Opioids are SAFE for CIP

[Guest guest]

Dear Friends in Pain and Chronic Illness,

Modern research supports the article below. There are many more research

articles available. I hope this gives some help to those concerned with the

use of opioids for NIP (nonmalignant intractable pain.)

Peace and blessings,

CHRONIC PAIN AND OPIOIDS

DEBUNKING THE MYTHS

BY FRANK FISHER, M.D.

WHAT IS CHRONIC PAIN?

Chronic pain is a progressive disease of the nervous system, caused by

failure of the body's internal pain control systems.The disease is accompanied

by

changes in the chemical and anatomical makeup of the spinal cord. Chronic pain

is a malignancy, in the sense that when it goes untreated, it increases in

intensity and spreads to areas that weren't previously affected, damaging the

sufferer's health and functioning.

WHY TREAT CHRONIC PAIN WITH OPIOIDS?

Opioids are substances naturally produced within the body to regulate pain.

They are commonly known as endorphins, and recognized as producing the state of

euphoria known as the runner’s high. Chronic pain victims, who can’t produce

enough opioids on their own, often benefit from supplementation with

pharmaceutical opioids

WHAT ARE THE GOALS OF TREATMENT?

Lowering of pain levels.

Reducing suffering through restoration of functioning in life activities, as

close to normal as possible.

Arresting and reversing the damage done by chronic pain to the nervous system

and overall health of the patient.

ARE OPIOIDS DANGEROUS?

When taken as prescribed by your doctor, opioids are among the safest drugs

available.

WHAT ABOUT THOSE " OXYCONTIN DEATHS " REPORTED IN THE MEDIA?

Oxycontin, like other opioids, is safe for patients who take their medicine

as prescribed. “Oxycontin deaths†occur in habitual substance abusers, not

patients, and are usually the result of combining the drug with overdoses of

alcohol and other drugs. These are deaths associated with Oxycontin, not caused

by

it, and they are not occurring in patients.

WILL I HAVE TO TAKE OPIOIDS FOR THE REST OF MY LIFE?

Opioids can be discontinued whenever they are no longer needed. Patients

often recover from chronic pain, and return to active lives.

WILL I GET ADDICTED, AND HOW CAN I TELL IF I AM?

Opioid addiction in pain patients is extremely rare. Addiction is defined by

the American Society of Addiction Medicine as, continued use in spite of harm.

If opioids make your life better by controlling pain, you are a pain patient.

If they make your life worse, and you continue to use them, you are an

addict.

WILL I HAVE TO TAKE LARGER AND LARGER DOSES TO CONTROL MY PAIN?

For most patients, their dose remains stable over long periods of time.

WILL I GET HIGH, OR LOSE CONTROL?

When opioids are taken on a regular schedule, tolerance quickly develops, and

the psychological “high†goes away, leaving the user feeling completely

normal. Long-term opioid users, as a group, have driving records for accidents

and

violations that are the same as everyone else’s.

WILL I HURT MYSELF BECAUSE I DON'T FEEL ANY PAIN?

No. Opioids improve functioning by reducing pain levels. They don’t remove

all the pain, or the ability to perceive new pain.

WILL I BECOME DEPENDENT?

You may. Dependence means that if opioids are abruptly discontinued you will

have a physical withdrawal reaction, similar to having the flu. This reaction

can be prevented by gradually tapering off the medication. Dependence is a

physical phenomenon, not a sign of addiction.

WHAT IF I HAD A PREVIOUS SUBSTANCE ABUSE PROBLEM?

This should not prevent a trial of opioids. Studies at Harvard Medical School

and the University of Washington indicate that a past history of substance

abuse has little predictive value for failure of opioid treatment. If you have

current behavioral or substance abuse problems, you may have trouble with

opioid treatment.

ARE THERE ANY SIDE EFFECTS?

Constipation, nausea, itching, insomnia, and drowsiness commonly occur. All

of these side effects can be successfully managed

WILL THE MEDICINE DAMAGE MY LIVER?

No. Opioids occur naturally in the body, and are not harmful to any organ

system. They can be taken safely for a lifetime, if necessary. Anti-inflammatory

non-opioid medications such as Motrin, Naprosyn, and Vioxx, on the other hand,

kill 16,500 patients each year through bleeding from the stomach, and are

toxic to the liver and kidneys.

WHAT IS THE CORRECT DOSE?

The amount that allows optimal functioning is the correct dose. There is no

upper limit to the dose of opioids that can be safely used, when the medicine

is increased gradually.

WHY WON'T MY DOCTOR PRESCRIBE ENOUGH MEDICINE TO CONTROL MY PAIN?

He is too scared. As part of the War on Drugs, law enforcement is conducting

a witch hunt against pain doctors who prescribe opioids compassionately. Most

physicians won’t risk being targeted by law enforcement, because they have

families to support. As a result, chronic pain sufferers have become

non-combatant casualties in the war on drugs.

THE NEWS CALLS OXYCONTIN " HIGHLY ADDICTIVE. " DO YOU THINK IT IS MORE

ADDICTIVE THAN OTHER FORMS? IT CERTAINLY IS MORE EFFECTIVE.

The idea that one opioid is more addictive than another is a misconception.

The prevalence of opioid addiction runs far below that for other common drugs

of abuse, such as tobacco, and alcohol. This is not for lack of exposure

either, because 23,000,000 people have surgery each year, and most receive

opioids

afterwards. The fact is, most people don't like opioids, and this is borne out

by experiments at NIDA, and mentioned in textbooks.

There are clearly differences in preferences expressed by people who pursue

opioids for the psychological reward they experience. So far, this is not borne

out by the scientific literature, but anecdotal evidence really leaves little

doubt.

The mistake often made, is using this preference observation to jump to the

conclusion that one opioid, such as Oxycontin, is more addictive than another.

The flaw in this reasoning is the extrapolation that because there are

preferences for specific opioids within the population of abusers, this means

that

certain opioids can cast some sort of evil spell over the rest of us. This

simply isn't the case. The fact remains that most human beings still aren't

inclined to abuse opioids.

I agree with your observation that oxycodone is more effective in the

treatment of pain than many other opioids. It seems to be the case, that the

more

effective opiods are also those preferred for their psychological effects. For

the reasons discussed above, this would not be a problem for the field of pain

management, except that doctors are blamed for not preventing abusers, who

would find a source of opioids anyway, from getting what they prefer.

The phenomenon of tolerance prevents chronic pain sufferers from experiencing

the psychological rewards that abusers pursue. Paradoxically, they take too

much, to be able to get high.

Comments/Opinions

B. Fisher, MD

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510-233-3490

Hallenbeck~Sikorsky~ BS,RN,UM,QC

Owner-Moderator

" AnGeLsInPain "

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Interqual Certified

Published Psychiatric Researcher

Advocate for those in CIP, HIV, Psychologic Pain

" The Lord Will NEVER push us beyond what we can endure. "