POST SCRIPTS

Most critical, and at stake, is the ability of patients to safely obtain pain medication for chronic, persistent pain. Medical Boards instruct physicians that “tolerance and physical dependence are normal consequences of sustained use of opioid analgesics and are not synonymous with addiction� But this advice has not penetrated deeply even into the medical community. Much of the general public, and most of the media, still equate physical dependence and addiction, which is completely unfounded. Even many pain patients, lacking factual counseling by their doctors, misperceive themselves as addicted. Mr. Limbaugh was one of them.

They have not been taught that when properly prescribed and taken as prescribed, OxyContin and all the opioids are effective medications for moderate to severe pain. They have only been exposed to the Media, which hyped the dangers (without mentioning that these almost always occur only when the drugs are abused) and caused a hideous stigma to be attached to those who take Opioids, especially OxyContin, legally or illegally. Out of prejudice, Pain patients who take opioids are assumed to be addicts. The stigmatization of OxyContin is even greater. Pain patients have lost jobs simply on the strength of employer awareness that they take OxyContin.

The Limbaugh matter perfectly exemplifies this phenomenon of “pseudoaddiction.� Any person who has untreated or under treated pain will set out to find adequate pain relief. And what we force them to do is then labeled “drug seeking behaviors� - including “doctor shopping� and purchasing on the illegal market (in the same way that both real addicts and drug diverters do.) The difference is that, unlike addicts, when they can find a way to adequately treat their pain, their ability to function and the quality of their life improves dramatically. The Amici (NFTP, APF and AAPS) are confident that Mr. Limbaugh is a pseudoaddict. His obvious ability to function belies true addiction.

Patients are driven to Pseudoaddictive behavior in reaction to the harsh reality of the prescribing climate in Florida and elsewhere in the United States. Under treatment, in turn, is a product of the opiophobic environment and law enforcement mind set.

Faced with real dangers, Doctors are afraid to prescribe opioids to therapeutic levels. Even worse, doctors are now being arrested and jailed when patients lie to them about doctor shopping, or about drug abuse or diversion and selling or injecting their medications, and particularly when someone dies from a drug overdose.

The law-enforcement mind-set works to the great detriment of patients. Doctors are not fools. Rather than risk their professional licenses or personal freedom, doctors routinely refuse to prescribe opioids to patients even when they know they would profoundly benefit from them. And even those who will prescribe frequently self-impose a dose limitation that falls short of therapeutic levels for the individual. These choices are ethically and clinically wrong - but the chances are good that a doctor who puts his patient first may be putting himself in danger.
Legislative and Medical Board actions accepting and encouraging doctors to use opioids for chronic pain are virtually worthless in a context of punitive and ill-informed law enforcement. Physicians can read the papers and the risks are real. Physicians are meant to be healers, but fear their patients’ misdeeds, and now must fear criminal prosecution. Patients are meant to be treated, but relief is rationed out of physicians’ fears. Law enforcement is dogging the heels of both.