Meloxicam Addiction and Treatment

Meloxicam Addiction and Treatment

Introduction

Meloxicam is a member of the oxicam class of nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to treat the signs and symptoms of arthritis, such as joint pain, swelling, and stiffness. Examples of oxicam pain medications include piroxicam, tenoxicam, isoxicam, and droxicam.

The U.S. FDA approved meloxicam in 2000. Its use skyrocketed between 2006 and 2016. In 2006, meloxicam was the 91st most frequently prescribed drug with 8,766,370 prescriptions. The number of prescriptions increased to 21,290,692 in 2016, making it the 36th most frequently prescribed drug in America.1

Most notably, meloxicam is the third most frequently prescribed NSAIDs among US Army active-duty soldiers. In 2006, there were 48,928 prescriptions among active-duty soldiers in the US army. The number increased to 101,929 in 2011; however, it decreased to 91,048 in 2014.2

While the drug is safe when used as prescribed, misuse or abuse can cause potentially fatal side effects. Many people are also concerned if the drug can cause addiction. Because meloxicam treats pain, many people believe it may act as a gateway drug to opioids (narcotics).  Addiction could require treatment in a rehab facility.

What is Meloxicam and How Does It Work?

Meloxicam is an oxicam oxicam class of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are widely prescribed medications for pain and swelling. Each year, doctors write over 70 million NSAID prescriptions.3 The number of US adults who used NSAIDs (except aspirin) regularly increased by 41% from 20.57 million in 2005 to 29 million in 2010.4

Both prescription and nonprescription (OTC) NSAIDs are available in the US.

Prescription NSAIDs

Celecoxib (Celebrex)

Diclofenac (Voltaren)

Naproxen (Naprosyn)

Piroxicam (Feldene)

Non-Prescription (OTC) NSAIDs

Aspirin (Bufferin)

Ibuprofen (Advil)

Ketoprofen (Actron)

Naproxen (Aleve)

Meloxicam is available only through a doctor’s prescription. Like other NSAIDs, it reduces pain and swelling (inflammation). It does so by blocking enzymes involved in the production of prostaglandins. The enzymes are called cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2). All oxicam NSAIDs block both COX-1 and COX-2. However, meloxicam blocks COX-2 more than COX-1.

When body tissue is injured or exposed to an infectious agent, the body produces prostaglandins. Prostaglandins play a central role in inflammation and pain. Thus, reducing prostaglandin production can help relieve pain and swelling, especially in the joints.

A Timeline of Approved Products and Uses

April 2000: The US FDA approved conventional (7.5 mg and 15 mg) oral tablets for the management of signs and symptoms of osteoarthritis (OA). Brand name: Mobic.

June 1, 2004: The FDA approved Mobic oral suspension containing 7.5 mg of the drug per 5 ml.

October 22, 2015: The FDA approved oral capsules for the management of OA pain. Brand name: Vivlodex.

October 19, 2018: The FDA approved orally disintegrating tablets. The approved uses include the treatment of pain and swelling due to OA and rheumatoid arthritis (RA). Brand name: Qmiiz ODT.5

Is Meloxicam a Controlled Substance?

Meloxicam is not a controlled substance. The Drug Enforcement Administration (DEA) categorizes drugs and illicit substances based on their abuse potential and approved medical use.

Schedule I substances have no medical use and high abuse potential. Examples include heroin, LSD, and ecstasy.

Schedule II substances have medical uses, but they can cause severe dependence. Opioids such as hydromorphone (Dilaudid) and oxycodone (OxyContin) belong to this schedule.

Schedule III substances have moderate-to-low abuse potential. Examples include testosterone and ketamine.

Schedule IV substances carry a low risk of dependence. Examples include Xanax, Soma, Darvon, and Darvocet.

Schedule V substances have the lowest abuse potential among the controlled substances. Examples include antidiarrheal agents such as Lomotil, certain cough suppressants, and certain cannabis-derived drug products.

How is Meloxicam Used?

Doctors prescribe meloxicam for patients who have arthritis. Arthritis causes pain and swelling in the joints. It’s used to treat the symptoms of two common types of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA).

The drug may also be used as a non-opioid alternative to pain medications. A doctor may use it before starting an opioid taper. This can help reduce the severity of opioid withdrawal symptoms. However, the U.S. FDA has not approved meloxicam for treating opioid withdrawal.

The method of use depends on the formulation you take. There are three formulations currently available on the market. They are:

Conventional (immediate-release) oral tablets. Brand name: Mobic tablets 7.5 mg and 15 mg.

Oral suspension. Brand name: Mobic oral suspension 7.5 mg/5 mL.

Orally disintegrating tablets. Brand name: Qmiiz ODT 7.5 mg and 15 mg.

A formulation containing 15 mg meloxicam and Duraflex topical gel (Comfort Pac) is no longer available in the U.S. since July 2018.

How You Take It?

Meloxicam can be taken with or without food. Taking the drug with food can help reduce the chances of having an upset stomach.

Place the orally disintegrating tablets on your tongue immediately after opening the pack. These tablets are designed to dissolve on your tongue. Thus, you should not drink water while the tablet is on your tongue. Avoid crushing, chewing, or breaking the tablets.

If you are using the oral suspension, shake the container before use. Measure the recommended dose using the measuring device supplied with the product. Ask your pharmacist how to use a measuring device if you need help.

How Effective is Meloxicam?

Studies have found that:6

For the treatment of osteoarthritis, 7.5 mg and 15 mg per day is as effective as diclofenac 100 mg per day and piroxicam 20 mg per day. All these medications had similar effects on relieving pain, reducing joint stiffness, and improving the quality of life.

For rheumatoid arthritis, 7.5 mg per day is as effective as naproxen 750 mg per day. Interestingly, a few studies suggest 15 mg may be more effective than 7.5 mg for reducing morning pain. Using higher doses rarely provides any added benefits. Moreover, using higher doses can increase the risk of side effects.

Is Meloxicam Addictive?

Meloxicam is not addictive because it does not affect any pathways associated with the brain’s reward system. It also does not cause tolerance and dependence. Thus, the risk of addiction is virtually zero. That said, it carries a risk of abuse, which may cause serious health effects.

Many people fear that using pain medications such as meloxicam can cause addiction. However, this is not true. No NSAIDs are considered addictive.

Whether a drug causes an addiction depends on how it affects the reward system of the brain. For example, addictive substances like opioids, cocaine, and nicotine increase the release of brain chemicals associated with reward, such as dopamine.

Over time, the brain pathways change in a way that the brain and body seek more and more of the feeling of reward. This can lead to an addiction. Interestingly, some drugs are so strong that even two weeks of use can cause an addiction. Addiction is a long-term brain disorder. It causes ongoing substance abuse despite the negative effects on health. Typically, addiction develops in three stages.

Three Stages of Addiction

The first is abuse. Drug abuse means taking a substance or a prescription/OTC medication in doses, frequency, and duration more than recommended.

The second is tolerance. Tolerance means that the body needs higher amounts of the drug to experience the effects that used to occur with a lower dose.

The third is dependence. Dependence occurs when normal function doesn’t occur without taking the addictive substance. Both the body and the brain may become dependent on a substance. When the substance is not used, dependence causes several undesirable effects. These effects are called withdrawal symptoms.

To date, no studies have shown that meloxicam causes tolerance or dependence. Nevertheless, some people might abuse or misuse the drug.

Can You Abuse It?

While meloxicam is not addictive, the drug may still be abused. Drug abuse refers to any use other than recommended. It could involve using the drug for a longer duration, in higher doses, or for conditions other than prescribed by your doctor.

Complications of long-term use of NSAIDs (OTC + prescription) contribute to 103,000 hospitalizations and 16,500 deaths each year.7

Abusing the drug can cause:

Stomach pain

Vomiting

A burning sensation in the chest

Long-term abuse significantly increases the risk of:

A heart attack and/pr stroke that may cause death

Bleeding in the stomach and intestines

Kidney damage

Liver damage (in rare cases)

About 7% of patients taking the drug have abnormal levels of liver enzymes.8 In severe cases, it may cause inflammation of the liver and jaundice.

Meloxicam is not a narcotic. Narcotics help reduce pain by blocking pain signals in the brain. Meloxicam is a type of anti-inflammatory drug (NSAID). NSAIDs help control pain by blocking enzymes involved in the production of substances that cause pain and swelling.

Can You Overdose on Meloxicam?

Meloxicam overdose is not as common as other drug overdoses. There is also a scarcity of information on overdose numbers. Case reports suggest that people who took 6 to 10 times the maximum doses have recovered with no long-term effects.

In one recent study, researchers found that over 40% of people who used ibuprofen and meloxicam exceeded the daily limit of meloxicam (15 mg).9 Nonetheless, these findings should be interpreted with caution, as the study involved only 1,326 participants.

An overdose can cause serious damage to the heart and other vital organs. The signs and symptoms of an overdose can include:

Severe pain and bleeding in the stomach

Racing heartbeat

Loss of liver function

A heart attack

Blue discoloration of the lips or skin

Coma

High blood pressure

Kidney failure

Slowed or stopped breathing

Swelling of the areas near your eyes, face, lips, or tongue

Seizures

If you think an overdose has occurred, call your doctor immediately. You can also contact the American Association of Poison Control Centers at 800-222-1222.

If symptoms are severe, call 911 immediately.

Is It Safe?

Any drug product with FDA-approved use is safe. A medication becomes available in the market only after it has passed several safety tests in both humans and animals. That said, certain drugs might cause potentially fatal effects if you do not use them properly, such as opioid pain medications, sleeping pills, and drugs used to treat muscle pain.

The FDA continues to monitor the safety of drugs even after the drugs have reached the market. Experts call this postmarketing surveillance.

Some approved drugs may show toxicity during postmarketing surveillance. For example, Rofecoxib (Vioxx), a drug similar to meloxicam, was found to increase the risk of heart disease. The manufacturer of Vioxx (Merck) withdrew the drug product from the market more than five years after the product first became available on the market.10

Safety Factors

Two factors determine the safety of a drug:

Patient factors such as the pattern of use and compliance with a doctor's instructions

Drug factors such as strength and potency. Some drugs are very powerful. If you take more than the recommended doses, these drugs can cause death.

Meloxicam has shown an excellent safety profile in various clinical studies. Since its approval in 2000, there have been no documented reports of death because of its use. If a person intentionally abuses or overdoses on any drug, such an event is not considered a result of the drug’s poor safety profile.

Moreover, meloxicam is available only on a doctor’s prescription. This means your doctor has already determined the doses and duration of use that best meets your needs. When used as prescribed, meloxicam is safe and effective for treating pain in arthritis.

So far, postmarketing surveillance has found no serious effects.

Short-term and Long-term Effects of Meloxicam

Along with the desired effects, meloxicam can also cause many short-term and long-term side effects.

The short-term effects can include the following:

Upset stomach

Bloating

Indigestion

Heartburn

Flushing

Dizziness

Fatigue

Joint pain

Constipation

Diarrhea

Flu-like symptoms

Swelling of the linings of the mouth and lips

Excessive sleepiness

Coughing

Skin rashes

The long-term effects can include the following:

Elevated blood pressure

Yellowish skin (jaundice)

Swelling of the feet of legs

Irritability

Irregular heartbeat

Rapid weight gain

Increased anxiety

Abnormal liver function test results

In some people, meloxicam can cause potentially life-threatening allergy. Severe allergic reactions are more likely to occur if you have a known allergy to other medications of the NSAID class. Seek emergency medical help if you have any of the following:

Rapid shallow breathing

Hives

Severe rashes

Irregular heartbeat

Swelling of the areas near the eyes

Skin peeling

How Do You Treat Meloxicam Abuse?

Meloxicam abuse rarely requires treatment. Adequate counseling and monitoring can help reduce the risk of abuse in most cases. Notably, people who use meloxicam are more likely to use other pain medications (including opioids) to curb pain. Prescription opioids have high abuse potential.

Moreover, people who have a long-term disease like arthritis may have co-occurring mental illnesses, such as depression and anxiety. People with rheumatoid arthritis are two to four times more likely to have a severe form of depression.11

Both ongoing pain and depression significantly increase the chances of abusing a drug. About 1 in 5 Americans with depression or anxiety abuses alcohol or other addictive substances, according to the Anxiety and Depression Association of America.12 Thus, treatment may be necessary for other forms of drug abuse in people who misuse meloxicam.