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A warning about narcotic pain medication/management A warning about narcotic pain medication/management

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  #1  
Unread 05-27-2003, 11:28 AM
A warning about narcotic pain medication/management

Hi y'all. I am going to post this and I am not sure how it will be taken, however, I feel that its important to hear the bad stuff as well as the good stuff about narcotic pain management. Everything I am going to tell you has happen, is happening and is true.
About a year ago almost exactly, my mother started having bad headaches. She was tested inside and out, with every test possibly ever made to diagnos the reason she was having these headaches. She was then sent to a headache pain management specialist. He put her on pain management. At first, it was like Lortab 7.5 as needed and sometimes she had to come into the clinic and get a demoral shot when it got real bad. Then it went to Lortabs 10's, then percocet. Then he decided to put her on oxycontin 2 mg, 2 times a day, with percocet 5's for breakthrough. Then it was percocet 10's for breakthrough and oxy 4 times a day. Then the oxy went up to 4mg's and perocet 10's for break through. That's an incredible amount of medication. This occured over the span of a year. On mother's day of this year, she announced to everyone, something that was very apparent to those around here already, she was addicted. Not dependant, addicted.
The thing is, this didn't happen with intentions of being a seeker. She has/had legitimate pain. She would have NEVER thought she'd become a narcotic addict. She says she assumed if a Dr gave it to her then it was ok. That if anyone would know she had a problem, he would. Also, she was under the misconception that just because she had a legitamate problem with pain, that there was no way she would become addicted and not just dependant.

I knew though. She no longer could drive. When I spoke with her, she thought she sounded fine for so many months. However, to me, she sounded doped up, most of the time. She made bad decisions with her money, she has now filed bankruptcy. She forgot all my kid's birthdays. She had virtually no short-term memory anymore, even when she was on the lighter doses. For example, I would speak to her 2 times on the phone a day and for 2 days in a roll. Each time she would tell me the same things. She thought she was acting normal. I saw things like her house becoming less tidy, she no longer bothered to put makeup on, and wear anything but slouchy clothing, as she thought or would say, she just wanted to be comfy. All these things, yet, she felt like her life was as normal as always and that is what she thought others saw as well.
The final straw she said was that she started having hallucinations. She also started hearing things that weren't there. Her heart almost gave out many times. She started having chest pains and never thought, it could be due to all the meds. Her kidneys started to ache. She was having a problem just getting her bowels or kidneys to work.
To her family, its been a very long hard year for us. We never once told her we thought she had a problem either. We thought it, but also wasn't sure, and wouldn't want her to be in pain. It has been hell, quite honestly. For her and for us. I used to actually wonder and expect the phone to ring some morning or late at night to say that she overdosed. That's another thing. She never took more than what the Dr said to take. She didn't have to. It was more than enough. Most people think that you have to be taking it differently, and then you have a problem.
She been off ALL these meds for over two weeks now. She weaned down to nothing. She says she still has headaches but that she thinks considering where she has been and the difficult road to come back, she can manage them, for now.

Okay, so that's it, the short of it anyway. I came here today to browse through and catch up on everyone. I felt a little scared when I realized everywhere I looked, there was a posting or even a help section of how to get good pain management. That's great, but I saw no warnings as well. I would never want anyone to suffer. But I also wouldn't want them to suffer through this, if they lived long enough to even tell the story.
Thanks for listening.
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  #2  
Unread 05-27-2003, 02:46 PM
A warning about narcotic pain medication/management

Charity,

I'm so sorry to hear of what your dear Mother has gone through

Did she get ever a diagnosis of migraines? Or any sort of dx? The reason I ask is because I have suffered from migraines since child hood...and I have tried many types of meds in the past. None of my many specialists have ever suggested the use of narcotics. In fact I know that Percocet can cause severe headaches.

It sounds like she didn't receive very good medical care as there are many, many meds specifically designed for chronic headaches.

Good for her for getting past the addiction...I hope she is able to get proper care for her headahces.

S
  #3  
Unread 05-27-2003, 06:02 PM
A warning about narcotic pain medication/management

Charity,

I am really sorry to hear about your mother's experience. It's really too bad that nobody said anything earlier. Quite frankly, I would say that the doctor your mother was seeing was irresponsible. The pain doctor I see would never have had a patient on the medications and doses you are describing. In fact, he is very much against using narcotic drugs for non-malignant pain. It is possible that he would do it under some circumstances, but not under the ones you describe. Unfortunately, I think we all have to take responsibility for ourselves and be our own advocate. To just trust a doctor blindly is easy to do but foolilsh. I don't mean that your mother did anything wrong. And I don't mean that you did anything wrong. It is very understandable that you did what you did. Hopefully others can learn from your situation. All pain doctors are not responsible. There comes a time when you don't just increase narcotic drugs to get rid of pain. There are lots of other ways to deal with pain. In my opinion a pain doctor should be helping his patients get the pain down to a level they can live with, not try to eliminate it altogether. And if heavy duty drugs are needed for non-malignant pain another opinion should be sought.

I'm glad to hear your mother is off drugs and I hope she will find ways to deal with her pain so that she can have a life that is satisfying to her.
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  #4  
Unread 05-28-2003, 11:24 PM
A warning about narcotic pain medication/management

(((Charity))),
I am so sorry to hear about your mother's experience for many of us tho, Pain meds have given us a new take on life I did want to share some info w/ you

Tolerance, Physical Dependence, and Psychological Dependence (Addiction)

  Quote:
There is considerable misinformation about the effects of opioids (Jaffe 1989; Jasinski 1989) which contributes to fear of using opioid analgesics (Morgan 1986). It is important, therefore, to clarify the meaning of key concepts and terms. There is considerable misinformation about the effects of opioids (Jaffe 1989; Jasinski 1989) which contributes to fear of using opioid analgesics (Morgan 1986). It is important, therefore, to clarify the meaning of key concepts and terms.

Tolerance to opioids is defined as the need to increase the amount of drug to produce the same pharmacologic effect (APS 1989). The development of analgesic tolerance is a pharmacologic property of opioids and is not synonymous with addiction. Tolerance is heralded by a decrease in the duration of analgesia and is managed by increasing the dose. Since there is no ceiling dose for most opioids, the development of analgesic tolerance rarely limits opioid therapy in pain management. It should be noted that many patients remain on stable doses of opioids for weeks to months with no evidence of significant tolerance (Foley 1989a). In general, increasing complaints of pain are a sign of worsening pain rather than the development of tolerance.

Physical dependence is the physiologic adaptation of the body to the presence of an opioid, and is a state in which withdrawal symptoms will develop if opioids are discontinued or an opioid antagonist is administered (APS 1989). Like tolerance, this is a pharmacologic property of opioids that is not the same as addiction and will occur in all pain patients maintained on opioids. If patients no longer need opioids because the cancer has been reduced by anti-neoplastic treatment, or because other analgesic therapies have been effective, opioids can be gradually and safely tapered over several days to avoid acute withdrawal symptoms.

As a general principle, psychological dependence, or addiction, is a condition characterized by a pattern of compulsive behavior and overwhelming involvement in acquiring a drug for non-medical purposes, e.g., for psychic effects as opposed to pain relief (APS 1989). Drug use alone is not the major factor in the development of psychological dependence. Psychological dependence (addiction) should not be confused with physical dependence (McIzack 1988; APS 1989; Portenoy 1990). Psychological dependence may or may not be accompanied by physical dependence or tolerance. Studies indicate that iatrogenic addiction is very rare, occurring in less than 0.1% of medical patients who receive opioids for pain and have no history of drug abuse (Medina and Diamond 1977; Porter and Jick 1980; Perry and Heidrich 1982). Pain patients may require frequent escalations in dose to overcome opioid tolerance and will be physically dependent on opioids without being psychologically dependent.

The under-treatment of pain may lead cancer patients to complain and to request opioids, sometimes by name. Such drug-seeking behavior mimics addictive behavior, and such patients may be incorrectly perceived as addicts by health professionals. In fact, this is an iatrogenic condition that has been termed "pseudoaddiction," and can be avoided by listening to the patient, conducting a careful pain assessment, and treating the pain (Weissman and Haddox 1989).

Opioids:

These medications are most often used to treat moderate to severe cancer pain, and they are always prescription medications. Opioids are sometimes combined with acetaminopen (Percocet) or aspirin (Percodan), for example. These medications can be taken in a wide variety of ways orally, by patch, rectally, by injection, transmucosally and are formulated to be long- and short-acting. Almost always, opioid treatment for cancer pain begins with a low dose, and the dosage is increased until pain relief is satisfactory to the person in pain.

For many people experiencing cancer pain that is expected to continue, opioids should be administered on an around-the-clock basis, rather than given only when pain becomes intense. The around-the-clock approach provides a consistent level of the medication in the blood, and this helps to provide a fairly consistent level of pain relief, preventing abrupt peaks and valleys of pain. Additionally opioid formulations for breakthrough pain probably should be provided.
  • Side Effects:
    Opioid medications can produce a variety of side effects. The most important to know about are:
  • Constipation:
    Almost without exception, every person using opioid medications on a regular basis experiences constipation, unless he or she is given information about a special bowel regimen designed to head off this problem, which can be very painful. Many cancer pain experts recommend that a bowel regimen be started immediately when opioid medications are prescribed. People taking these medications should also drink 8- 10 glasses of water each day, and increase fiber in their diet, if possible.
  • Nausea and vomiting:
    Some people experience nausea and sometimes vomiting when they begin using opioids. There are excellent anti-emetic (anti-nausea) prescriptions medications available today, such as Zofran and Kytirl; ask your health care provider about using them to combat nausea. For most people, the nausea fades away after taking the medication for a short period of time.
  • Sleepiness: It is not unusual for some people beginning opioids to experience sleepiness for several days. For most people, this is a temporary side effect, and it is worthwhile to stay on the medications for a few days to see if the drowsiness fades away. If the sleepiness is severe, contact your health care provider.
  • Respiratory depression:
    A serious side effect of opioids is slow, shallow breathing. This side effect rarely occurs when opioids are taken as prescribed._ If you have concerns about this side effect, be sure to discuss them with your health care provider.

http://www.cancer-pain.org/treatments/treatments.html
Getting the right pain medication:
  Quote:
It's important to know that there are different types of cancer pain and different types of medication used to treat cancer pain. Often more than one medication is necessary to effectively manage cancer pain. For example, many people with chronic cancer pain also experience intermittent flares of severe pain called breakthrough cancer pain. These flares of pain are normal and can occur even though a person is taking analgesic medications on a fixed schedule for pain control. (It's called breakthrough pain because the pain "breaks through" the regular pain medication schedule.) Like other cancer pain, breakthrough pain can severely impact a person's quality of life. Thus, breakthrough cancer pain needs to be treated with the appropriate medications. Instead of being taken on a fixed schedule, breakthrough pain medications are taken as needed (i.e., when the pain occurs). These medications are often referred to as supplemental or "rescue" medications.

Managing cancer pain is not a "one-shot" deal. It may take several tries to get the right combination of medications. And some medications take time to before they begin working. Also a person's level of pain may change over time and over the course of the illness, necessitating a change in medication or the frequency of medication. Good pain relief should not leave the patient feeling overmedicated. If the medication stops the pain but leaves the person "in a fog" or unable to get out of bed, then the medication should be changed or the dosage adjusted. If your loved one is not experiencing adequate pain relief or is feeling overmedicated, you should contact his or her doctor or nurse to discuss adjusting the dose or trying another type of medication.

Barriers to pain management:

Several barriers often stand in the way of good pain management. Some physicians have not received adequate training in pain management or they may be more focused on the control the disease rather than control of the pain ( Von Roenn JH, et al., Ann Intern Med 1993;119 121-6). Another barrier is that pain may be underreported by the patient or there may be language or cultural differences. For example, studies have shown that elderly and minority patients with cancer are less likely than other groups to receive optimum pain relief. The severity of their pain is more likely to be underestimated by their doctors ( Barnabei R, JAMA;279:1877-82; Cleeland CS, et al., Ann Intern Med 1997;127:813-16). If you think that barriers such as these may be influencing the expression or treatment of pain in the person you're caring for, initiate a discussion about pain with the patient and his or her physician. If the patient is not getting adequate pain relief, you may want to request a consultation with a pain management specialist.

Using Opioids to Control Pain:

Doctors and Patients Are Unnecessarily Cautious about Using Opioids to Treat Pain

Most people facing a very serious illness fear dying in pain as much as they fear death itself. But 95 percent of pain, including the worst cancer pain, can be controlled. When lesser painkillers fail, morphine and its synthetic cousins (opioids) should be considered.Patients and American doctors (who should know better) are unreasonably afraid of opioids. This "opiphobia" is not based on fact, but is a product of outmoded knowledge and the War on Drugs. Medical research demonstrates the utility and safety of opioid use for otherwise untreatable pain. Major medical organizations have created policies and standards to advise doctors on the findings and resultant practice guidelines. A recent joint statement by the American Pain Society and the American Academy of Pain Medicine outlines current goals and standards for the use of opioids in pain management.

Despite this activity at the top of the profession, pain management in hospitals, nursing homes and doctors' offices in the United States falls far short of the standard for medical care. Doctors only recently had good pain management training available to them. They are often very reluctant to use opioids effectively, even when a patient is dying. Many never even consider opioids for long-term therapy for non-cancer pain. Very sick patients are entitled to the best modes of pain control. They, not their doctors, are the best judges of how much pain they feel and whether a particular mode of pain management is working. For chronic pain patients the key is whether the medications make them better able to function in their daily lives than do more frequently dispensed pain medications. Opioids are not the answer to every pain problem or even every severe pain problem. They are serious and, if abused, dangerous drugs. However, every patient should receive consideration of pain that is not clouded by ignorance or unreasonable fear of particular medications.

Dispelling the Myths about Opioids:

Pain patients very rarely become addicted. An addict is a person who compulsively takes drugs for nonmedicinal purposes. Addicts will continue to seek out the drugs despite bad effects on their ability to function in the community, to hold a job, to care for their families and to maintain social relationships. In contrast, pain patients often take very large amounts of opioids and other medications to improve their function, but do not seek out the drug for its own sake or "crave" the medication. Their ability to work, care for families and live productive lives is improved by their medications. A recent study demonstrates that fewer than one percent of pain patients receiving opioids become narcotics abusers. No patient in pain should hear that relief is barred because "you will become an addict." No patient in pain should reject opioids out of fear of becoming addicted. Even former and current substance abusers can be treated for severe pain by doctors with experience in the field.
There is a critical difference between "addiction" and "tolerance.""Tolerance" is a physical event that will always happen when a patient takes opioids. Tolerance begins with even one dose. This physical fact is not linked to harmful effects. It means only that, over time, pain patients can be expected to need higher doses of the medication to obtain the same relief. A patient who has been receiving opioids for pain over time can tolerate levels that would kill a person who is "opioid naive" (someone who has not built up any tolerance). For this reason it is often said that there is no theoretical upper limit to the amount of opioids than can appropriately be prescribed to control pain. Careful physicians will monitor dosage closely and increase it when necessary as tolerance builds to maintain a good effect on pain control. Moreover, some medications mix opioids and other pain relievers such as aspirin, acetaminophen and other non- steroidal compounds. A patient taking these medications will reach a ceiling dose at some point because the other drugs in the compound are toxic. Some pain relievers, such as Demerol, should not be used for any extended period because of toxicity. Confusion between "addiction" and "tolerance" is common even among physicians. Identification of patients with substance abuse problems is even more difficult. The best distinction between the two is the patient's ability to function. Pain patients can expect to improve function with optimal dosages of opioids. "Dependence" is another physical fact. It refers usually to the need to maintain opioid levels in a tolerant individual or experience withdrawal. Both addicts and legitimate pain patients will experience withdrawal if the drug is withdrawn abruptly.
Until a patient achieves pain relief there is no such thing as "too much" morphine or other opioids. Pain experts agree that there is no "theoretical upper limit" for opioid dosages for pain relief. The upper limit is "what works." It is important not to assume that high dosages or a large number of prescribed pills means that the patient is "an addict." Of course, the doctor must monitor to make sure that the dose is appropriate for that patient. Morphine and its derivatives do have side effects. The most frequent is constipation. Most side effects can be managed. A doctor may have to try a number of pain medications or combinations of medications to reach the maximum relief with minimum side effects. Patient and doctor need to work together to reach an appropriate dose for the patient.

Careful pain management does not kill:

Pain researchers and informed clinicians now agree that morphine, properly prescribed, does not depress respiration and kill opioid-tolerant patients. Pain is a powerful antagonist to respiratory depression. (Think, for example of how your heart beats faster and you breathe more quickly when you're in serious pain.) The American Pain Society and the American Academy of Pain Management have concluded in a consensus statement that "respiratory depression induced by opioids tends to be a short-lived phenomenon, generally occurs only in the opioid-naive patient, and is antagonized by pain. Therefore, withholding the appropriate use of opioids from a patient who is experiencing pain on the basis of respiratory concerns is unwarranted."Despite well-documented evidence to the contrary, the fear of respiratory depression and resulting death permeates medical, legal and ethical discussions of pain management. Advocates will have to be educators and should never fall into the trap of accepting misinformation, however well-intentioned. It is very possible to kill an opioid-naive patient with opioids. The critical factor is the physician's intent and his or her adherence to good precepts of pain management.
Pharmacists often err on the side of caution. Pharmacists are not trained to understand pain control. They have legal responsibilities under state and federal licensing regimes to refuse to fill prescriptions they believe are not for appropriate medical purposes. They often err on the side of caution and refuse to fill any opioid prescriptions, or do so with exaggerated scrutiny. A nervous, agitated and upset pain patient may look like an "addict" to them. Recent studies signal the possibility of racial profiling in filling and refusing to fill particular prescriptions. Pharmacies in poor inner-city neighborhoods may refuse to carry opioids because they fear robbery. Pharmacists' legitimate concerns too often translate into hardship for legitimate pain patients. Patients should not allow pharmacists to intimidate them when they submit valid prescriptions to control their pain. Asking the doctor to intervene should change the pharmacist's approach.
If a pharmacist challenges a prescription, the patient should ask the pharmacist to call the prescribing doctor immediately. Patients should also discuss the problem directly with their doctors.
Doctors who have legitimate pain practices should make efforts to work closely with pharmacies. They should also, with the patient's consent, be willing to put a note on the prescription showing diagnosis.
http://www.cancer-pain.org/caregivers/know.html
s to you & your Mom....Thanks for sharing....
  #5  
Unread 05-29-2003, 12:37 AM
A warning about narcotic pain medication/management

Charity :

's to you & your mother. I am sorry that she went thru such an awful experience. As a migraine sufferer I sympathize with her
Judester is right - its not often that narcotics are given for headaches. Although, my neuro Dr. used to give me an RX for Lortab for my sinus headaches that I sometimes wake up with. But he only gave me 10 pills per month - not much. He also gives me Depakote - it has worked wonders for my migraines, I rarely ever get them anymore.
As far as the narcotics go - I am on Methadone & also lortab for breakthru pain (dont get much of it). I have severe nerve damage in the groin from my hysterectomy, besides many other health problems. And I will say this - if it werent for the meds - I wouldnt be here talking to you right now. There is nothing else the Drs. can do for me. And I have finally accepted that. The meds I take have literally given me my life back, as they have for (((((Sheri))))).
I truly hope that your mother can get her headaches under controll. She will be in my prayers


Susan
  #6  
Unread 05-29-2003, 07:20 AM
A warning about narcotic pain medication/management

Hi,

Hope things are getting better for your mom. I just wanted to point out that using narcotics for breakthrough pain is very acceptable (I am on this regime myself) and is very different than using it as the regular pain medication. This may be necessary in some cases, but usually for non-malignant pain it is avoided if at all necessary. Using it for breakthrough pain leads to irregular use and makes it harder to build up a tolerance.

I wonder what a headache clinic would do for your mom. My mother has had disabling migraines all of her life and has never found anything that helps, but I know that there are new ways of treating migraines that work for some people. (Well, my mom says that a bottle of beer and Tylenol 1s help her but I'm not recommending that! )
  #7  
Unread 05-29-2003, 09:49 AM
A warning about narcotic pain medication/management

Well, it was a headache center that my mother was going to. The concept is to get a dx for the headaches and then treat them. The only dx she has ever had is that they are either or both, migraines and she has a compressed area at the base of her skull.
It wasn't like he hadn't had her on almost every single non-narcotic remedy as well. There we shots she got in the head, shots she would give herself at home, and all kinda of non-narcotic ways to get her relief.

So thanks for all the good thang you guys have said.

Sherri, that info is the same thing I was clicking to see what info was provided about PM. I felt that it gave very little real warning. I totally realize that for those who suffer on a daily basis, its hard to get a Dr to even prescribe something stronger than for the cat. I often wondered how a Dr could see me crying in his office in pain and desperation, and still worry that I could get hooked on the 10 lortabs he decided finally to give me to last for a month.
However, I also didn't realize that there were Drs out there who would go this far in the PM field, and not realize their patient is almost dying. About a year ago, my cousin's husband lost his father. After the autopsy was performed, it was a confirmed OD. However, his tox levels showed he didn't take more than what his pain Dr had perscribed. He too was on oxycontin. Somehow, they'd not digested properly and a few doses stayed together and it was enough to stop his breathing. I was amazed.
But then again, I also found out the equalivant of what my Mother's Dr had her on in a day this: a 4mg oxy is the same as 8 percocets. Multiply that times 4xdaily and you get 32 percocets daily. Then add in the allowance of 2 perc 10 mg allowed every 4-6 hours for breakthrough. It just blows my mind. I know that tolerance is what got her to that dosage, but it would seem to me that any Dr would realize how toxic that could make a body.

Anyway, this isn't a soapbox on pain meds. I wouldn't want to see anyone suffer, God knows I needed help so many times and couldn't get it. Its just a whisper in the wind to anyone who thinks that its 100% without risk.
  #8  
Unread 05-29-2003, 09:54 AM
A warning about narcotic pain medication/management

  Quote:
I just wanted to point out that using narcotics for breakthrough pain is very acceptable (I am on this regime myself) and is very different than using it as the regular pain medication. This may be necessary in some cases, but usually for non-malignant pain it is avoided if at all necessary.
Joselle,
I use narcotics as my *regular pain medication*. Break-thru pain, when on Long-Term narcotic Therapy, is what our regular meds dont/wont cover or when the pain is so bad it break's thru them

  Quote:
Federal Controlled Substances Law:

The federal Controlled Substances Act (CSA) and related regulations establish a positive framework for the use of opioids in the treatment of intractable pain in the following ways:
  • 1) The CSA recognizes that many controlled substances are necessary for the public health. The controlled substances which have been approved as safe and effective under the Federal Food, Drug and Cosmetic Act may be prescribed by physicians for legitimate medical purposes in the course of professional practice, including for indications not included in the approved labeling (U.S. v. Evers 1981; Federal Register 1983). It should be noted, however, that off-label prescribing of dronabinol, a synthetic form of THC approved by the FDA for the treatment of nausea and vomiting due to cancer chemotherapy, is an exception to this rule; the Drug Enforcement Administration (DEA) has ruled that off-label prescribing of dronabinol subjects a practitioner to possible criminal or civil action under the CSA (Federal Register 1986).

    2) The CSA does not regulate legitimate medical practice with controlled substances (U.S. House of Representatives 1970). While refills are limited, medical decisions such as the amount or duration of prescribing are not regulated by the CSA.

    3) The CSA is not intended to interfere with the availability of controlled substances for legitimate medical and scientific purposes (U.S. Code. Title 21. Sec. 826). The CSA requires DEA to establish production quotas for Schedule II drugs that will satisfy legitimate medical and scientific needs in the U.S. (Federal Register 1988).

    4) The use of opioid analgesics to treat intractable pain is considered a legitimate medical purpose for opioids and is considered to be within professional medical practice (Code of Federal Regulations 1988). DEA has emphasized that physicians should not hesitate to prescribe controlled substances including narcotics when they are medically indicated for pain in patients with terminal illness or chronic disorders (DEA 1990a).

    5) The CSA clearly distinguishes between the analgesic use of opioids and their use to maintain or detoxify a narcotic addict. Under federal law, "addict" is defined as an individual who habitually uses a narcotic drug so as to endanger public health or safety, or who has lost control over narcotic use (U.S. Code. Title 21. Sec. 802). Prescribing opioids to maintain narcotic addiction is not a legitimate medical purpose and is prohibited. However, a physician may register as a narcotic treatment program to use opioids to maintain or detoxify opioid addicts; in this event, methadone is the only opioid that has been approved for this purpose, and its use must be in accordance with applicable federal and state law and regulations. Federal controlled substances regulations allow a physician to use opioids to maintain or detoxify a person when the condition being treated is a medical or surgical condition other than addiction, such as pain (Code of Federal Regulations 1988; DEA 1990a). The regulations do not prevent physicians from using opioid analgesics to treat intractable pain in a person who has a current or past history of drug abuse.

Chronic Non-Malignant Pain:

Under federal law, the legality of using opioids for an extended period does not change if the patient's diagnosis is chronic non-malignant pain. At the state level the authors are unaware of outright prohibitions of this practice. However, some medical boards have responded in different ways to the use of opioids in chronic non-malignant pain. At least one board (Oregon) has focused investigative efforts in this direction (Portenoy 1990; Kofoed et al. 1989), and one board (Washington) has indicated it does not recognize prescribing of controlled drugs as appropriate therapy for chronic pain, although the board clarified that this policy was not intended to interfere with clinical judgment in the care of patients with chronic pain (Washington State Medical Disciplinary Board 1989). The Texas Board of Medical Examiners issued a statement clarifying that the prohibition on prescribing narcotics to an habitual user was intended to apply only to "habituated patients for whom the repeated use of narcotics or other drugs is not otherwise medically indicated" (Texas State Board of Medical Examiners 1988). Subsequently, Texas and then California adopted Intractable Pain Treatment Acts that define intractable pain without regard to whether the source of pain is malignant, and which recognize the physician's ability to use opioids to treat intractable pain. As previously noted, the Massachusetts board has endorsed guidelines for physicians to use when managing chronic nonmalignant pain with opioids. Guidelines for the use of opioids in the management of chronic non-malignant pain are not as well-developed as in cancer pain. The long-term use of opioid analgesics for patients with non-malignant pain has been criticized for many years in the U.S. because of concerns about both iatrogenic addiction and interference of drugs with the recovery of the patient's functioning (Portenoy 1990). More recently, new knowledge about pain and pharmacology and the extensive experience in managing cancer patients without significant problems with tolerance and addiction has stimulated a reevaluation of the role of opioids in chronic nonmalignant pain within the medical and scientific community (Portenoy and Foley 1986; Turk and Brody 1991; Dubner 1991; Melzack 1988). Portenoy (1990) has reviewed the literature and has suggested that "there probably is a selected subpopulation of patients with chronic non-malignant pain who may obtain sustained partial analgesia without the development of toxicity or the psychologic and behavioral characteristics of addiction." It should be recognized that chronic pain, regardless of its source, is debilitating; unrelieved chronic nonmalignant pain may even lead to suicide (Fishbain et al. 1991). Clearly, there is a need to establish the efficacy and safety of opioids in chronic non-malignant pain conditions; clinical investigation and research are proceeding. The Agency for Health Care Policy and Research (1992) has plans to develop clinical practice guidelines for the management of chronic non-malignant pain including low back pain problems. Dubner (1991) recently called for "more science, not more rhetoric, regarding opioids and neuropathic pain," recognizing that many patients with chronic non-malignant pain are not obtaining pain relief. Dubner (1991) recommended that "(c)areful administration of opioids in the manner suggested by Portenoy (1990) should continue while well-controlled clinical trials are undertaken to establish opioid analgesic efficacy." Portenoy's proposed guidelines, developed from a review of existing literature and clinical experience. The Commonwealth of Massachusetts Board of Registration in Medicine has also endorsed guidelines for prescribing opioid analgesics for patients with chronic non-malignant pain (Commonwealth of Massachusetts Board of Registration in Medicine, 1989).
  Quote:
Diagnosing chronic pain often requires extra time -- X-rays and the usual tests may turn up nothing, even when patients are visibly suffering -- and managed care demands extra efficiency. Doctors who participate in that system, with its attendant focus on quickly moving patients in and out of doctors' offices, "are extremely pressured for time," Carr says. "Anything that looks like it will take more time is a tremendous disincentive." Greater obstacles to aggressive pain management resulted in more undertreated sufferers of chronic pain. A handful of doctors, aware of the problem, sought to focus on treatment of pain by forming specialized study groups in the early '70s. But it wasn't until 1985, when an article in the New England Journal of Medicine identified a widespread lack of adequate care, that victims of undertreated chronic pain became more visible to doctors and the public.
The journal article, by Dr. Kathy Foley, offered new medication and treatment guidelines that became the model for doctors treating pain. Medical schools and regulatory boards also responded, gradually, with dedicated training programs and ethical guidelines for the treatment of pain. Tufts University was the first, in 1991, to establish a master's program for doctors in pain studies. By 2000, 24 state medical boards had adopted pain guidelines that specifically advised doctors on the dangers of undertreatment. Meanwhile, large healthcare providers created pain clinics, increasing the number of locations where strong drugs could -- and would -- be prescribed. And then, out of the blue, came the OxyContin scare. Abuse of the drug began to reverse advances in pain management by early 2001, in concert with a broad crackdown on painkillers. The problem with OxyContin was not its main ingredient (oxycodone hydrochloride), which is found in Percocet and other painkillers, and has been around long enough to be widely prescribed and relatively uncontroversial. The problem was with OxyContin's potency, promotion and chemical formula. OxyContin carried an extremely high dose of oxycodone -- up to 160 milligrams or 16 times the highest dosage available in Vicodin. It was extremely popular (sales exceeded $1 billion in 2000), which made it very accessible. And its time-release qualities were easily defeated by simply crushing the pill. Towns that didn't have easy access to heroin or other hard drugs became the first "Oxy" hotspots. Rural Maine, western Pennsylvania and the Appalachian areas of Kentucky, Virginia and West Virginia in early 2001 were the areas first hit. But word -- and addiction -- spread fast, and deaths attributed to the drug began to be reported. Calls for legislation and increased law enforcement came quickly, and painkillers of every variety came under new scrutiny. The first controls of the drug sought to cut off abuse by Medicaid patients. There was no body of data indicating that the poor abused the drug more than wealthier Americans, but by the summer of 2001, six states had introduced legislation making it harder for Medicaid patients to get their pills. Other states followed, with regulations aimed at aid recipients with OxyContin prescriptions or at Medicaid patients in need of pain medication. Vermont, at the behest of its Gov. Howard Dean, who is a physician, ended coverage of OxyContin for all its Medicaid patients. If poor patients needed the pills, said the state's lawmakers, they had to move. "I'm on Medicaid and I'm scared that the state's going to stop paying [for OxyContin,]" says Sarah Murray, a 51-year-old Louisiana woman on Medicaid who suffers from multiple cysts in her kidneys and liver. "I know in some states they've stopped paying. And if they stop paying here, I'm dead." In the past 18 months, 17 states set up electronic prescription databases to track doctors who prescribe, and patients who receive, Schedule II drugs. Six more states are considering similar systems. Meanwhile, legislators in West Virginia are considering a ban of all the drugs that contain oxycodone. One Pennsylvania legislator has introduced a bill that would move OxyContin from Schedule II to Schedule I, a category that includes mescaline, heroin and other drugs considered to have no medical purpose. "The entire idea of [the Virginia tracking law and others like it] is to go after people who are willingly and intentionally breaking the law," says Tim Murtaugh, spokesman for the Virginia attorney general's office. "It's clearly growing as a problem, and we believe that it's the commonwealth's responsibility to address it." But doctors have blanched at the sweeping changes and proposed bans, and their panic has only increased in the wake of cases like that of Dudley Hall, a Bridgeport, Conn., doctor charged July 17, 2001, with 36 counts of over-prescribing. Sure, they argue, Dr. Hall, who prescribed more OxyContin that any other doctor in his state, (earning the title Dr. Feelgood), deserves to be prosecuted. But Hall was busted by officers posing as patients, and doctors fear that undercover operations will become the norm. The new laws, say doctors, even if they didn't lead directly to Hall's arrest, make police especially brash, far too confident in their ability to decide which prescriptions are valid or invalid
Many doctors looking for creative ways to deal with new layers of regulations have found loopholes that can result in further suffering for the patients they are willing to keep. Many physicians, for instance, are continuing to prescribe pain medication, but are cutting dosages. For sufferers of chronic pain, who often require increased dosages over time because of increased tolerance to their medications, this is a move that promises less relief in the face of increasing pain. Dabrowski, for one, says she's suffering unnecessarily because of this practice. Dale Denton of Franklinton, La., says it has been disastrous for his 79-year-old father, who suffers from an advanced form of melanoma. Four months ago, his father's doctor cut his father's daily medication intake in half -- from two 40-mg tablets of OxyContin to two 20-mg pills. "Then [the doctor] cut him down to morphine, which is making him sick," says Denton, whose father is on Medicaid. "He told her about it but she wouldn't give him enough. She said there's too many dopeheads. I said, 'They're not going to get it,' and she said, '**** right, because I'm not giving it to him.'" In fact, most users of OxyContin and other strong pain medications are not addicts, says Carr at Tufts University. "For every one case of a robbed pharmacy to get an opioid, there are probably 100 people who are undertreated or appropriately treated." But, adds David Joranson, director of the pain and policy studies group at the University of Wisconsin Medical School, "America is a country where the treatment of pain is governed by how we perceive the drug-abuse problem." As a result, he adds, "there's a multiplier effect." Laws aimed at the minority are having an enormous effect on the majority, most of whom feel they can barely survive without their pills. Denton is angry that his father is suffering from unnecessary pain, but he is even more furious that his father's suffering is making the end of his life intolerable. "When he was on Oxy, he could he enjoy his life a little," Denton says. "He was comfortable; he was able to go in the yard a bit. But since they took him off, he's been down in bed and he ain't been back up." Doctors in many areas also are shuffling pain patients off their rosters. Rather than deal with the increased scrutiny, they're referring patients to pain specialists, many of whom are already overwhelmed. Michael Brennan is dealing with the issue first-hand. About 90 percent of his practice's 800 patients suffer from non-cancer chronic pain and Brennan says that he's in danger of burning out -- in large part because he's receiving a substantial uptick in referrals. "We have little old ladies on 10 milligrams of OxyContin referred to us because their doctor doesn't want to prescribe it," Brennan says. "People aren't willing to take the risk for their patients. Some will put their patients on non-narcotic pain relievers -- which puts patients at risk -- and others ultimately just say, 'Hey, let's send them to the pain doctor.'" John Schoos, 45, is a retired banker who used to fill his prescription for the opioid Levo-Dromoran at the CVS near his home in Hawthorne, N.Y. Now, to calm the constant pain resulting from nerve damage suffered during treatment of testicular cancer and hip surgery, Schoos has to go to Memorial Sloane Kettering Hospital in Manhattan, an hour's drive away. And even there, he says, there's strong prejudice against pain medication. "One of my family friends is a doctor at Memorial, a surgeon," he says. "He knows that I've been on this drug for a long time so one night, he asks me at a party, 'Hey, are you off the pills yet?'" "And I was like, Jesus, if he doesn't get it, the fact that I need these pills to get up in the morning, imagine how many others don't understand." Once patients get their drugs, they are frequently limited to a maximum of one month's supply. That means they run out faster, and then, because pharmacies can no longer carry large supplies, they struggle to find a pharmacy to refill their prescriptions. A further limitation, which is another direct result of the painkiller crackdown, is that many patients are being forced by their doctors to sign contracts in which they promise never to visit another doctor or pharmacy for prescriptions. So, if the pharmacy specified in the agreement doesn't have what the patient needs, the patient has to decide what is worse: to violate a contract by going to another pharmacy? Or to forgo medication that makes life livable?
Sara Patterson was forced to make such a choice just last month. Her daughter Holly, who is 7, suffers from damaged nerves and a degenerative spinal disorder. Essentially, says Patterson, "her body doesn't regulate the pressure of her spinal fluid, and the fluid puts pressure on her damaged nerves, which causes the pain." Holly's form of excruciating agony comes and goes. She can spend three or four months in unrelenting, paralyzing pain, and then enjoy a month of relative comfort, only to have the pain strike suddenly once again. Last month, when the pain hit, Patterson called her daughter's pain clinic -- a two-hour drive from her Central Florida home -- to get a prescription for Holly. The doctors didn't answer.
In a panic, Patterson went to Holly's local pediatrician, who immediately offered to prescribe medication. "But I said no, you can't do that," Patterson says. "I told her I had signed a contract that prohibited me from buying medication from another doctor. I was afraid of getting in trouble." Instead, Holly endured another day without relief before getting the right medication from the "legal" source. Meanwhile, Patterson says she fears that Holly will commit suicide.
"Every birthday, she blows out her candles and wishes for the pain to go away," Patterson says, her voice quivering. "She constantly says that she doesn't want to live. She just asked me 15 minutes ago if she could go ahead and kill herself. Right now she doesn't understand what it means to terminate her life. But what happens when she gets older? She might actually succeed. Our time is running out." The DEA justifies its steps to limit access to opioids with figures that blame the diversion of OxyContin from patients to addicts for an estimated 300 deaths in 31 states over the past two years. As recently as March 22, DEA chief Asa Hutchison called for more prescription-drug tracking to help law enforcement nab addicts and doctors. To be fair, Hutchison also has stressed that increased enforcement should not affect pain patients, and the DEA's OxyContin Action Plan states that "these actions are not intended to impact on the availability of legitimate drug products for medical use." But experts question the sincerity of law enforcement's dedication to those who truly need strong pain medication. There have been no mitigating laws passed in the interest of patients. Joranson, the pain policy expert, argues that in many states new prescription laws amount to simple politics: "Politicians need to be seen as doing something about drugs," he says. And others fear that Hutchison's stated attempt to protect legitimate prescribing will go unheeded. With press attention focused on doctor busts and new laws that extend police powers, authorities may not curtail their efforts, but expand them. "While the DEA has strived to be sensitive in their central office to pain medications, I question whether that commitment has trickled down to the field," says John Giglio, one of several pain-management advocates who met with Hutchison last fall to plead the pain patients' case. "I also question whether the people in the office of diversion control have really gotten that message, much less gotten the additional training that they need to treat doctors and patients fairly." Some patients are fighting back. Mike Schrader, for example, had his prescription switched from OxyContin to methadone a month ago. At first, the former X-ray technologist didn't mind. The methadone alleviated some of the pain he suffers in his hips and back -- the result of 14 separate surgeries -- and he was willing to give it a try. But eventually he discovered that the new pills were weaker than expected. "My pain level before OxyContin was an 8 out of 10," he says. "With OxyContin it was on a 4-5 level. Now I'm back up around a 6." Schrader figures that there's no reason to sit back and take the pain. He says that for as long as the methadone fails him, he'll keep asking his doctor for the same level of relief he received with OxyContin. "I'm not going to let him force me to suffer just because he's scared to write the prescription," he says. Few victims of chronic pain have Schrader's energy or clarity of mind to protest undertreatment, so pain advocates are trying to back them up -- to little avail. "We are an opiophobic nation," says Barbara Coombs Lee, president of the Compassion in Dying Federation, a nonprofit that is suing U.S. Attorney General John Ashcroft for trying to overturn Oregon's physician-assisted suicide law. "We have a craziness about this issue and the effect is that it harms patients in pain and those at the end of their life." Adds Murray, "If [OxyContin] was taken off the market right now, it would not hurt the drug addicts," she adds. "It would only hurt the people who need it. The addicts will get another drug. It's gonna be us that pays."
http://www.salon.com/mwt/feature/200...ef/index3.html
PERSONAL HEALTH; Misunderstood Opioids and Needless Pain:
By JANE E. BRODY (NYT)
  Quote:
Chronic pain suffered by 30 million Americans robs people of their dignity, personality, productivity and ability to enjoy life. It is the single most common reason people go to doctors, contributing to an overall cost to the economy of billions of dollars a year.

Yet chronic pain, whether caused by cancer or a host of nonmalignant conditions, is seriously undertreated, largely because doctors are reluctant to prescribe -- and patients are reluctant to take -- the drugs that are best able to relieve persistent, debilitating, disabling pain that fails to respond to the usual treatments.

These drugs are called opioids, which are natural and synthetic compounds related to morphine, generally known as narcotics. Many studies have indicated that ignorance and misunderstanding seriously impede their appropriate use.

Studies suggest that about half of patients with cancer-related pain and 80 percent of those with chronic noncancer pain are undertreated as a result. These patients suffer needlessly, as do their loved ones.

''Some patients who experience sustained unrelieved pain suffer because pain changes who they are,'' say Dr. C. Richard Chapman of the University of Utah School of Medicine and Dr. Jonathan Gavrin of the University of Washington School of Medicine.

Chronic pain, they wrote in The Lancet medical journal, results in ''an extended and destructive stress response'' characterized by brain hormone abnormalities, fatigue, mood disorders, muscle pain and impaired mental and physical performance.

Neurochemical changes caused by persistent pain perpetuate the pain cycle by increasing a person's sensitivity to pain and by causing pain in areas of the body that would not ordinarily hurt.

''This constellation of discomforts and functional limitations can foster negative thinking and create a vicious cycle of stress and disability,'' the researchers wrote. ''The idea that one's pain is uncontrollable in itself leads to stress. Patients suffer when this cycle renders them incapable of sustaining productive work, a normal family life and supportive social interactions.''

Dr. Jennifer P. Schneider, a specialist in addiction medicine and pain management in Tucson, Ariz., agrees. ''When patients feel hopeless and think they will never get relief, it makes chronic pain and its effects that much worse,'' she said in an interview.

****Abundance of Misinformation****:

Far too little has been done to correct the misunderstandings of both patients and doctors that stand in the way of using opioids to control chronic pain. Nowadays, doctors are more inclined to use narcotics for pain relief in patients with advanced cancer, assuming erroneously that ''since they're dying anyway, it won't matter if they become addicts.'' But the reluctance to use opioids for noncancer-pain patients persists, and patients are equally likely to resist taking them should they be prescribed.

''Like most doctors, most patients are relatively uninformed about the safety of using narcotics for pain, thinking they're dangerous drugs that will do bad things to them,'' Dr. Schneider explained. ''They don't understand the difference between physical dependence and addiction, and as a result they're afraid they'll become addicts.''

As Dr. Henry McQuay, a pain specialist at the University of Oxford in England, put it: ''Opioids are our most powerful analgesics, but politics, prejudice and our continuing ignorance still impede optimum prescribing. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The medical use of opioids does not create drug addicts, and restrictions on this medical use hurt patients.''

In three studies involving nearly 25,000 patients treated with opioids who had no history of drug abuse, only seven cases of addiction resulted from the treatment.

Dr. Schneider was distressed last month by a segment of ''48 Hours'' on CBS depicting a woman who had been taking the sustained-release opioid OxyContin. The woman said that although the drug had relieved her chronic pain, she stopped taking it because she feared becoming an addict. But instead of tapering off gradually, she quit cold turkey. As any pain expert would predict, she suffered withdrawal symptoms typical of physical dependence on a narcotic: aches all over, tearing eyes, runny nose, abdominal cramps and diarrhea.

Physical dependence, whether to an opioid or to an immune-suppressing drug like prednisone, involves reversible changes in body tissues. To avert withdrawal symptoms, the medication must be stopped gradually. Addiction is mainly a psychological and behavioral disorder.

Dr. Schneider described the hallmarks of addiction, whether to alcohol or narcotics, as loss of control over use, continuing use despite adverse consequences, and obsession or preoccupation with obtaining and using the substance.

The Benefits of Relief:

Unlike an addict, whose life becomes increasingly constricted by an obsession with drug use, a patient using the drug for pain experiences an expansion of life when relief comes from this life-inhibiting disorder, Dr. Schneider said. An addict gets high by taking the drug in a way that rapidly increases the dose reaching the brain. But opioids properly used for pain do not result in a ''rush'' or euphoria. When given for chronic pain, opioids are typically given in a form that provides a steady amount throughout the day.

Nor do pain patients require ever-increasing amounts of opioids to achieve pain control, because patients in pain do not become ''tolerant'' to properly prescribed opioids. Higher doses are needed only if an inadequate amount of the drug is given in the first place or if the pain itself worsens with time.

Tolerance does develop to some of the common side effects of opioids, including sedation, respiratory depression and nausea, although constipation tends to persist as long as the drug is taken. But an opioid taken to relieve chronic pain does not block acute pain sensations that might result, for example, from surgery or an injury. A broken arm or gallbladder surgery will hurt just as if no opioid were being taken and will require additional treatment with some other analgesic, Dr. Schneider said.

Of course, round-the-clock narcotics are only one aspect of proper treatment for chronic pain that fails to respond adequately to lesser drugs.As Dr. Schneider explained, chronic pain is ''a primary disorder'' that can itself cause disabling complications, including difficulty sleeping, muscle spasms and depression.

Thus, pain specialists commonly prescribe a low-dose antidepressant like Elavil to promote sounder sleep, muscle relaxants and anticonvulsants to relieve spasms, anti-inflammatory drugs, full-dose antidepressants to counter depression and an increase in physical activity to improve mood and reduce feelings of incapacity.

Patients may also be referred to psychologists for cognitive-behavioral therapy, physiatrists (for exercises and pain-relieving injections), physical therapists, hypnotists, biofeedback specialists and even acupuncturists, Dr. Schneider said.

To help reduce the risk of drug abuse, Dr. Schneider and many other pain specialists insist that before receiving opioids for chronic pain, patients sign a ''contract'' that, among other things, insists that only one doctor and one pharmacy be used to provide opioids and that no change in dose be made without prior consultation with the prescribing physician.

The contract also states that there will be ''no early refills,'' no matter what the excuse, and that patients must agree to undergo random urine drug tests if the doctor suspects the drug is being abused.

http://query.nytimes.com/search/rest...A80894DA404482
Stories like I posted above, make me fight harder to advocate the need for relief no matter what the source is...except something illegal we are the ones often left to pay

Big (((hugs))) to all my fellow sufferers

One me thing that really puts it all in perspective:a

Chronic Pain Statistics:
  Quote:
  • CNP, pain that lasts six months or more and does not respond well to
    conventional medical treatment, affects more people than any other type of
    pain. Thirty-four million Americans suffer from chronic pain, and most are
    significantly disabled by it, sometimes permanently.
  • The economic impact of CNP is staggering. Back pain, migraines, and
    arthritis alone account for medical costs of $40 billion annually, and pain
    is the cause of 25% of all sick days taken yearly. The annual total cost of
    pain from all causes is estimated to be more than $100 billion.
  • Despite the magnitude of suffering, CNP remains grossly undertreated in
    most patients. The reasons for this are: the low priority of pain relief in
    our health care system; lack of knowledge among both health professionals
    and consumers about pain management; exaggerated fears of opioid side
    effects and addiction; and health professionals' fear of medical board and
    DEA scrutiny, even when controlled substances are used appropriately for
    pain relief.
  • Contrary to common fears, numerous studies have shown addiction is
    extremely rare in pain patients taking opioid drugs, even in patients with
    histories of drug abuse and/or addiction. CNP patients will develop a
    physical dependence on opioid drugs, but this is not the same thing as
    addiction, which is an aberrant psychological state.
  • Unrelieved pain has many negative health consequences including, but not
    limited to: increased stress, metabolic rate, blood clotting and water
    retention; delayed healing; hormonal imbalances; impaired immune system and
    gastrointestinal functioning; decreased mobility; problems with appetite and
    sleep, and needless suffering. CNP also causes many psychological problems,
    such as feelings of low self-esteem, powerlessness, hopelessness, and
    depression. (12, 15, 16, 18, 19)
  • Undertreatment of CNP often results in suicide. In a recent survey, 50%
    of CNP patients had inadequate pain relief and had considered suicide to
    escape the unrelenting agony of their pain. Unrelieved pain also leads to
    requests for physician-assisted suicide, another indicator of pain's harsh
    impact on the quality of life of many patients and their families.
  • Discrimination against CNP patients is pervasive in the American health
    care system. Women, racial/ethnic minorities, children, the elderly,
    worker's compensation patients, and previously disabled patients (e.g.,
    those with cerebral palsy, or who are deaf, blind, amputees, survivors of
    childhood polio, etc.) are at great risk for undertreatment of their pain,
    even though patients belonging to one or more of these groups are the vast
    majority of all CNP patients.
  • CNP patients with severe, unrelenting pain from permanent structural
    damage to the neurologic or musculo-skeletal systems are often subjected to
    expensive and unnecessary surgeries and other painful invasive procedures.
    Arachnoiditis and reflex sympathetic dystrophy are the most common causes of
    severe CNP. Other common causes include: post-trauma, adhesions, systemic
    lupus, headaches, degenerative arthritis, fibromyalgia, and neuropathies.
http://groups.google.com/groups?q=Ch...one.net&rnum=8
  #9  
Unread 05-29-2003, 10:24 PM
A warning about narcotic pain medication/management

  Quote:


Stories like I posted above, make me fight harder to advocate the need for relief no matter what the source is...except something illegal we are the ones often left to pay

Big (((hugs))) to all my fellow sufferers

One me thing that really puts it all in perspective:a

Chronic Pain Statistics: [/b]
And stories like mine make you want to...........? I understand totally what others who suffer with pain go through. But there has to be an understanding. My mother didn't go into that Clinic wanting to be an addict. She didn't think sometime in her life that one of her goals was to become addicted to painkillers. And unlike the rare statistical information, the addicts that break into pharmacies or buy the meds on the street, aren't the majority. I've been to these recovery meetings and seen the majority. They are people you know all around you, "normal people." Who never knew it was even possible that they'd be overtaken by something like this. Addicts don't have a certain name or face. And addiction doesn't get picky with its victims. This disease is just as devistating as suffering with pain. As a matter of fact, it is nothing but pain. These aren't people who sit around high and happy while everyone who NEEDS pain relief are being neglected. They are miserable, deathly souls. If they even have much of a soul left. They started out just like you or I.
To advocate something that does actually carry this risk, WITHOUT realizing the need for some natural, normal fear and warning is very dangerous.
And these statistics or studies that I just read. It keeps saying rare. I must be special then. I have encountered 4 of my close family now either suffering or have already died from prescription abuse. I guess we are the 4 out of millions then? Not likely. One of my closest friends is even a pharmacist who is a recovering prescription drug addict.
The warning was not from a page of statistics. It was from real, personal experience.
Its something that everyone who has to take these medications should be clearly aware of and know if it starts to become a problem. Why? Most of the time, by the time they find out, its too late. It takes over and no matter how much they want to get well, the addiction is just stronger.
  #10  
Unread 05-30-2003, 05:27 AM
A warning about narcotic pain medication/management

It's not common, but addiction can happen even when pain meds are taken for chronic pain. Thank you Charity for bringing you Mom's story to our attention. I'm so sorry she had to go through this.
Reply

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