Monday, March 15, 2010

Pain and Pills

 Are Doctors Too Reluctant to Prescribe Opioids?
            Decisions about a patient's pain treatment are now made much more collaboratively, but even in modern times, the process is fraught with moral judgment, stemming largely from the nature of available pain treatments and an incomplete understanding of how to use them.

            APA Gets Opioid "Addiction" Sorted Out
            A review draft of the American Psychiatric Association's latest Diagnostic and Statistical Manual of Mental Disorders finally eliminates perplexing "Substance Abuse" and "Dependence" disease categories and suggests replacing them with a new "Addiction and Related Disorders" designation. The more appropriate language and definitions will help to dispel unfounded fears and accusations of addiction for those taking opioid medications for pain.
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The simple fact is that fewer than 1% of patients become addicted to pain meds, and most of them can be identified in advance because they have addictive personalities.  Not just a history of drug or alcohol abuse but becoming addicted to computer games, etc.  Weed out those people and give appropriate medication to those who can be trusted.


NFontese said...

You are wrong about your 1% assertation. Dead wrong. Do some reading of professional studies regarding this subject and you will see the real numbers and averages. And as a side note, it is also documented in controlled scientific studies that are also backed up with clinical evidence that for a number of individuals it takes a mere three days for some to become addicted. These are facts that must be considered when physicans are asked to prescribe the type of medications you are referencing.

CFS Facts said...

One of several sources for that statistic:

No evidence supports fear of addiction as a reason for withholding narcotics
when they are indicated for pain relief. Studies show that regardless of
doses or length of time on narcotics, the incidence of addiction is less than

"PAIN: A Clinical Manual of Nursing Practice", McCaffrey RN, MSN, FAAN, 1989

NFontese said...

Ms. McCaffrey is a well known, educated and respected health professional in regards to accessing patient pain and management. I myself have been privileged to hear her speak on two occasions when she worked with the WHO. However, I ask you to note the publication date of the article you cite, and also the last year that book was published (1999), keeping in mind that she used that statement in the first printing, which was 1979-80, if I recall correctly. Since that time, as a self-employed consultant on pain management and someone who leads nursing/health professional workshops in dealing with pain management she herself no longer uses the statement you offer. In fact I do not think she has offered an opinion on addiction statistics at all in the past 5-7 years. Many more studies done since 1979 (and far more accurate as they include larger numbers of subjects) have invalidated the previously held assumption of 1% at risk of addiction. This is not to say she was incorrect in 1979 based on studies available at the time, just that more is known and understood now. I will not disagree that physicians and other health-care providers may at times not offer such medications when they may be of benefit to a patient but feel the whys must be understood. If only 1% percent of patients are at risk than how do we explain away a national average of 8-11% of the US population being addicted to either legal medically obtained substances or illicit ones? It is only rational reasoning that if an average of 10% of people can become addicted, patients under medical care must also be counted in that percentage and care must be taken to not make their situation worse by adding the burden and woes of addiction, even with prescribed medications.