RISK OF ADDICTION
TO PAIN RELIEF IS SMALL
SAN ANTONIO, TX -- February 21, 2000 -- Most pain experts say
concern about inadvertently becoming addicted to
while being treated for pain is unfounded.
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
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),
over the weekend (Feb. 19-20) in San Antonio, TX.
Even patients with a history of drug abuse who legitimately
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
can be treated safely," Dr. Farkas said.
"I've seen patients in the
Emergency Department who I knew
were drug addicts
treated them before, but now
they came in with a
broken arm or
and were in pain.
You treat their pain and get
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
to try the
it will not make
them an addict, it will only make
Many eventually come around
and agree to try a
low dose of an opioid.
Then they feel better, and we take it from
Pseudo addiction is a case in which the patient complains
pain has returned and wants another dose of
narcotics in less than
"That person may look like a drug addict," Dr. Farkas said,
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
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
Dr. Farkas said. "You might try something in addition to
opioid therapy, another medication for the particular kind
of pain they are having." He said there are
several time-release opioids available which
the drug level at a steady state in the therapeutic range.