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
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
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.
THE TROUBLE WITH HEROIN
I found this intimate description of heroin withdrawals so compelling I began to squirm as I read (. I’m sharing it here so those of us taking opioids for pain can understand the dilemma of those who begin taking opioids for recreation. What starts as “fun” quickly turns into a desperate compulsion to avoid truly unbearable misery.
A lot of people are physically sick when taking gear [heroin] for the first time. The body is reacting naturally by dispelling poison from its system, heroin is a poison to the body. The body quickly adapts to regular heroin intakes, the speed of the addiction is revealing, after a few days your body can tolerate and then require regular top ups to feed the tolerance. Continue reading
Opioid Withdrawal Not Deadly? Wrong | Medpage Today – by Jeffrey E. Keller, MD Nov 2018
I’ve seen enough patients withdrawing from opioids [in a jail medical practice] that I think I am reasonably knowledgeable on the topic. Because of this, I was quite surprised when I ran across this sentence in a recent edition of The Medical Letter: “Opioid withdrawal is not life-threatening.”
The problem is that although this sentence seems quite self-assured, it is flat out wrong. In fact, it is not just wrong; it is also dangerous.
People do die from opioid withdrawal. I know of several such cases from my work with jails. Continue reading
Are Media and Politicians Aware That Addiction and Dependence Are Not the Same Thing? – September 18, 2018 – Jeffrey A. Singer
Hardly a day goes by without a report in the press about some new addiction.
One gets the impression that life is awash in threats of addiction. People tend to equate the word “addiction” with “abuse.” Ironically, “addiction” is a subject of abuse.
The American Society of Addiction Medicine defines addiction as a
- “chronic disease of brain reward, motivation, memory and related circuitry…characterized by
- the inability to consistently abstain,
- impairment in behavioral control,
- craving” that continues despite resulting destruction of relationships, economic conditions, and health
Why there’s an overdose epidemic — in two graphs – STAT – By Hawre Jalal and Donald S. Burke – September 20, 2018
Here two of the authors write more about their recent study of the “Overdose Epidemic”:
The “overdose epidemic” that so many Americans are talking about isn’t really a single epidemic. It’s actually several of them, something we began exploring when we graphed the yearly counts of overdose deaths for the last 40 years.
It turns out that, when totaled, these sub-epidemics trace a nearly perfect exponential growth curve. For four decades, overdose deaths have been growing, doubling about every eight years. Continue reading
Richard Sackler, member of family behind OxyContin, was granted patent for addiction treatment – By Andrew Joseph @DrewQJoseph – Sept 2018
Again, truth proves to be stranger than fiction. Apparently, there’s money to be made from both leading into and leading out of addiction, so I suppose it’s natural that a pharmaceutical company would follow the money.
A member of the family that owns Purdue Pharma — which is being sued by more than 1,000 jurisdictions for its alleged role in seeding the opioid crisis with its pain medication OxyContin — has been awarded a patent for a treatment for opioid use disorder.
Critics told the FT that they were disturbed that the patent could enable Sackler to benefit financially from the addiction crisis that his family’s company is accused of fueling. Continue reading
Diversion of Blame and the Opioid Crisis – By Richard Dobson, MD – Pain News Network – Sept 2018
Dr. Dobson proposes an interesting model of how blame for the “opioid crisis” has fallen on pain patients instead of the drug abusers and drug dealers that are responsible for it.
…after years of bewilderment, I have come upon a clinical description that seems to describe the plight of people who suffer from chronic pain. Let me try to simplify this complicated and mystifying condition.
First, a brief overview of the current situation.
There are five basic groups of people involved in the opioid crisis: Continue reading
Why genetics makes some people more vulnerable to opioid addiction – and protects others – 2018
From a scientific standpoint, addiction is a disease. And, as researchers who study opioid addiction, we’re hopeful about where epigenetics, the science of how DNA code is regulated, can lead us.
Just as genetics can affect a person’s risk for heart disease, cancer or diabetes, it can also make them more or less susceptible to addiction.
A great deal of research in the last decade has focused on tiny differences in a person’s DNA – termed single-nucleotide polymorphisms, or SNPs. These SNPs can indicate whether you have a higher or lower rick for addiction. Continue reading