Pain medication versus pain addiction
Petra Stark
English 1010 (Mon& Wed 08:30-9:40)
Research- Pain medication versus pain addiction
Carolyn Tuft starts her morning with a pain pill. She takes more throughout the day to
take the edge off her constant companion: Suffering from a shotgun blast that tore away
flesh, nerves and muscles in three places, and the lead poisoning from the buckshot still
in her body that leaves her bones throbbing.
"I wouldn't be able to get out of bed or function without it," said Tuft, 50, a victim of the
2007 Trolley Square shootings, where her daughter and four others died.
Roy Bosley lives with a different kind of pain: Memories of arriving at his Ogden home to
find his wife of 38 years, Carol, dead from an overdose of the pills she took for back
pain.
Patient Jonathan Judy, was once prescribed medication for back pain after car accident,
he was given very little information about the possibility of became addicted to opioids.
After time he was obtaining additional pain medication off the street. Currently he is
heroin user for over a 10 years
If Jonathan Judy and Carolyn Tuft illustrate polar ends of an ongoing debate over the
safety and effectiveness of opioids, their former doctor, Lynn Webster, is among the
physicians whose aggressive prescribing triggered it.
The Utah anesthesiologist has spent the past decade writing and lecturing about how to
safely prescribe opioids, as use of the drugs exploded in the U.S. He created a widely
used screening tool to identify patients at risk for abusing them.
Emergency visits increased from 627.000 in 2004 to nearly 1.430.000 in 2011. Per
CDC (Center for Disease Control) More than three out of four people who misuse
prescription painkillers use drugs prescribed to someone else. 7 most prescription
painkillers are prescribed by primary care and internal medicine doctors and dentists,
not specialists. Roughly 20% of prescribers prescribe 80% of all prescription painkillers.
In 2008, more than 36,000 people died from drug overdoses, and most of these deaths
were caused by prescription drugs choose carefully which patients is in need of pain
medication.
Majority of overdose occur in people who obtained them illegally.
Safely prescribed pain medication
Dr. Webster is presenting guideline which he developed. For easy recall he summed
them into acronym RELIABLE – Respiratory, Experience, Long term, Initiating
methadone, Apnea, Benzodiazepines, Look for comorbidities, Experience caution with
switching.
I believe it is important to know patient family background and substance abuse history,
to determent to potential for misuse. I have meet several patient that started use
medication because they were easy to get from home medicine cabinet.
Yes, cause/effect was implied by the author. He is emphasizing the problem that was
once quoted as epidemic of overdose deaths from prescription drugs.
How to prevent opioid addiction and misuse
The academy and other physician groups "understated the risks and overstated the
benefits" of narcotic pain killers, fueling a dramatic rise in opioid prescriptions and
overdose deaths, said Korff. But there's no evidence these drugs are effective at
managing chronic pain and medical opinion is changing. "These are treatments that
should be used selectively, with great caution and at low doses."
Webster concedes, "Opioids are not the best treatment for many people." There aren't
enough long-term studies to show what subset of the population benefits, he said. But
currently, he said, there's no substitute for the "many people who simply could not live
unless they had strong pain relievers."
Patients need to be warned of the dangers, but if patient take too much, more than
prescribed, that's their fault, not the doctor's.
As a society, we must care for the millions of people who suffer from pain, while
preventing those same patients from ending their lives by overusing their medications.
Dr. Webster is one of the most highly respected physicians in the field and has worked
tirelessly to prevent the overprescribing and misuse of opioids as part of a pain
treatment regimen.”
Dr. Webster is introducing information on how to safely prescribed opioids medication.
He is concern about increasing number of abuse/misused of prescribed drug and mostly
about unintentional overdose deaths.
Patients can also be treated with psychological therapies, as well as physical and
occupational therapy, he says. Many patients, however, do not receive a
multidisciplinary approach to treating chronic pain because it generally requires the
resources of an academic medical center. Doctors who are treating patients without
these resources need to collaborate with others who have the knowledge they don’t,
either in addiction medicine or pain medicine.
Almost all prescription drugs involved in
overdoses come from prescriptions originally; very few come from pharmacy theft.
However, once they are prescribed and dispensed, prescription drugs are frequently
diverted to people using them without prescriptions. More than three out of four people
who misuse prescription painkillers use drugs prescribed to someone else.7
Most prescription painkillers are prescribed by primary care and internal medicine
doctors and dentists, not specialists.10 Roughly 20% of prescribers prescribe 80% of all
prescription painkillers.
100 people die from drug overdoses every day in the United States.4
Annotated Bibliography
Los Angeles Times, Girion, Lisa, and Melissa Healy
"Responding to calls to stem a growing epidemic of prescription drug addiction and
overdose deaths, federal officials are urging doctors to reserve the most powerful pain
drugs for patients who need long-term, around-the-clock treatment that can't be
managed by other means. Leaders of the Food and Drug Administration said they
hoped new drug labeling guidelines unveiled Tuesday [Sept. 11, 2013] would prompt
doctors to be more cautious in prescribing long-acting and extended-release forms of
oxycodone, morphine and other narcotic painkillers, known as opioids." (Los Angeles
Times) This article discusses the FDA's action to require stricter labels for opioid
painkillers. The "FDA will now require the manufacturers of 20 long-acting opioid
products to rewrite the drugs' labels to reflect that they should be used more sparingly."
Milwaukee Journal Sentinel, Fauber, John, Feb 19, 2012
"Prescriptions for narcotic painkillers soared so much over the last decade that by
2010 enough were being dispensed to medicate every adult in the United States around
the clock for a month. Behind that surge was a network of pain organizations, doctors
and researchers that pushed for expanded use of the drugs while taking in millions of
dollars from the companies that made them, a Milwaukee Journal Sentinel/MedPage
Today investigation found." (Milwaukee Journal Sentinel) This article discusses how the
pharmaceutical industry has influenced the "practice of pain medicine."
CDC (Center for Disease Control), Jun 30, 2011
Emergency visits summary. Graph
Michael Von Korff, an epidemiologist in Seattle and a member of Physicians for
Responsible Opioid Prescribing, Sept,2013
Webster LR, Dove B.
Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners, 2007
This book was written to help all interested parties (eg, clinicians who treat pain, drug
and medical-practice regulators, law-enforcement authorities and pharmacists) to sort
out the clinical, regulatory, and ethical issues associated with the prescribing of Opioids.
Prescription Drugs Abuse and Addiction; National Institute on Drug Abuse (NIDA)
Summary: This site examines "the non-medical use of prescription drugs-opioids,
central nervous system depressants, and stimulants-describing adverse health effects
of their use and the prevention and treatment of addiction."(NIDA) Trends, prevention
and treatment are discussed. A glossary is included.