Killing Pain, Creating More Limbaugh Case Sheds New Light On Addiction

When Rush Limbaugh admitted his addiction to painkillers in October and checked himself into a drug treatment center, the news shocked his radio listeners and followers of politics and media.
It did not, however, shock doctors who prescribe pain medication or counselors who work with drug addiction on a daily basis.

“Regardless of what you feel politically for him, he’s a human being struggling with a problem,” said Phil Day, program manager of Alcoholism and Drug Services in Springfield, who sees similar struggles all the time. “It shows that you can have all the worldly success on the planet and still not be immune from the demands and challenges that can afflict human beings.”
Still, it was surprising for most to learn that the top-rated radio host in America — who has a long history of urging stronger punishment for drug abusers — had fallen prey to OxyContin and other medications in the years following an unsuccessful back surgery in the late 1990s.

Limbaugh returned to the airwaves on Nov. 17 after spending five weeks in detox and rehab, a move made to “once and for all break the hold this highly addictive medication has on me,” he said. But he refused to portray himself as a victim — even though his drug use, which might have encompassed tens of thousands of illicitly obtained pills over the years, could still lead to legal consequences.

But the story can also serve some good, area physicians and counselors say, by shining a spotlight on a common addiction that most victims — many of whom had never been addicts before — didn’t feel could ever happen to them.

“Sometimes people have a back injury, they’re prescribed a narcotic, and three months later, when they’re supposed to be well and off the medication, their body says they still need this drug,” Day said. “This is where people begin long drug histories.”

Manner of Speaking

Dr. Robert B. Steinberg, chief of Pain Management Services at Baystate Medical Center, said words like ‘addiction’ and ‘dependence’ are tossed around so casually in the media that people without medical backgrounds don’t realize they mean very different things.

“First of all, you have to distinguish — and people usually don’t — between addiction, dependence, and tolerance,” Steinberg said. “Addiction is a behavioral disease, one that makes you say, ‘I’m going to knock over the corner drugstore to get it.’ With tolerance, you have taken a drug, gotten accustomed to it, and need more to have the same effects as you did initially. People become tolerant to painkillers fairly quickly, although that usually stabilizes.”

Dependence, on the other hand, means that if someone stops taking the drug, withdrawal results, making him or her sick in some way. However, the term ‘dependence’ doesn’t always carry a negative connotation, Steinberg said.

“Drug dependence is a physiology,” he explained. “Diabetics are dependent on insulin, but you don’t say they’re insulin addicts. You have a disease and need medication. Painkillers are no different, as long as you have the right tool for the right job.”

And that’s where the key factor in prescribing painkillers — patient evaluation — comes in, he said. Those relying on drugs to soothe emotional pain or completely eliminate all physical aches are more likely to develop a dependence.

“If it’s a chronic pain source, we figure out what the diagnosis is first and then what the person’s reaction is to it on a psychosocial basis, and we set the appropriate treatment goals,” Steinberg said.

“You can never give people medicine and make the pain go away 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5},” he continued, adding that some patients are candidates for other types of treatment, such as nerve blocks, steroid injections, or simple behavioral counseling. “If someone wants to take enough medicine to make them feel 16 again, they’ll never get there, and they’re the wrong person to give medicine to. If a person experiences the same sore back we all have, but has some emotional pain, narcotics aren’t the answer.”

For patients who do use prescription narcotics and struggle with dependence, it’s a different sort of hold than that of, say, alcohol, Day said.

“Many people who are alcoholics do manage to stop for periods of time. You can drink only on weekends, drink periodically, and still be an alcoholic,” he added. “With someone who’s addicted to narcotic medication, like OxyContin, one of the main fears is going into withdrawal, so they’re constantly seeking to make sure they have their next hit. They tend to use it on a daily basis to avoid withdrawal as well as get high.”

If administered and monitored properly and to the right candidate, he said, dependence should not be an issue. “If people are medicated properly, they should be able to function to some degree with their pain and learn to live with it.”

The Right Remedy?

Part of determining whether a drug is proper for a patient or not has to do with predisposition, said Coralee Dutil, an addiction specialist in the Holyoke Hospital partial hospitalization program. And family history can have a strong bearing there.

“If a person has a predisposition for substance abuse in their family background, they probably increase their risk of becoming addicted a lot,” she said. “If one parent is an addict, that already increases it 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. So that history and predisposition need to be taken into consideration.”

Dutil said one reason why OxyContin is so addictive is because it’s time-released, meaning the effect lasts longer than other analgesics.

“If you’re on any addictive medicine long enough, you’ll become addicted,” she said. “But what happens with the opiate family is that, eventually, you’re going to build up a tolerance and need more. A lot of pain management clinics tend to deny this.”

Limbaugh himself didn’t appear to see this effect coming. Although he says the whistle-blowing reports of his former maid, Wanda Cline, contain “inaccuracies and distortions,” Cline told authorities that she helped Limbaugh obtain some 30,000 hydrocodone, Lorcet, and OxyContin pills over a one-year period between 2001 and 2002.

“The reality is, somebody uses these drugs for effect,” Dutil said. “If something takes you away from your reality and makes you feel good, you want to increase that effect. Chronic pain can affect people terribly, and they find these medicines make them feel better, so they build up a tolerance and want more. And that’s where it starts for some people.”
The path is an easy one to understand, said Day, who told The Healthcare News that he sees the pattern repeated often.

“We do see people report that they started using pain medication as a result of a medical situation, and as they recover, they continue to use it, even after the doctor determines that their symptoms are cured,” he said. “So they start to go to non-physician sources, or they go doctor-shopping.” In those cases, patients might exaggerate their symptoms to a new physician, or fabricate complications.

“These painkillers are incredibly powerful drugs,” Day continued, “and even people who do not have substance abuse histories are prone to fall into difficulties if they’re not administered carefully and monitored carefully, and if the person does not have all the supports to help them.”

First Steps

And that support all begins with the right treatment to begin with, Steinberg stressed.

“When we’re considering recommending chronic medical management of any kind, especially chronic analgesic management, we first need to do a psychosocial evaluation,” he said.
“We can’t give medicine for the wrong reasons. People who have post-traumatic stress from being abused when they were kids might have chronic tension headaches because they never dealt with all the emotional issues they needed to deal with. You can give the wrong medicine, or the right medicine for the wrong reason. You can’t treat one symptom in isolation; you have to deal with the whole problem.”

When someone does become hooked, Dutil said, the addiction is often not immediately life-threatening, but withdrawal can be just as rough as with other drugs.
“Depending on how long they’ve been on the pain pills, it might feel like a really bad case of the flu. They can get sick in that sense. It feels really awful, and goes into the joints and becomes achy and painful. It usually takes a good seven to 10 days in detox to get off.”

With the financial resources at Limbaugh’s disposal, he hasn’t had a problem finding treatment for a longer period than that. But it did take him awhile to seek that help. The day he returned to the radio, he said he had tried to detox himself twice, but was forced to admit he was “powerless” over his problem and couldn’t shake it on his own.

“I spent five intense weeks, probably the most educational and intense five weeks on myself that I have ever spent,” Limbaugh said. “I would have had no idea how to do this myself.”
Meanwhile, critics of the conservative icon wonder whether those resources and connections will keep him from facing the legal consequences administered to other drug users in his home state of Florida, including jail time.

It’s a legitimate question, they say, considering that this is someone who said on the radio in 1995 that “too many whites are getting away with drug use. The answer is to … find the ones who are getting away with it, convict them, and send them up the river.”

Day thinks that, no matter what the legal ramifications, it doesn’t hurt that the public is talking about painkiller addiction.

“On one level, these drugs do a great thing for people — they help them improve their quality of life,” he said. “But they need to be vigilant and responsible for their own lives, to be informed with all the pluses and minuses of their actions. You can take a doctor’s recommendation, but we’re all responsible for our own behavior.”

That begins with being honest with doctors about past addiction history — if only because certain drugs might have effects that mimic a product that gave a patient trouble in the past, and other pharmaceutical options might be available.

“The problem is not just pain management, but opiates in general,” Dutil said. “And, from what I’ve seen, it’s a pretty big problem.”

Doctors and counselors only hope that Limbaugh and other high-profile cases set just as big an example — not only of the ease with which people fall into painkiller addiction, but of how those same people can return to healthy living. In that sense, the Limbaugh story is far from over.