Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: Pmb on 05/07/2013 23:05:40
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I've mentioned the subject of pain on this forum in the past. It appears that many people here believe that its highly probable that people who take narcotics for pain will become addicted. I recently learned that nothing could be further from the truth. I explain this below.
Yesterday I learned about a new bill that Massachusetts has in the works regarding the assessment, management and treatment of pain. I.e. https://malegislature.gov/Bills/188/House/H2002
to prompt assessment, management and treatment of his or her pain.
Right now the bill has no teeth. I'd like to see that change and that's what I wish to talk about right now, yes, again! :)
What does it say to us that the medical community actually has to be forced by law, to assess, manage and treat a patients pain? They didn't know that they were supposed to do that?
In the near future, perhaps next week, I plan on going to my state rep and senator and talking to them about this issue. In the meantime I want to get as much input on this subject as I can because this bill needs more than it states already. For example it doesn't say what lengths doctors must go to in order to help reduce pain, under what circumstances can the patient be refused narcotics, since they work so well, and when should the doctor be required to refer the patient to pain specialist?
Did you know that it's actually a well-established fact that it's unlikely for a patient who takes narcotics for pain to actually become addicted to pain medication? I read this in a book I have on addiction to prescription medication. In a survey of 12,000 patients who were on opiates for acute pain only 4 became addicted. In another study of 38 patients with chronic pain only 4 of those became addicted.
I obtained a pamphlet that a local hospital gives patients during pre-op regarding pain management. It says
Are you afraid that you'll become addicted to pain medicine?
This is a common concern of patients. Studies show that addiction is unlikely. This is especially true if the patient has never had an addiction. Talk to your doctor or nurse about your fears.
So all these doctors who state that they don't prescribe pain medication because they're concerned about their patients becoming addicted are just ignorant of these studies? Where did they get the idea that their patients would get addicted? From what I've read patients who take pain medication for pain don't get addicted. Only those people who abuse them, use them for recreation or to deal with emotional problems get addicted.
Even if a patient had a substance disorder it doesn't apply. In fact both AA and NA state that there's no reason not to give people with a substance disorder pain medication. In fact AA states in their pamphlet on this subject The AA member - Medications & Other Drugs page 13
It becomes clear that just as it is wrong to enable or support any alcoholic to become readdicted to any drug, it's equally wrong to deprive any alcoholic of medication which can alleviate or control other disabling physical and/or emotional problem.
NA says the following in their pamphlet In Times of Illness page 35
Our experience shows that many NA members have been successful in taking medications prescribed for chronic pain and keeping their recovery in tact.
Each of those pamphlets are available on the internet.
I think that in order for a doctor to keep his narcotics license For example they should be required to know trends, research and medications so as to make sure that they're up to date on the nature of narcotics, the relevant statistics, the suicide rates for people who have untreated chronic pain, solid knowledge about tolerance, current protocol for determination of whether someone is abusing them etc. I think that if we put our minds to it we can come up with some ideas for this which could help a large number of people live with less pain and perhaps even save a few lives.
What do you say folks? Can you give me some ideas to bring with me to me my representatives in government?
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Whatever ones opinion on whether narcotics can be taken long term without the eventual development of addiction, I think it's important to view addiction as a side effect of the drug, not a defect of the person taking the medication. When you think about it, pain medication is the only medication where we blame a side effect on the patient.
Even if only a certain percentage of patients becomes addicted, that does not necessarily mean they are doing something wrong, or have an "addictive personality." Not every one experiences the known side effects of other medications, but again, we don't blame the person who develops a rash or weight gain or muscle aches when they take a drug. We look for an alternative medication, or weigh the benefits against the risks.
Earlier, some one defined "abuse" as not following instructions, taking more than prescribed. But in my experience, many patients who do this are not trying to get high. They either have more pain than expected, they have an intense (and reasonable) fear of breakthrough pain that may or may not occur, they are building tolerance faster than expected, or they are attempting to alleviate the onset of withdrawal. But again, if we view this as a problem with the drug, not the patient, sometimes these problems can be managed or prevented.
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Abuse is any repetitive action that society thinks is wrong. Unfortunately there is often a division between those who think they have a right to dictate the personal behaviour of others, and those who do not arrogate such rights. I'm firmly in the second camp: it's your body, and as long as you don't upset anyone else or make demands on the taxpayer, you can do what you like with it.
That said, it is clear that whether through nature or circumstance, some people are likely to become dependent on some non-food substances and this can lead to problems if society has deemed that substance to be illegal or prescription-only. Well, walking in front of a bus will kill you and seriously inconvenience many others, but we don't make motor vehicles illegal: they are "on prescription" (trained drivers only) and we tell kids to watch out for traffic before crossing the road. Every year about 3000 people are killed on British roads and 1800 from substance "abuse" (excluding alcohol, which is a major contributor to road and other accidental deaths). But since road deaths have no positive value and the drugs at least made someone happy or pain free, it seems to me that we could take a rather more adult view of substance abuse altogether, and save a fortune on policing the drug trade.