Individuals struggling with chronic pain walk a tightrope between obtaining relief from their pain through medications and avoiding potential addiction to the drug itself. It may seem that becoming addicted to opioids for pain relief is a new phenomenon, but there is actually a long history of it. Opiate addiction related to treating pain can be dated back to the Civil War era, when opium tinctures and morphine were routinely prescribed. By the late 1800s, the unregulated sales of opiates amounted to 15% of all drugs dispensed in Boston, for example. Interestingly, by the end of the 19 century, 60% of opiate addicts were women, treated for menstrual cramps or diseases of a “nervous character.” With a historical precedent for the dangers of overprescribing opiates for chronic pain relief, it is surprising that the modern pharmaceutical manufacturers of opioid analgesics appear to have ignored the well-documented past regarding the potential for abuse and addiction. Indeed, many of these opioid producers likely misled doctors in the 1990s regarding the drugs’ potential for addiction. Over the past decade, the dangers of opioid pain relievers have taken center stage as our nation comes to terms with the risks associated with these drugs. In 2017 approximately 17,000 Americans died from a prescription opioid overdose, according to the most recent statistics from the Centers for Disease Control. This statistic does not include those individuals who switched from prescription opioids to heroin, a common result of prescription opioid addiction, and therefore died of a heroin or fentanyl overdose. The challenge for someone living with persistent pain is how to maintain a productive and fulfilling quality of life with the help of prescription opioids without falling victim to the dangers of addiction or chemical dependency. The medical community is now addressing over-prescription of the drugs, as well as identifying new methods for managing chronic pain, to minimize the risk of opioid addiction. Chronic pain is defined as experiencing ongoing pain, from dull continuous pain to severe pain, which lasts beyond the time expected for tissue to heal. The Journal of Neuroscience reports that over 100 million adults in the U.S. suffer from a chronic pain condition. Chronic pain may be experienced as a burning sensation, an ache, throbbing, or as a sharp pain that occurs intermittently. The pain messaging is transmitted from the source of the pain through the nervous system and to the brain. This persistent pain can be experienced in any part of the body. Chronic pain may be caused by inflammation or dysfunctional nerve activity related to an injury, a disease such as cancer, multiple sclerosis, gallbladder disease, fibromyalgia, or arthritis, infection, or nerve damage. The effects of chronic pain on overall physical and mental health are significant. Being in constant pain can negatively impact sleep quality, causing increased stress levels, fatigue and weakness, and can lead to depression. In fact, according to an article published in Neural Plasticity, “The Link Between Depression and Chronic Pain: Neural Mechanisms in the Brain,” the authors conclude that both depression and chronic pain share common brain regions that are involved in mood regulation. How Can Chronic Pain Lead to Addiction? Someone who lives with chronic pain will be grateful to find relief in prescription opioid analgesics. There is no arguing that the drugs are very effective in managing the effects of persistent pain. However, as the body increases its tolerance to the effects of the opioid medication, higher dosage of the drug may follow. The brain has receptor sites for opiates like morphine, synthetic opioids, and heroin. When an opiate binds to these receptors they can modify the body’s pain perception while also increasing levels of dopamine, resulting in elevated mood. Opiates can flood the body with dopamine, even up to ten times the normal levels of dopamine produced by the brain, setting up the brain’s reward response. The brain pathways then become altered and the brain will eventually decrease dopamine production. Opioid pain medications are extremely addicting, potentially leading to addiction within a few short weeks of use. Chronic pain patients may at some point find that their physician will no longer prescribe the dosages they have become accustomed to, leading some to seek alternative sources to achieve comparable pain relief. Too often this results in switching to heroin, which is readily available and costs a fraction of the price. According to the National Institute on Drug Abuse, about 80% of heroin users report a history of prescription opioid misuse. Because a number of chronic pain patients become addicted to the opioids meant to treat them, targeted substance use disorder treatment programs designed for chronic pain patients have become part of the addiction and recovery milieu. These programs introduce treatment methods to help wean the patient off the opioids as much as is reasonable, while also introducing them to alternative pain management solutions. Unwinding the brain’s dependence on opiates takes time, requiring patience and commitment. But with a positive attitude along with an effective recovery program to guide them through, it is possible for patients to mitigate chronic pain and enjoy a life filled with hope and promise.