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OxyContin: Pain Relief vs. Abuse

Are worries over abuse having an impact on the drug's legitimate use as a painkiller?

Treatment of Pain in Addicts

Is it inhumane, as some in pain management believe, to withhold opiates from someone in pain who has a history of addiction? No, say two experts in chemical dependency who talked with WebMD.

"Medical professionals need to be educated about addictions," says Peter Provet, PhD, president of Odyssey House Inc., in New York City. "A problem with addicts is they don't like pain of any kind. They've been medicating their emotional pain, physical pain, or familial pain. The addict is quick to ask for a pill, but sometimes we have to deal with our pain.

"All other kinds of treatment should be first considered before the physician jumps to what is the easiest solution, a synthetic opiate," he tells WebMD. "An addict or recovering addict suffering pain from cancer or after a car accident should talk with a physician well-versed in addiction. On occasion, someone who is in recovery may need a drug like OxyContin. It would need to be done thoughtfully with full knowledge of addiction, and then the treatment should be very carefully monitored."

Pinsky, author of When Painkillers Become Dangerous: What Everyone Needs to Know About OxyContin and Other Prescription Drugs, says the risk of addiction is so great, not only for addicts but for anyone genetically prone to addiction, that any patient who comes forward with pain should first be asked if there is a family history of alcoholism or addiction.

"How does the health care provider know who is genetically predisposed to addiction? It may be hidden back three generations. The risk is triggering opioid and opiate addiction, the addiction with the poorest prognosis." Opioids and opiates act similarly on the brain and the terms are often used interchangeably, but unlike opiates, opioids -- such as methadone -- are not morphine based.

Pinsky admits to holding a minority view when he says no one should be treated with opiates more than two weeks, particularly if there's a family history of addiction. "If you have a history of addiction and have an extraordinary need to go beyond two weeks, it needs to be monitored very carefully by someone in the addiction field." He says there are many non-narcotic pain medications, such as Toradol, and alternative therapies, such as acupuncture, massage, and chiropractic treatment.

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