Tag Archives: addiction

Rx Drug Monitoring Programs: Helpful or Harmful?

How Helpful—Or Harmful—Are Prescription Drug Monitoring Programs? – FilterMag.org – by Jackie Rocheleau April 9, 2019

Before admitting new patients to his practice, Dr. Miguel Diaz checks their prescription history. Diaz, a family medicine physician with Community Care Physicians, PC in Clifton Park, New York, logs onto the state’s prescription drug monitoring program, or PDMP.

There, he sees everything the patient has been prescribed during the past year and who prescribed it.

PDMPs are now being used for all “scheduled” medications, not just opioids, and are made available for perusal by law enforcement and their minions.  Continue reading

Inconsistent Definitions of Opioid Use Disorder

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study – The Lancet Psychiatry – free full-text – Mar 2015

Background

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used.

I find it outrageous that OUD can be diagnosed on a whim just by using the fitting definition in one of the several classification systems.

The DSM-5 is the worst, thanks to its “spectrum” of Opioid Use Disorder (OUD), which always places us pain patients, with our regularly prescribed opioids, into the low end of this spectrum.  Continue reading

Low rates of dependence/addiction from opioids for pain relief

I edited the title because it’s been pointed out that “dependence” isn’t the right word. I knew this but was paraphrasing the article title, which uses that word instead of addiction, even though they are clearly talking about opioid misuse. We can thank the DSM-5 for this confusion.

Development of dependence following treatment with opioid analgesics for pain relief: a systematic view – June 2012

Aims: To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.

Spoiler alert from the happy conclusion:

The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence.    Continue reading

What Is Addiction? And What Are Its True Causes?

What Is Addiction? And What Are Its True Causes?By Wolfgang Vogel – Feb 2019

Here’s another article pointing out that addiction isn’t lurking inside drugs like opioids, but rather inside the individual.

This seems so obvious because hundreds of millions of people are routinely prescribed opioids for post-surgical pain and if all or most of them became addicted, there would hardly be any non-opioid-addicted people left.

Unfortunately, most individuals know little about what addiction actually is, and even less about what causes it.   Continue reading

Addiction Versus Dependence in DSM-V

What’s in a Word? Addiction Versus Dependence in DSM-V | American Journal of Psychiatry  – by Charles P. O’Brien M.D., Ph.D., Nora Volkow M.D., T-K Li M.D. – May 2006

…completely revised diagnostic classification published in 1987 known as DSM-III-R. This was an important contribution to the mental health field because it provided a clear way of defining addiction as compulsive drug-seeking behavior using criteria that turned out to have excellent interrater reliability and applicability to all forms of drug addiction.

The classification was adopted with only minor changes in DSM-IV.

One of us (C.O.) was a member of the committee who attended every one of the committee meetings throughout the 1980s. There was good agreement among committee members as to the definition of addiction, but there was disagreement as to the label that should be used.   Continue reading

The Science of Drug Use and Addiction

The Science of Drug Use and Addiction: The Basics | National Institute on Drug Abuse (NIDA) July 2018

Here’s what our own government’s experts of the National Institute of Drug Abuse (NIDA) believe about addiction. It’s an amazingly realistic appraisal, very different from PROP’s anti-opioid rhetoric.  

Addiction is defined as

  • a chronic, relapsing disorder characterized by
  • compulsive drug seeking,
  • continued use despite harmful consequences, and
  • long-lasting changes in the brain.   Continue reading

Can You Really Be Addicted After Just One Dose?

Can You Really Become Addicted to a Drug After Just One Hit? – VICE – by Matilda Whitworth |Oct 22 2015

The idea that one toke on a crack pipe destroys your life is popular, but it contradicts what we know about brain chemistry.

You know the story. The one that says some drugs are so enjoyable, so insidious, that just one try will get you hooked. And you’d be forgiven for believing this as the media really backs the theory.

  • “The Danger In Just One Hit of Cocaine,” reports the Daily Mail.
  • Official: 1-Hit Addiction to Meth No Myth,” announces the Times Daily.
  • “It Only Took One Hit to Get Hooked,” writes news.com.

But is it actually true? Can a person become addicted to a drug after using it a single time? Continue reading

Misconceptions about Opioid Abuse in Chronic Pain

Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies — NEJM – Nora D. Volkow, M.D. [Director of the National Institute on Drug Abuse (NIDA)], and A. Thomas McLellan, Ph.D. – Mar 2016 – free full-text article

I’m reposting this classic paper, which ironically came out the same month as the CDC Guidelines. Those guidelines showed zero understanding of the latest research and facts about opioid abuse and chronic pain that our own government is aware of.

Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage.

The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction   Continue reading

DSM-V splits drug dependence by specific drug

With what we know about addiction these days, it makes no sense to split the “substance dependence” diagnoses into groups by the specific drug. Addiction happens when the brain habituates to a malfunction of satisfying cravings despite increasing harms.

It’s the users that become addicted and have a problem, not the substance!

Wikipedia information on DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA).   Continue reading

Very Little Opioid Misuse in Military Patients

Only 1 in 4 troops have an opioid prescription in a given year – By: Karen Jowers – Dec 2018

Nearly 1 in 4 active-duty service members had at least one prescription for an opioid at some point in 2017, according to Defense Department research.

About 1 in 4 retirees also had at least one opioid prescription.

That doesn’t necessarily equate to opioid addiction. Opioids are prescribed for moderate-to-severe pain after surgery, injury, or for pain from conditions such as cancer.
Continue reading