Letter: Painkiller prescriptions fuzzy
The drug, OxyContin in 80mg tablets. For story on the painkiller drug. July 25, 2001 Newsday Photo by Kathy Kmonicek Credit: SUNDAY/Kathy Kmonicek
I read with interest the article regarding the painkiller crisis ["A doctor's balancing act," News, Feb. 24], which focused on physicians' "dilemma over how to sort out patients in genuine need from addicts and criminals."
That statement assumes that addicts are not in need, and that addicts and pain patients are separate populations. The first assumption is clearly wrong, and the second is not clear at all.
Addicts are often severely depressed and anxious, unable to work or have normal interpersonal relations, and are suffering physical problems at rates that greatly outpace the general population. They benefit from treatment with suboxone and methadone, which have similar mechanisms as prescribed painkillers.
I agree that we need to identify those people who are only trying to resell the pills. My objection goes to distinguishing between the chronic pain and the chronic opioid addiction populations. In fact, the physiological similarities between these far outweigh any differences. Tolerance, mechanisms of neuro-adaptation, the brain structures that activate during withdrawal, as well as the symptoms of withdrawal, are the same. Both groups have a reduced ability to modulate pain.
If doctors are required to distinguish between the two as a prerequisite to treatment, many patients will be misclassified, some will misuse their medicine, certain doctors will be vilified and pain will be undertreated. The medical evaluation should not overly focus on the initial diagnosis. Rather, the evaluation should identify which symptoms are impairing the patient and which treatments would help relieve pain and improve function.
Another underappreciated problem is the widespread use of sedatives such as Xanax, Klonopin, Soma and Ambien, especially in combination with the opioid pain medication. These truly increase the level of disability as well as the risk of overdose.
Doctors and the public do not perceive these drugs to be harmful. However, they contributed to the problems of Whitney Houston, Michael Jackson and countless others.
Dr. Stuart Wasser, Rockville Centre
Editor's note: The writer specializes in addiction medicine.
