who take pain medication only as directed never become addicted — even during long-term use. The key is to take the medication exactly as prescribed by your doctor. Ask your doctor for printed instructions. Understand possible side effects and interactions with other drugs.

What are the warning signs?
Medication addiction can develop very subtly. Look for these warning signs:

You take more pain medication than your doctor has prescribed.
You request prescriptions from multiple doctors.
You use alcohol or other medications to increase the effects of the pain medication.
You take pain medication to deal with other problems, such as anxiety or stress.
Your doctor, friends or loved ones express concern about your use of pain medication.
If you're worried about medication addiction, be honest with your doctor. Share your concerns, including any personal or family history of substance abuse or addiction. Your doctor needs this information to choose the type of pain medication that will work best for you.

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