Friday, October 28, 2005
Chronic pain patients vs. addicts: my take
Please consider this a public service announcement to the healthy people who read my blog and/or a refresher course for those of you experiencing chronic pain.
For a few weeks now, I've wanted to write something coherent about the basics of pain control and how the general public confuses people who are addicted to pain meds with people who need pain meds to function. This is not in my opinion the public's fault, really; I see it as a by-product of good ol' Nancy Reagan's "just say no" campaign. This nation is so terrified of drugs that most of us can't conceive of a narcotic being anything other than dangerous and evil. And the publicity surrounding Rush Limbaugh's abuse of OxyContin didn't clarify the issue any. So where does that leave people with chronic daily pain?
I think a good place to start would be this article from WebMD:
Nothing to Fear but Pain
Basically, strong pain medication, when dispensed in the proper amount at the proper time, does NOT produce a high in a person who is truly in pain. It merely knocks the pain down a few notches, like turning down the volume on a stereo. This enables the chronic pain patient to think more clearly, to sleep through the night, to move more easily, to function more normally. When the medication wears off, the pain patient typically does not crave more; he/she just wants to hurt less.
Exactly the reverse is true if someone without pain takes the same medication. The addict gets a "buzz" that the pain patient does not. The addict may experience alterations in thinking, sleep patterns, behavior, etc. that the pain patient doesn't. And when the medication wears off, the addict wants more, in order to enjoy the buzz. And unlike most pain patient, the addict will do just about anything to get more.
Real confusion sets in when it comes to dependence. No matter what you've seen in the movies and on TV, this is NOT the same thing as addiction. Dependence is a factor with many medications, not just the ones for pain. For instance, a diabetic who takes insulin will do so for the rest of his/her life. Why? Because his/her body requires this substance in order to function. Deny a diabetic their medication, and they could die. Now, pain medication is usually not a matter of life or death, but for chronic pain conditions, it is often a necessary part of treatment. A patient who takes daily doses of an opioid (like morphine) will come to rely on it to function and will experience physical withdrawal symptoms if the med is suddenly completely discontinued. Does this mean they're an addict? Usually not. The pain patient is usually not mentally craving the medication at all, and if for some reason they need to discontinue the medication, if they are tapered off of it slowly, they will not experience withdrawal symptoms either.
The addict, like the pain patient, experiences physical withdrawal when they stop their drug of choice cold turkey. But unlike the pain patient, they also crave the medication for psychological reasons. Some become so desperate to get and/or stay high that they resort to illegal means to obtain more. It is the crime committed by those wanting a fix that makes the news and frightens the public.
Now, what happens if a pain patient's condition improves and he/she no longer experiences pain, yet continues to take the same dose of pain medication? Then that person may experience a buzz and may begin to enjoy how that feels, and may crave that medication to the point of either faking continued pain or resorting to illegal means to continue obtaining that drug. These are the stories the media loves to publicize, yet they are NOT that common.
Now here's where I get on my soapbox. I understand the fear of crime, and the desire to punish those who will stop at nothing to get high. But what few consider is the effect the paranoia about addicts has on the legitimate pain patient who needs that same drug to have a quality life. Here is an article that appeared in a Detroit newspaper that illustrates the problem pretty well:
Painkiller drugs scarce for poor
The war on drugs in effect kills pain patients with friendly fire. Many doctors are so afraid of the DEA prosecuting them for prescribing strong medication that they simply let pain patients suffer. If they do find a doctor who will treat them, pain patients often have to sign pain management contracts with their doctor agreeing to not go to any other doctor for pain medicine. They are not allowed more than one month's worth of medication at a time, may not refill the script early, and cannot have the script mailed to them but must be examined by the doctor once a month and get their prescription in person. If they lose the script before getting it filled, well, too bad, they must suffer for a month. All because we are trying to guard against addicts.
If the person in pain does get a prescription, they may have trouble getting it filled, either because the pharmacy won't carry meds linked to crime or because the pharmacist gets on his/her moral high horse and decides the patient is an addict. They usually require ID of the patient and may not allow anyone but the patient to take delivery of the medication (in other words, a friend or relative may not pick up the prescription on behalf of the patient). If the pharmacy does carry the controversial meds favored by addicts, they are usually kept under lock and key. Again, all because we are trying to guard against addicts.
There are other issues to make the dispensing of strong pain meds problematic. The doctor may be an addict and write scripts for himself. The pharmacist may deliberately put fewer pills in the bottle than the prescription requests and pocket the rest. The patient comes up short because if they come in to complain, the pharmacy will generally accuse the patient of pocketing the pills. And then there is the issue of theft from family or friends. The patient again has to pay the price because he/she is not going to be able to get their refill until a certain date and may not be believed when they try to explain the theft. In other words, the patient constantly runs the risk of being mistaken for an addict.
The worst case scenario is being burglarized for your medication. I know a dear lady who required narcotic pain relief. Her cleaning lady broke into her house while she was on vacation and stole her medication. When she reported this to the police, she discovered the cleaning service was really a front for the woman to steal drugs.
I will be honest. I have very mixed feelings about addicts. I saw Oprah's show yesterday about a man who overcame addiction. While I was very moved by his story and was happy that he overcame his addiction, I couldn't help but think about how many people he hurt, whether directly or indirectly, intentionally or unintentionally, when he got high. I know they say addiction is an illness, and as such, I should really be sympathetic to their suffering. And I do try hard not to be prejudiced against whole groups of people. But I really struggle with this one, because I am sick too, and because of the medication I must take in order to function, I can easily be mistaken for an addict who basically lives to get high and who might steal, lie or even kill to get high. I really really resent that assumption. I also really resent the possbility that I might be held up at gunpoint for my meds while leaving the pharmacy. Ok, that last one probably will never happen, but you get the idea. Pain patients shouldn't have to feel like criminals if they need an opioid to treat their condtion.
I wonder if addicts have any idea how much their behavior hurts legitimate pain patients? Now, instead of people recognizing OxyContin as a godsend for cancer and other chronic pain sufferers, they say, "Oh, yeah, that's what Rush Limbaugh got high on". There are thousands of people in pain going without treatment because they are terrified of becoming an addict. The truth is just not getting much publicity, I guess because we are so eager to save people from themselves.
There were other points I wanted to make, but I'm too tired to continue. I did want to mention one more thing, though: I wrote this entire post after I took a methadone. Are these the ramblings of a closet addict? You decide.
For a few weeks now, I've wanted to write something coherent about the basics of pain control and how the general public confuses people who are addicted to pain meds with people who need pain meds to function. This is not in my opinion the public's fault, really; I see it as a by-product of good ol' Nancy Reagan's "just say no" campaign. This nation is so terrified of drugs that most of us can't conceive of a narcotic being anything other than dangerous and evil. And the publicity surrounding Rush Limbaugh's abuse of OxyContin didn't clarify the issue any. So where does that leave people with chronic daily pain?
I think a good place to start would be this article from WebMD:
Nothing to Fear but Pain
Basically, strong pain medication, when dispensed in the proper amount at the proper time, does NOT produce a high in a person who is truly in pain. It merely knocks the pain down a few notches, like turning down the volume on a stereo. This enables the chronic pain patient to think more clearly, to sleep through the night, to move more easily, to function more normally. When the medication wears off, the pain patient typically does not crave more; he/she just wants to hurt less.
Exactly the reverse is true if someone without pain takes the same medication. The addict gets a "buzz" that the pain patient does not. The addict may experience alterations in thinking, sleep patterns, behavior, etc. that the pain patient doesn't. And when the medication wears off, the addict wants more, in order to enjoy the buzz. And unlike most pain patient, the addict will do just about anything to get more.
Real confusion sets in when it comes to dependence. No matter what you've seen in the movies and on TV, this is NOT the same thing as addiction. Dependence is a factor with many medications, not just the ones for pain. For instance, a diabetic who takes insulin will do so for the rest of his/her life. Why? Because his/her body requires this substance in order to function. Deny a diabetic their medication, and they could die. Now, pain medication is usually not a matter of life or death, but for chronic pain conditions, it is often a necessary part of treatment. A patient who takes daily doses of an opioid (like morphine) will come to rely on it to function and will experience physical withdrawal symptoms if the med is suddenly completely discontinued. Does this mean they're an addict? Usually not. The pain patient is usually not mentally craving the medication at all, and if for some reason they need to discontinue the medication, if they are tapered off of it slowly, they will not experience withdrawal symptoms either.
The addict, like the pain patient, experiences physical withdrawal when they stop their drug of choice cold turkey. But unlike the pain patient, they also crave the medication for psychological reasons. Some become so desperate to get and/or stay high that they resort to illegal means to obtain more. It is the crime committed by those wanting a fix that makes the news and frightens the public.
Now, what happens if a pain patient's condition improves and he/she no longer experiences pain, yet continues to take the same dose of pain medication? Then that person may experience a buzz and may begin to enjoy how that feels, and may crave that medication to the point of either faking continued pain or resorting to illegal means to continue obtaining that drug. These are the stories the media loves to publicize, yet they are NOT that common.
Now here's where I get on my soapbox. I understand the fear of crime, and the desire to punish those who will stop at nothing to get high. But what few consider is the effect the paranoia about addicts has on the legitimate pain patient who needs that same drug to have a quality life. Here is an article that appeared in a Detroit newspaper that illustrates the problem pretty well:
Painkiller drugs scarce for poor
The war on drugs in effect kills pain patients with friendly fire. Many doctors are so afraid of the DEA prosecuting them for prescribing strong medication that they simply let pain patients suffer. If they do find a doctor who will treat them, pain patients often have to sign pain management contracts with their doctor agreeing to not go to any other doctor for pain medicine. They are not allowed more than one month's worth of medication at a time, may not refill the script early, and cannot have the script mailed to them but must be examined by the doctor once a month and get their prescription in person. If they lose the script before getting it filled, well, too bad, they must suffer for a month. All because we are trying to guard against addicts.
If the person in pain does get a prescription, they may have trouble getting it filled, either because the pharmacy won't carry meds linked to crime or because the pharmacist gets on his/her moral high horse and decides the patient is an addict. They usually require ID of the patient and may not allow anyone but the patient to take delivery of the medication (in other words, a friend or relative may not pick up the prescription on behalf of the patient). If the pharmacy does carry the controversial meds favored by addicts, they are usually kept under lock and key. Again, all because we are trying to guard against addicts.
There are other issues to make the dispensing of strong pain meds problematic. The doctor may be an addict and write scripts for himself. The pharmacist may deliberately put fewer pills in the bottle than the prescription requests and pocket the rest. The patient comes up short because if they come in to complain, the pharmacy will generally accuse the patient of pocketing the pills. And then there is the issue of theft from family or friends. The patient again has to pay the price because he/she is not going to be able to get their refill until a certain date and may not be believed when they try to explain the theft. In other words, the patient constantly runs the risk of being mistaken for an addict.
The worst case scenario is being burglarized for your medication. I know a dear lady who required narcotic pain relief. Her cleaning lady broke into her house while she was on vacation and stole her medication. When she reported this to the police, she discovered the cleaning service was really a front for the woman to steal drugs.
I will be honest. I have very mixed feelings about addicts. I saw Oprah's show yesterday about a man who overcame addiction. While I was very moved by his story and was happy that he overcame his addiction, I couldn't help but think about how many people he hurt, whether directly or indirectly, intentionally or unintentionally, when he got high. I know they say addiction is an illness, and as such, I should really be sympathetic to their suffering. And I do try hard not to be prejudiced against whole groups of people. But I really struggle with this one, because I am sick too, and because of the medication I must take in order to function, I can easily be mistaken for an addict who basically lives to get high and who might steal, lie or even kill to get high. I really really resent that assumption. I also really resent the possbility that I might be held up at gunpoint for my meds while leaving the pharmacy. Ok, that last one probably will never happen, but you get the idea. Pain patients shouldn't have to feel like criminals if they need an opioid to treat their condtion.
I wonder if addicts have any idea how much their behavior hurts legitimate pain patients? Now, instead of people recognizing OxyContin as a godsend for cancer and other chronic pain sufferers, they say, "Oh, yeah, that's what Rush Limbaugh got high on". There are thousands of people in pain going without treatment because they are terrified of becoming an addict. The truth is just not getting much publicity, I guess because we are so eager to save people from themselves.
There were other points I wanted to make, but I'm too tired to continue. I did want to mention one more thing, though: I wrote this entire post after I took a methadone. Are these the ramblings of a closet addict? You decide.
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