Prescription pain meds and their abuse by pt's. - page 3

How are each of you dealing with patients who are abusing prescription medications? There has been so much emphasis put on the patients right to pain control (over the past ten years or so). I... Read More

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    Umm, not to sound stupid, but isn't it a true physiologic condition where some people really and truly do not have opiate receptors and so certain pain meds honest to God don't work?

    Just asking y'all...I'm ignorant.

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  2. 0
    Originally posted by shay
    Umm, not to sound stupid, but isn't it a true physiologic condition where some people really and truly do not have opiate receptors and so certain pain meds honest to God don't work?

    Just asking y'all...I'm ignorant.

    ::nodding:: And it's just as true that people can develop a physiologic tolerance to opiates and require a higher dosage than what we might generally see in the acute care setting. Opiates do not have a "ceiling" and can therefore be tolerated in increasing amounts in patients.

    I disagree that we as members of the healthcare industry create addicts. Addictive behaviors are psychologic, and have been researched and clinically proven to be due to a variety of factors. Whether someone is addictied to narcotics, smoking, food, sex or whatever, addiction is a separate issue from true pain management issues.

    Yes, we've all experienced those individuals who are psychologically addicted. These people are certainly difficult, if not impossible to manage. But please do not confuse psychological addictions to those of tolerance, poor pain control, or side effects of either the pain medications themselves, or some of the non-effective adjuvants (i.e. phenergan/inapsine) which are given to supposedly "potentiate" the narcotics effects, but in actuality generally only serve to further sedate a STILL poorly controlled patient in pain.

    One additional comment. Patients in pain will learn whatever behaviors it is we expect in them, in order to obtain the amount of medication necessary to attain adequate pain relief. Think on this: How do YOU expect a patient to act in order for YOU to believe they are in the amount of pain THEY are describing?

    THAT is exactly how they will very quickly learn to act....

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    Link to NIDA web site for their report on Prescription Drug Abuse

    Here is Former Director Alan Leshner's introductory letter on the topic:

    From the Director
    Most people who take prescription medications take them responsibly; however, the nonmedical use or abuse of prescription drugs remains a serious public health concern. Certain prescription drugs - opioids, central nervous system (CNS) depressants, and stimulants - when abused, can alter the brain's activity and lead to dependence and possibly addiction.

    An estimated 9 million people aged 12 and older used prescription drugs for nonmedical reasons in 1999; more than a quarter of that number reported using prescription drugs nonmedically for the first time in the previous year. We would like to reverse this trend by increasing awareness and promoting additional research on this topic.

    The National Institute on Drug Abuse (NIDA) has developed this publication to answer questions about the consequences of abusing commonly prescribed medications. In addition to offering information on what research has taught us about how certain medications affect the brain and body, this publication also discusses treatment options.

    This publication was developed to help health care providers discuss the consequences of prescription drug abuse with their patients. According to a recent national survey of primary care physicians and patients regarding substance abuse, 46.6 percent of physicians find it difficult to discuss prescription drug abuse with their patients.

    Prescription drug abuse is not a new problem, but one that deserves renewed attention. We hope this scientific report is useful to the public, particularly to individuals working with the elderly, who because of the number of medications they may take for various medical conditions, may be more vulnerable to misuse or abuse of prescribed medications.

    Alan I. Leshner, Ph.D.
    National Institute on Drug Abuse

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