So, what is a doctor to do about the abuse of pain-killers? If doctors begin to act like police officers, then the doctor-patient relationship suffers. But doctors can keep an eye out for certain risk factors which may indicate a current or future problem with narcotics in a given patient.
A recent article in the “Annals of Internal Medicine” discusses such risk factors, which include mood disorders, other addictions, younger age, and male sex. Unfortunately, there are few novel treatments for pain, and therefore doctor and patient are often left only with narcotics, which have been around for a long, long time. It would be helpful to have other weapons in the fight against chronic or recurrent pain, weapons which are less addictive.
In the meantime, industry and the medical profession are looking at ways to combat abuse of prescription pain-killers. For example, Oxycodone will soon be available embedded in a viscous gel. In this form, the pill cannot be crushed, pill crushing being a common practice among opioid abusers. The gel does not allow intravenous use of Oxycodone. Another proposal is to combine antidotes to narcotics with the narcotics; this would tend to blunt the rapid euphoria some get from narcotic use.
Doctors must also make sure that those patients receiving narcotics for pain are actually benefiting from that treatment. If a patient is getting no pain relief, then continued use of the drug might only serve to create or maintain an addiction. Narcotics certainly have an unclear role in chronic back pain. Many studies indicate these drugs may be only effective in the short term.
Patients can also benefit from the structure of a prescription narcotic “contract,” which can allow for monitoring and reinforces in the patient’s mind the need to comply with the amounts of drug prescribed.
The abuse potential of prescription narcotics should in no way dissuade their use. The challenge for the doctor is the need to be able to appreciate the risk factors for abuse. This appreciation will allow for the continued and confident treatment of pain, and will hopefully not lead to a generalized distrust of the “pain patient.”
Meanwhile, prescription narcotic misuse continues to grow. In 1990, 600,000 persons reported first-time nonmedical use of prescription pain-killers. According to data from the United States government, that number increased to 2 million in 2001. Admission rates for narcotic pain-killers at substance abuse treatment centers increased by 155% between 1992 and 2002. And the number of emergency room visits for abuse of these drugs more than doubled between 1994 and 2002.
Enlightened doctors, patients, and pharmaceutical industry leaders by necessity will have to join forces to insure that these numbers do not continue an upward spiral.