How do you get rid of an addiction to strong painkillers (opiates)? We ask addiction doctor Loes Hanck, clinical epidemiologist Willem L Digiting and pharmacist Anke Lambooij of the Institute for Responsible Use of Medicine.

With severe pain you can get morphine or a painkiller with the same effect as morphine. These painkillers are called opiates. Of these strong painkillers, especially oxycodone is known, since there has been a significant increase in its use since 2008. Other opiates are, for example, fentanyl, buprenorphine and methadone.

Figures about opiates

  • The total number of opiate users has already exceeded one million in 2017
  • In 2017, 438,000 people used oxycodone. In 2007 there were more than 75,000 and 146,000 in 2012
  • More than 200,000 people in the Netherlands use long-term opiates
  • In 2018 there were 424 possible oxycodone poisoning

Sources: Zorgverzekeraars Nederland, Zorginstituut Nederland, National Poisons Information Center

Strong painkillers prescribed for severe pain

You cannot buy strong painkillers yourself, but are prescribed by people with general practitioners and specialists in the hospital to people with pain complaints. A broad group, know clinical epidemiologist Loting, who investigated this. "From people with low back pain, cancer or chronic pain, to the elderly and people with depressive symptoms."

The use of strong painkillers only becomes a problem if people continue to use them for a long time - for example for several weeks - and can no longer do without, the three experts say. Pharmacist Lambooij: "More than 200,000 people in the Netherlands use long-term opiates and that increases the chance of addiction and complaints."

"In the United States, 10 in 100,000 people died of opiate poisoning in 2017. In the Netherlands, that is 1 in 100,000, or about 220 people," L grading sums up.


What is oxycodone, the commonly used heavy painkiller?

Where do you go with addiction?

If you think you are addicted to a strong painkiller such as oxycodone, you often go to the doctor. Lambooij: "Most people can be helped by a doctor or a pain clinic by means of a personalized dismantling schedule. If it is a complex addiction, the person will be referred to an addiction institution."

See also: Why more and more people are taking heavy painkillers

The latter is happening more often, NRC reported earlier this year. In the space of six years, the number of addicts to strong painkillers from five rehab clinics has tripled: from 92 to more than 292. This increase is continuing.

Same treatment plan as with heroin addiction

Jellinek is such an addiction institution where people can go who cannot be helped by the doctor or pain clinic and who are heavily addicted to, for example, oxycodone. Addiction doctor Hanck: "We treat these people according to the same guidelines as a heroin addiction." The effect of oxycodone corresponds to heroin, they are both opiates.

Lambooij does not think that exactly the same treatment can be given: "People use the illegal and highly addictive heroin for recreational purposes, while a prescribed opiate such as oxycodone is initially given against pain complaints. If those pain complaints are still there, you cannot just go to complete "You want an alternative to that. But a clear approach does not yet exist."

Too little knowledge about opiate addicts

Several addiction doctors believe that there should be a national approach to help oxycodone addicts, they reported to RTL News . Minister of Health Bruno Bruins has therefore drawn up the Task Force on the appropriate use of opioids, of which Lambooij is a member. This group is investigating how the treatment of people who have become addicted to these drugs can be improved.

"We don't know exactly how we can best help these people." Anke Lambooij, pharmacist

Lambooij: "We do not know exactly how we can best help these people and as caregivers we must be prepared for what we can best offer to these patients. That means interaction between pain specialists, behavioral therapists and addiction doctors."

Hanck believes that the heroin addiction guideline can be used. "In addition, we have been dealing with complex patients for years, such as people with alcohol dependence and underlying severe anxiety disorders. So we are used to looking outside the doors of addiction care and working together." However, she agrees that more knowledge would be good.

The addiction doctor of Jellinek wants to make sure that the stamp 'addict' is not too quickly stuck on someone.

Rehabilitation requires willpower

Rehabilitation of an opiate requires willpower, Lambooij reports. "Even a small dosage adjustment causes some people to experience vibrations and drowsiness for days." Hanck agrees that a true opioid addiction is "a very annoying addiction."

For example, kicking off oxycodone can be accompanied by vomiting, drowsiness, trembling, anxiety, increased pain, and in exceptional cases, someone experiences suicidal thoughts. That immediately shows that good guidance is important, says Hanck.

Reducing strong pain relief is always tailor-made. Lambooij: "Some people miss the euphoric feeling that opiates give, others notice that the underlying pain comes back. It is together looking at: how quickly can you reduce? What goes well? What gives complaints? And how far can you go?"