Addiction to Prescription Pain Killers Among Patients and Physicians

Chemical dependency and recovery in patients and physicians are closely examined in a series of articles and editorials in the July 2009 issue of Mayo Clinic Proceedings. The subject is especially timely. As the immense challenges, including potential tragedies, of prescription chemical addiction and abuse are being discussed, these articles offer crucial overview, direction and optimism.

Addiction to and abuse of prescription opioid drugs are prevalent, and they exact an immense toll on patients, physicians and society, according to Steven Passik, Ph.D., Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, in “Issues in Long-Term Opioid Therapy: Unmet Needs, Risks, and Solutions.”

Opioid drugs have been used by humans for thousands of years and are the longest continuously used class of medications, explains William Lanier, M.D., editor-in-chief of Mayo Clinic Proceedings. Dr. Lanier and Evan Kharasch, M.D., Ph.D., Department of Anesthesiology, Washington University in St. Louis, authored the editorial “Contemporary Clinical Opioid Use: Opportunities and Challenges.” It summarizes the recent increased interest in this drug category.

Opioid medications are chemicals that work by binding to specific receptors, particularly in the nervous system and gastrointestinal tract; decrease perception of pain and reaction to pain; and increase pain tolerance. Side effects include sedation, respiratory depression and constipation. When opioid consumption is ongoing, physical dependence can and will develop. This, in turn, can lead to problematic withdrawal upon abrupt discontinuation of medication. Dependence, coupled with the feeling of euphoria these drugs can produce, leads to abuse.

According to Dr. Lanier, the recent growing interest in opioids stems from five sources: advances in the design of these drugs; expansion and innovation in methods of drug delivery; increased public awareness of pain management options and the appropriateness of aggressively treating pain as the “fifth vital sign” and pain relief as a fundamental human right; growing recognition of the serious consequences of opioid misuse, misadventure and addiction; and medicolegal aspects of practitioners’ prescribing practices and legal consequences for under- or overprescribing.

In addition to individuals who have chronic pain, both cancer and non-cancer related, anesthesiologists have the greatest risk of opioid dependence and abuse among health care providers. Also in the high-risk group for health care providers are nurse anesthetists and sedation nurses. Challenges specific to these groups are discussed by Michael Oreskovich, M.D., Washington Physicians Health Program in Seattle, and Ryan Caldeiro, M.D., Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, in “Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?”

Severe chronic pain includes that produced by cancer and such non-cancer conditions as back injury and surgery. Opioids are a cornerstone of pain management for individuals in these categories, according to Howard Smith, M.D., Department of Anesthesiology, Albany Medical College, N.Y. In “Opioid Metabolism,” he writes that approximately 10 percent to 20 percent of physicians will develop a substance abuse problem during their career, a rate similar to or exceeding the general population. For anesthesiologists, according to Drs. Oreskovich and Caldeiro, the increased risk is cited as an occupational hazard because of the highly addictive medications they administer to patients daily.

Health care professionals helping patients with chronic pain must balance aggressive treatment with the need to minimize the risks of misuse and abuse, according to Dr. Passik. In “A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain,” Charles Argoff, M.D., and Daniel Silvershein, M.D., both from the Department of Neurology, Albany Medical College, N.Y., write that management of chronic non-cancer pain, for example, requires comprehensive assessment of each patient; the establishment of a structured treatment regimen or program; ongoing reassessment of the pain condition and the response to therapy; and a continual appraisal of the patient’s adherence to the treatment. Their colleague, Dr. Smith, stresses the importance of understanding the metabolism of opioids in individual patients.

Keen awareness by family and friends of potential addiction is crucial for physicians and other health care providers, not to mention the general public, who might be at risk, according to “Chemical Dependency and the Physician” by Keith Berge, M.D., Department of Anesthesiology, Mayo Clinic; Marvin Seppala, M.D., Hazelden Foundation, Center City, Minn.; and Agnes Schipper, J.D., Mayo Clinic Legal Department. Especially important is that family, friends and co-workers of health care providers confront any suspected addiction and abuse because of the potential harm that might befall the individual and his or her patients. Health care facilities should have written policies and procedures in place to assist when these highly emotionally charged situations involving health care providers occur, Dr. Berge and his colleagues write. Long-term recovery and sobriety can be achieved with appropriate treatment, aftercare and monitoring, they add.

New opioid formulas designed to minimize abuse are now in late-stage development and could help, Dr. Passik says. These drugs are chemically designed to diminish euphoric effects, thus possibly reducing problematic use. For now, responsibility coupled with expertise, insight, diligence and compassion are among the components that can meet the challenges of opioid use in pain management, the authors agree.

Source: Mayo Clinic, July 7, 2009

Comments

  1. quiact says

    The Dangerously Euphoric Violet Delight

    Often, medications for pain are made from what are called opoid plants. These purple-flowered plants produce poppies that are used in the production to make the analgesic, opium.

    Poppy plants exist and are grown in areas of Asia. The country of Afghanistan is the number one producer of poppy plants. The United States is the number one country that consumes what is derived from these plants.

    Opium is what we in the U.S. call narcotics, and they essentially dull and numb those in pain who ingest these opium-based medications. The narcotics are the drugs of choice for pain management.

    Some narcotics are from natural opium, such as cocaine. In addition, the opiates from the poppy seeds can be used to create semi-synthetic narcotics, such as Heroin. Heroin was marketed by Bayer Pharmaceuticals for 12 years, and during that time this company told potential users of Heroin that it is a non-addicting form of morphine (pure opiate drug).

    This was believed to be a welcome relief for those many soldiers who became addicted to morphine after the U.S Civil War. During that same period of time, Bayer marketed heroin for other medical conditions, such as young children with coughs.

    Of course, we now know that Heroin is very addictive in fact. Ironically, Morphine has been given to Heroin addicts who are recovering.

    Opium-derived medicines once could be bought freely in the U.S. by anyone less than 100 years ago. Yet now, they are classified by the Drug Enforcement Agency as narcotics, and are scheduled accordingly to monitor and limit the use of such drugs by others, as there is a very real element of danger with narcotic usage by others.

    Internationally, the opium trade has been actively placed throughout the world. Historically, brutal force has been implemented by various nations to control what opium plants provide that others desire, as there is a pleasant euphoria experienced by the consumers of narcotics in addition to relieving pain.

    While prescribed to patients for such issues aside from pain on occasion, such as chronic coughing and diarrhea, the intended use of opium drugs is for pain management. Vicodin, which is comparatively a mild narcotic, is the most frequently prescribed and abused drug in the United States presently out of the narcotics available by prescription.

    Overall, there are about 10 opium-based medications available, and each has a length of effectiveness after administration for a period of about 4 hours

    If patients take opium-derived drugs for long periods of time, tolerance may develop with such patients. When this occurs, this patient needs and desires more of the opiate medication to acquire a level of relief.

    As a result, such patients may develop a dependence on these types of drugs, which is what often leads to addiction and possible abuse of the narcotic drug. This is why overdose of these types of drugs have occurred.

    The reasons for taking these drugs initially become replaced with a desperate need for relief due to addiction in some who take narcotics for a long period of time.

    Dan Abshear

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