AAEM: Risk Of Addiction To Pain Relief Is Small, Expert Says

Doctor's Guide
February 21, 2000   By Robert Carlson Special to DG News

SAN ANTONIO, TX -- February 21, 2000 -- Most pain experts say the public's concern about inadvertently becoming addicted to narcotics while being treated for pain is unfounded. Unfortunately, some physicians share that concern, and some patients are not getting the pain relief they need.

"You will not make any patient an addict if you give them drugs to treat their pain," says Henry Farkas, MD, MPH, Medical Director of the Northern Chesapeake Hospice and a staff physician at Union Hospital, in Elkton, MD. He pointed to the results of a very large study done in the 1980s, which found that only four patients became addicted out of 12,000 treated with opiates for pain. "It's just not a problem for more than 99 percent of people," he said.

Dr. Farkas discussed the topic at the 6th annual scientific assembly of the american academy of emergency medicine (AAEM), held over the weekend (Feb. 19-20) in San Antonio, TX.

Even patients with a history of drug abuse who legitimately need pain treatment can be given opioids, he said, if they genuinely want to stay off drugs.

"Assuming they are motivated to stay clean, most times their pain can be treated safely," Dr. Farkas said. "I've seen patients in the Emergency Department who I knew were drug addicts because I treated them before, but now they came in with a broken arm or dislocated shoulder and were in pain. You treat their pain and get them better, and they don't go back to drug abuse."

Then there are patients who need pain medication but are so afraid of becoming addicted that they refuse drugs. "I tell them I know how to treat pain without opiates but it will not be as effective," he said. "Then I treat them as best I can with adjunctive therapies.

"But I also assure them that, at any time, if they want to try the stronger medication, it will not make them an addict, it will only make them feel better. Many eventually come around and agree to try a low dose of an opioid. Then they feel better, and we take it from there."

Pseudo addiction is a case in which the patient complains that the pain has returned and wants another dose of narcotics in less than four hours.

"That person may look like a drug addict," Dr. Farkas said, "but their dose may actually be too low. The peak drug level gets into the therapeutic range, but drops below the therapeutic range in less than four hours."

Here is the difference: if the dose is increased and the patient's functionality improves, that's a good indication; if the increased dose makes them drowsy and sleepy, that's an indication it should be cut back. "But that doesn't mean you should stop pain treatment completely," Dr. Farkas said. "You might try something in addition to the normal opioid therapy, another medication for the particular kind of pain they are having."

He said there are several time-release opioids available which keep the drug level at a steady state in the therapeutic range.

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