Addiction

In talking to many other chronic pain patients who are using legally prescribed opioids safely and responsibly, I have noticed many general practitioners (GPs) are not trained in chronic pain management. They may not know how to differentiate between the observable, destructive addiction behaviors displayed by people with substance abuse disorder and the requests of a chronic pain patient who requires a regular, stable dose of pain-relieving opioids. This issue is magnified many times over if a chronic pain patient has to explain their condition to a new doctor — or worse still is required to present to a hospital emergency department due to the acute flare-up of a chronic condition. On such occasions, the patient may need to outline their often complex symptoms to a doctor or nurse who does not know their history and who then may incorrectly assume the patient has addiction because they are requesting temporary or additional opioid treatment to get through an acute treatment phase. As a medically retired registered nurse, I understand that in this type of emergency environment, it is just not possible to know everything about the patient in such a short span of time when decisions must be made promptly. However, the terms “psychological addiction” and “physical dependence” cannot even be agreed upon by the world’s experts and international peak bodies, which doesn’t help. In my personal experience, having to go up to my GP every four weeks and ask for opioid pain relief brings anxiety from being able to continue on my normal dose in the long term. Furthermore, having to justify why I need my medications every four weeks can be rather stressful, especially when I get told, “You know, you have to taper off these medications one day!” Why, I ask? If a chronic pain patient is stable, their quality of life and mobility has improved, and the current pain medication they use as part of an overall pain management plan is beneficial, why do we need to change the protocol for all patients just because a minority of people? Reputable large-scale international studies indicate that the addiction risk in chronic pain patients who do not have a history of substance abuse disorder is far less than one percent. Perhaps people and the media need to be reminded and re-educated about legally prescribed opioid pain medications. Chronic pain patients never asked for their condition in the first place, and it is my opinion that the vast “silent majority” may manage to cope to the best of their ability by using all reasonable treatment options available to them within their “pain toolbox” — which may include pain medication. The illicit or recreational drug trade — especially synthetic Fentanyl, which is largely responsible for the high opioid overdose rates in America — is an entirely different law enforcement debate. However, there is increasing, undeniable evidence that many chronic pain patients who have been “forcibly tapered” or stopped “cold turkey” are turning to the black market to source their drug of choice for pain control. This is not an ideal outcome. It seems the American medical industry — specifically the Centers for Disease Control (CDC) and their 2016 “Guideline for Prescribing Opioids” has turned their back on chronic pain patients and in many cases, no legal or viable options remain for this forgotten demographic. Surely we DO NOT want the same “one-size-fits-all” approach to health care — where pain relief is denied to vulnerable chronic pain patients — to come to our Australian shores.