Facing fears about opioid addiction

Acello, Barbara

doi:10.1097/00152193-200030050-00040

Cited by 2 publications

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“…What rules do we have to live by when it comes to pain medications and the specter of drug abuse and addiction? For one thing, it is clear that a great deal of fear exists about the use of opioids among patients, caregivers, and families [15][16][17]. When celebrities are treated without proper controls, those of them who are vulnerable to abuse and addiction eventually get into trouble, creating spectacular headlines that only serve to heighten this fear of drug addiction in the general public.…”

Section: The Have Notsmentioning

confidence: 99%

Double Standard for Access to Pain Management

Passik¹,

Kirsh²

2008

AMA Journal of Ethics

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First, do no harm. Clearly, this is one of the tenets of medicine and the allied health professions and is expressed in one of our core ethical principles: nonmaleficence. If we see a patient in pain and we are unable to relieve it, then, at the very least, we should not contribute further to that patient's suffering. This standard has direct ethical implications in the practice of pain management, since the medications used in this endeavor are, in large part, potentially addictive and habit-forming substances [1][2][3]. Pendulum Swings in Pain ManagementOpioids have been available in one form or another for thousands of years, and yet they have been avoided, and pain has gone undertreated [4]. The fear of creating or worsening addiction has been one of the main reasons for this irrational avoidance of an effective but admittedly "blunt instrument" in the treatment of pain. For many decades, the exaggerated fear that exposure to these medications brought about addiction-and the intent to prevent that consequence-amounted to nonmaleficence gone awry. Paired with, perhaps, an underestimation of the benefits of simply relieving pain (as opposed to being able to correct its underlying etiology), the need to avoid addiction at all costs has led to tremendous, unnecessary patient suffering.A paradigm shift that has affected the way opioids are used, however, has been occurring for the past 20 years in the U.S. and several other countries. Fueled by the observation that people with cancer seem to be able to take these medications and enjoy good outcomes (analgesia, enhanced activity, tolerable adverse effects, and minimal or no aberrant drug-taking) the thinking about opioid use changed. Implicit in the change is the obvious assertion that having cancer itself did not bestow protection against addiction [5][6][7].As this revolution occurred, the clinical practice and rhetoric of aggressive pain management moved faster than the clinical trials, and, when groups of patients who were considerably more diverse than those with cancer were tested, the results were mixed. Unfortunately, the claims of diminished harm from drug use tended to trivialize addiction to the point where it was commonplace to hear that the risk of taking the medications was virtually nonexistent [8]. Thus, beneficence dictated that opioids could not be ethically withheld in many clinical circumstances. Under this new model, the worst thing a physician could do-ethically speaking-was to deny

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Section: The Have Notsmentioning

confidence: 99%

Double Standard for Access to Pain Management

Passik¹,

Kirsh²

2008

AMA Journal of Ethics

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“…Individuals with chronic pain who use potentially addictive medication need to be monitored to make sure that addiction does not develop over time. For some people with chronic pain, there is a risk of life-long medication dependency (Acello, 2000;Herr & Kwekkeboom, 2003). Medication dependency detracts from an individual's ability to engage in life-enhancing occupations.…”

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confidence: 99%

Paradigm of Life

Fisher

Albright

Finelli

et al. 2006

CALIF J HEALTH PROMOT

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The purpose of this study was to explore the daily routines of persons with chronic pain, to analyze the role of occupations in the chronic pain experience, and to develop a grounded theory on the role of occupation in the lives of people with chronic pain. The participants were ten individuals with chronic pain who lived in four northeastern states. Data collection tools included demographic sheets, one openended question, the Assessment of Occupational Function (AOF), an occupational configuration, the Rand 36-Item Health Survey 1.0 Questionnaire Items assessment, and the Mankoski Pain Scale. The data was first reduced into ten separate case studies. The case studies were then analyzed via closed and open coding. Closed coding was conducted according to four occupational risk factors (Cronin-Davis, Lang, & Molineux, 2004). A grounded theory emerged from this coding process. The researchers named this emergent theory the Paradigm of Life. The Paradigm of Life clarifies the relationship between occupation and pain, and it may be useful guide the development of worksite injury-related secondary and tertiary prevention programs. It also shows how occupational engagement can enhance quality of life in persons who live with chronic pain.

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Facing fears about opioid addiction

Cited by 2 publications

References 0 publications

Double Standard for Access to Pain Management

Double Standard for Access to Pain Management

Paradigm of Life

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