warning

Unfortunately, most people (professional healthcare providers and the general public) have no idea what the FACTS** are concerning addiction to opiates (narcotics such as demerol, morphine, codeine, oxycodone, hydrocodone, etc). When addiction to "pain medicine" is suspected, most people react emotionally rather than objectively. This significantly hinders the process of evaluation which in turn hinders the ability to properly control pain.

Why are patients with chronic pain labeled addicts? The answer is simple: Lack of Knowledge!

Although there has been improvement in training for MDs, RNs, and Pharmacists in recent years, the majority of healthcare professionals have received little if any formal training in pain management. In order to improve pain relief the following topics must be addressed:

-What is the current definition of addiction?

-What do studies show about the incidence of addiction when a person is treated with opioids?

-What are common indicators erroneously considered to be signs of addicition?

-What is Addiction?

Addiction is defined as BEHAVIOR that is overwhelmingly focused on obtaining and using a substance for it's PSYCHIC effects, not for the intended medical prescription. There is a high incidence of "relapse" or continuing to use the medication after the pain is no longer present or physical withdrawal symptoms disappear.

Here is a critical point to recognize: Use of opioids for pain relief is NOT addiction since pain relief is an APPROVED medical indication!!

Definitions:

ADDICTION: As above...a BEHAVIOR characterized by the compulsive search and use of a medication when there is no longer a medical indication for the use of that medication.

PHYSICAL DEPENDENCE: A physiological response to the prolonged use of an opioid in which the sudden cessation of the medication results in a physiological response with specific signs and symptoms.

TOLERANCE: After repeated administration of an opioid, the original dose is no longer as effective as when first initiated. This is an EXPECTED result from the chronic use of opioids and is NOT a sign of addiction.

Signs Which are Frequently Cited as "Proof" of Addiction:

-Higher and higher doses are required to continue to provide adequate pain relief.

-The patient requests medication in anticipation of pain.

-Prolonged use of opioids.

-The patient "watches the clock". Prefers injections over pills.

-Appears to "enjoy" the opioids effects.

-Knows the name and dose of opioids.

None of these signs are reasons for suspecting addiction!!

Let's examine these signs, one by one.

1) Higher and higher doses are required to continue to provide adequate pain relief. This is a sign of TOLERANCE which is to be expected with prolonged use of opioids.

2) The patient requests medication in anticipation of pain. This is actually something that is encouraged by most pain management specialists. Prevention of pain requires smaller total doses than allowing pain to become unbearable and then trying to "catch up".

3) Prolonged use of opioids. This implies prolonged use will inevitably lead to addiction. There is no evidence to support this belief. Several studies have shown once pain is eliminated, slowly tapering off the medication to prevent "withdrawal" syndrome (which is an EXPECTED effect of prolonged use of opioids) and these individuals are not out buying illegal drugs or "doctor shopping" to get pain medications.

4) The patient "watches the clock". Prefers injections over pills. This is one of the first signs of to tolerance. It is also an indication that initial doses are inadequate for this individual person. Let me ask a simple question. If a dose of pain medication didn't relieve your pain and no one would give you additional medication until a certain time, WOULDN'T YOU WATCH THE CLOCK?!?

5) Appears to "enjoy" the opioids effects. Euphoria can be expected in the first days and/or weeks of opioid therapy. This "enjoyment" can also be anticipated since the relief of pain can lead to improved mood.

6) Knows the name and dose of opioids. To illustrate the absurdity of this comment, let's look at another situation. Anyone with a chronic condition that requires medication to control or prevent complications as a result of a disease or injury SHOULD know the names of their medication and the correct dosage. My mother is diabetic. Believe me, SHE KNOWS THE NAME OF HERE MEDICATIONS AND APPROPRIATE DOSES OF THAT MEDICATION" And even more interesting, she is considered a "good patient" since she has taken responsibility for the management of her disease. So why is the chronic pain patient treated differently? LACK OF KNOWLEDGE!

We fear those things we don't understand. Since many chronic pain conditions are difficult to diagnose, lack outward signs of disease, and in all probability will never be cured, people with these conditions are feared.

Unfortunately the average clinician (nurse, doctor, pharmacist) truly thinks they are following accepted protocols when they under-dose the patient in pain. Also, pain relief isn't high on the list of things to accomplish for most professionals.

One thing is clear. YOU, the patient, MUST become more knowledgeable about all aspects of your treatment(s) in order to obtain the best pain relief possible.