Reports about escalating prescription drug abuse, over-prescription of narcotic pain pills, closing of a few pain clinics, and suspension of physicians' licenses have caused great concern among the public. The main problem appears to be the chronic use and abuse of codeine-containing narcotics like oxycodone, Percocet, etc., and their impact on society.
According to National Institutes of Health, prescription drugs are the second most commonly abused drugs, behind marijuana, but ahead of cocaine, heroin, methamphetamine and others. One estimate says that nearly 20 percent of Americans may be overusing or abusing prescription drugs.
I am not questioning the rightful need to alleviate pain by whatever means available for patients who have legitimate illnesses like advanced cancer or severe spinal disease that are not amenable to any other therapy. Some acute, painful medical conditions including trauma may need short-term drug therapy. These people should not be branded as addicts and should not suffer from lack of appropriate painkillers.
However, there is a segment of the population truly addicted to pain medications — and nobody is really immune to developing this habit.
While in practice, I used to get requests from patients for a prescription of these medications. And often they would slip this in casually at the end of their visit like, "Oh, I am running out of my pain meds, can you please refill it?" Or, "I lost the previous prescription, I need another one," etc. Some of them get the same drug from multiple sources and at times don't hesitate to use fake prescriptions. Unfortunately, doctors are often targets for drug pushers and addicts. But I must admit there are also pill mills where drugs can be obtained without difficulty for a hefty fee.
Let's try to understand the basis of the problem. Most habit-forming drugs, especially narcotics like oxycodone — perhaps the most commonly abused drug — are quite powerful in their potential for addiction. Often the users don't know this. Withdrawal needs close monitoring, special attention and in some cases, hospitalization. The users crave the drug and will line up at pain clinics for long periods of time to get their refill. That is the nature of the illness.
The most difficult aspect of therapy is the inherent ability of the pain itself to erase the idea that a pain-free life is possible without the drugs. One detox expert told me that the craving for the drug is always on the addict's mind. This mind-set needs to change.
Another issue is that the drug habit becomes a social glue among users. They often hang out together bound by their common addiction. This type of networking poses a formidable challenge to rehabilitation and recovery. The habit can return like an old plague if the patient is not totally committed to withdrawal.
Social and societal consequences of drug addiction are many: domestic violence, motor vehicle incidents, theft and severe violence. Those who are high on these drugs don't know what they are doing. Society needed to be protected from them. And the users need to be protected from themselves.
It's important for all of us to take personal responsibility for our own actions. Since addiction is almost self-perpetuating, the earlier you start the withdrawal process, the better. The emphasis should be on preservation of one's health and long-term well-being without harping solely on medication to kill every pain. There are also new laws concerning prescription of controlled substances for physicians and pain management clinics that must be strictly observed.
Many types of chronic pain, especially back pain, can be tackled by a combination of regular exercise, proper diet, maintenance of normal body weight, avoiding bad habits like smoking and excessive alcohol use and, of course, no substance abuse. Proper relaxation techniques are crucial too. I recommend yoga with its bountiful benefits to your body and mind. Many professional athletes now practice yoga regularly. It is drug-free. A good pain management specialist can recommend other options that do not involve chronic, addictive drugs. But, yes, you will need willpower and total commitment to embark on the journey toward total withdrawal.
The Nature Coast Recovery Alliance — a partnership among the Hernando County Medical Society, Hernando County Medical Alliance, Crescent Community Clinic and Hernando County Anti-Drug Coalition — is holding a symposium on addiction, substance abuse, recovery and relapse prevention, at 10:30 a.m. Feb. 26 at Silverthorne Country Club. For information, email [email protected]
Dr. M.P. Ravindra Nathan is a retired cardiologist living in Brooksville.