Nearly a year ago I began having pain and weakness in my left arm. As I have advanced osteoarthritis, some pain is never surprising, but this worsened. A doctor prescribed a low dose of Norco that relieved the pain for a while. Then it returned. In the hope of strengthening my arm muscles I spent a month in physical therapy, but the pain continued. I continued taking Norco, then switched to Percocet, a stronger painkiller. Eventually an MRI showed a completely torn rotator cuff tendon and damage to the underlying bones that would require a shoulder replacement. Getting in appointment with a surgeon, scheduling the surgery, and getting clearances for surgery from various doctors took months; during that time I continued taking Percocet for the increasing pain.
Both Norco and Percocet contain opiates, synthetic derivatives of the opium found naturally in opium poppies. (The similar term opioid refers to both the natural and synthetic drugs.) Norco and Percocet also contain acetaminophen, the nonaddictive drug sold as Tylenol. The opiate in Norco is oxycodone, that in Percocet is hydrocodone. Both are prescribed routinely for pain following athletic injuries and surgeries.
As everyone knows now, the United States has an opiate epidemic. People who begin taking the drugs for pain can develop a tolerance for them, craving higher doses to be effective. They become addicted, taking the drugs not just to control pain, but also for insomnia or for generally feeling euphoric. Opiates are widely available and surprisingly inexpensive. (Having Medicare Part D, I have never paid more than a few dollars for a large supply.) Teens who want a high from drugs may simply raid Granny’s medicine cabinet to get a supply.
Short-term effects of opiates include sleepiness, pain relief, and euphoria. These result from the release of large amounts of dopamine in the brain. Dopamine is a chemical that links brain cells chemically and is responsible for desire and general feelings of happiness. Though those effects can be positive, dopamine can also lead to unpleasant side effects such as nausea, paranoia, and extreme drowsiness. Like alcohol, opiates can interfere with the ability to drive. When I was taking Percocet, I felt rather sleepy and stupid much of the time. Simple arithmetic and memory tasks were hard for me.
Long-term effects of opiates comprise constipation, abdominal bloating, vomiting, and damage to the brain and liver, as well as dependence (inability to feel well without the drug). Dependence can continue to addiction and to further increase in need for opiates.
Even addiction to Norco or Percocet can be serious, but if a person goes on to use the most potent opiate drugs such as heroin, the results can be catastrophic, even fatal. Norco and Percocet are swallowed as tablets, but heroin is injected into veins. According to the Centers for Disease Control and Prevention (CDC)[i], in 2016, more than 64,000 deaths were related to overdoses of opiates and related drugs (mainly Fentanyl).
After my shoulder surgery I received another vial of Percocet for the pain that followed. Not wanting to become an opiate addict, I cut back to the milder Norco after a couple of weeks. Now, five weeks post-op, I take only one Norco tablet a day, and am gradually cutting back even more. I often treat pain with ice packs, Tylenol, or a small glass of wine. As the healing proceeds I will soon be taking no opiates at all.
Though the outcome has been good in my case, I think it could have been better. Mild painkillers like acetaminophen or aspirin can control mild pain. (Large amounts of acetaminophen can cause liver damage, however.) Some people can benefit from cannabis or acupuncture. Ice packs or meditation are even better. If the opiates had been expensive, I would have been less likely to use them often. (I also have to take a very expensive drug for a pancreatic disorder, and am careful to buy only the minimum amount needed!) Medical providers and the DEA could benefit patients and have an effect on the opiate epidemic by heeding these suggestions.