Not all drug addicts fit the stereotype

Yes, I was none too pleased with the “blame the doctors” tone he took. Why is it always the doctors’ fault? I’ve read several recent articles that portray the doctor who wrote the narc scripts as the source of the drug dependency. Isn’t the patient, the patient’s pain, and the patient’s way of presenting their pain (+/- lies and manipulation) ever to blame?

Mrs. Hooper’s “Whole story” doesn’t begin to uncover the potential complexities associated with Andrew’s, and other similar stories.

Why people become “Addicted” and what that relationship to their pain treatment history happens to be – is never a simple tale.

I’m going to ‘throw’ a couple of things into these comments – worthy of consideration.

Andrew started out getting the same type of haphazard pain treatment that usually is insufficient to cover a patients needs – and actually predisposes those same patients to early and rapid development of tolerance [ and potential addiction ]

1- Using rapid rise blood level type drugs [ Percocet, demerol, Tylenol #3, vicodin, etc. ]

2- Interruptions in treatment – based on lack of attentiveness and understanding on the part of the physicians, along with public policy pitfalls;such as not having regional or national plans implemented to insure that pain is treated as a disease-not just a symptom.

Add to this the ‘demonization’ of oxycontin, and the belief, on the part of most doctors, that methadone should only be used for addiction treatment [ and not for managing chronic pain ]and you have the perfect ingredients for the development of future problems.

It is unlikely that most readers of this story are ever going to fully understand these issues. At the same time, the medical profession hasn’t done much to help undo the myths and prejudices surrounding opioid prescribing.

The orthopedic community, in particular, has not responded properly to the post-operative pain needs of their patients.

This is not an irresponsible accusation, based on my own prejudice. It comes from 20 years of close observation and interaction with the orthopedic community.

Its as if a radiologic improvement in fracture alignment was justification for walking out of an operating room with an inflated feeling of accomplishment.

Often times it isn’t their fault – their daddy teachers – never taught them much about human suffering.

Andrew Hooper may have been genetically predisposed to addiction – if he really is addicted. I’m not so sure from reading this story that he wasn’t really a pseudoaddict who got mislabelled after which it became convenient to just take more and more medication-for fear of never being able to get it again.

In any event – he needs our help and our compassion. For a couple of nations that have spent billions on liberating Iraq and drinking gin in India – you’d think that a little more spent on addiction treatment wouldn’t be a problem.

And when the funds are properly allocated – here are some ideas:

1- Train health care workers to use the proper pain drugs right from the outset.

2- Start divesting doctors of their ridiculous beliefs, such as, for example, that opioids shouldn’t be used in- and do not help – patients with neuropathic pain; THEY DO.

3- Prescribe long-acting controlled relief meds from the beginning – such as oxycontin, ms-contin.

4- Appreciate how genetic influences modify pain-and the spinal cord.

5- Treat suffering – not just pain.

These things will be a good start.

Dear Anon 10:54,

This is a tremendous letter. I agree with what you say, and sympathize with what you deal with.

I want to give a meaningful reply-and appreciate your asking my opinion.

Allow me to reply a little later-today.

For now,I want to clarify that orthopedists do well at what they do best. It’s a tough field-under a lot of scrutiny. they can’t be all things to all people.

Having said this – they do tend to be a bit dismissive of longer term painful conditions in addition to viewing the presence of persistent pain as a sign of failure. This is especially true with regard to post-operated cervical and lumbar conditions.

This attitude tends to be more prevalent in the larger eastern cities-here. If you go to Iowa or Seattle-it’s a different ballgame.If you’re at a medium size Philadelphia hospital or the ‘old days’at Hahnemann – you were doomed to be ignored-period!!

Briefly-with regard to post op OxyContin, we have to consider the type of anesthetic agent, amount-if any-of intraop opioids given iv, and the subtleties of O2/CO2 response curves in the post anesthesia period, and sophisticated things of that nature.[ as I am sure you know ] But-given the simplicity of your question-the simple answer would be that maybe 20mg. of oxy was a little too much for that patient.

In general, during the first 24-48 hrs post op PCA or IV stuff is better than an oral opioid. It was with injured-yet ambulatory – patients that I was focusing when I claimed that long-acting agents are better than short. Obviously, not all situations are ideal.

Be that as it may-10-20mg. of OxyContin, in most patients-even opioid naive- should not cause any degree of respiratory impairment that I would consider as dangerous-in my experience over about 12 years of prescribing this medication on a routine basis to about 340 people every two weeks or so. The 340 patient population has been ‘turned over’ many times during those years-and I cannot remember even one complication. That speaks to the relative safety of this medication in the ambulatory chronic pain patient. Post-ops are different, for many reasons.

I’ll write a bit about my favorite subject-’Who is a pain specialist’? – later on.

Hopefully that will answer the other part of your inquiry.

By the way- I mean no respect, in particular, to your system or British history. It must be tremendously difficult for you to manage these issues with finances and so forth.

I hope that I can say with the folks over on your side —

There will always be an England.

Best wishes and thanks.

Thanks for the info. I will look at the articles.

” Why don’t they just admit this (pain control) is out of their specialty and turn those paitients over to a pain specialist following surgery”

Many do turn their patients over to PCP’s/hospitalists after surgery. A pain specialist’s wait is often 3-6 months (if you can see them at all). You want to wait that long. A good internist/op should be able to manage non-long term issue on their own.