Despite @Dan_Lyons’ bland assertion, my own reading – not firsthand experience – tells me that when opioids and other narcotics are taken for legitimate long-term pain management, there is much less chance of addiction. There is always a chance of addiction; especially since not all patients and not all doctors are honest. Pain described by a real sufferer may not be as intense as what the good doctor comprehends, so the doctor may over-prescribe unintentionally. That could lead to a dependence on the drugs, which could easily morph into a full addiction.
Good doctors are always cognizant of that, and for that reason will usually only increase the dose gradually, relying on a patient’s honest feedback about what is or is not working to manage the pain. But not all patients are honest, are they? Some only mimic pain symptoms because they are already addicted and simply want a legitimate source of more meds. On top of the doctor’s own concern for his patient, the DEA is clamping down hard on the “Doctor Feelgood” operators, who are basically drug pushers who happen to have a license to practice medicine.
Because of heavy DEA oversight over the entire dispensing process, a huge majority of “good” doctors tend to avoid any kind of “pain management” specialty, because they can’t deal with the constant investigation and harassment that comes with it. Of the good doctors who do specialize in pain management, they tend to accumulate more and more patients from farther and farther away, which means that they are dispensing and prescribing more and more drugs to more and more people. Consequently, they call down more and more “investigation” on their heads. It’s a tough situation to be in for the doctor and for the patient, because as doctors are driven out of the field, whether because of retirement, overwork, or mistakes that lead to prosecution and loss of license, the patient who already couldn’t find a doctor close to home now has to go farther afield to prove his pain is real to another doctor, and go through the same “be careful and start slow” process with a new physician.
On top of that, of course, is the decreasing efficacy of opioids over time. Assuming that “a source and level of pain” remains constant, it takes more and more of a given drug to handle that level of pain. The body develops a tolerance to a drug, and the physician, knowing this, has to gradually increase the level that’s administered, just to maintain a status quo. If the pain is worsening over time due to level of illness or structural malfunction increasing, then that compounds the problem.
So now there’s a situation where a more-or-less overworked doctor, who has probably more patients than he can comfortably see, from farther and farther away geographically, and whose practice is more or less dedicated to dispensing very strong painkilling drugs… in increasing doses. So the DEA increases their level of surveillance. It’s a very vicious cycle.
As patients die, as all kinds of doctor’s patients (and all of us, anyway) eventually do, if the cause is the least bit “drug-related”, then another doctor is pilloried, stripped of his license and discarded, or worse. And the problem doesn’t get better.
From a “community” perspective, it’s a bad thing for a good doctor to risk over-prescription, because it can harm his patient, wreck his practice and ruin the lives of a lot more people that you can’t see.
Composing members:
0
Composing members:
0
