Nothing to Fear but Pain Itself
Are You Opio-Phobic?
While the torrent of news stories about OxyContin abuse has
certainly raised public awareness of this deadly new drug trend, it's also
fanned the flames of opio-phobia, say critics.
As the point man in implementing new federally mandated
pain-control measures at Johns Hopkins, Carducci says he deals daily with the
results of painkiller paranoia.
"I am implementing this plan in which all patients are
asked if they have pain, and then a pain care plan is started," he says.
"Now it makes that job even harder because people are afraid to take drugs
New Drug, Old Fears
Many pain experts are concerned that scary headlines are making
opio-phobia worse, says Daniel Bennett, MD, a Denver-based pain management
specialist. Bennett, co-founder of the National Pain Foundation, recently
joined other pain specialists for an international symposium on the problem of
irrational fear of opioid drugs.
Much of the attention being paid to OxyContin abuse is silly
because very similar drugs like "MS-Contin have been around for 10 years or
longer," he says, with no attendant bad media.
The U.S. has a history of opio-phobia that stretches back to
legendary newspaper publisher William Randolph Hearst, says Bennett, who used
his newspapers to campaign against the dangers of opium almost 100 years
In the current environment, opio-phobia is flourishing because
both physicians and patients are uneducated about pain and pain treatment.
"The average physician has less than two hours of formal
training in the treatment of pain," says Bennett, assistant clinical
professor at the University of Colorado Health Sciences Center in Denver.
"Yet, the number one reason for visiting a doctor is because of some
Dependence Doesn't Equal Addiction
Even though pain leads people to seek medical help, too many
patients suffer needlessly because they have misplaced fears about the use of
opioid medicines, says Akshay Vakharia, MD, a pain management specialist at the
University of Texas Southwestern Medical Center in Dallas. Those fears often
stem from confusion about the difference between dependence and addiction.
Patients who are treated for long periods with opioid medicines
like OxyContin -- meaning more than two weeks -- will experience physiological
dependence on the drug. That means, simply put, that if the patients abruptly
stopped the drug they would have symptoms of withdrawal, such as tremors,
nausea, diarrhea, and sweating. In many cases the symptoms are mild and not
like Diana Ross' bathroom histrionics in "Mahogany." And if the patient
is gradually tapered off the drug, there are no symptoms and, most importantly,
there "is no relapse, no drug-seeking behavior," says Vakharia.
Bennett says he and other pain experts want to get the message
out that addiction is not a significant risk when drugs like OxyContin are used
to treat pain. Moreover, he says that the whole concept of tolerance, meaning
that patients get used to the drug at a low dose and then need higher and
higher doses to overcome pain, is flat-out wrong.