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Author Mel Pohl
Mel Pohl

The article linked to in last week’s post discusses the increase in deaths associated with the prescription drug abuse epidemic. In A Day without Pain (Revised and Updated) (ADWP), I discuss many aspects of pain management, including the use of prescription medication. There are many alternatives to treat pain, however, prescription medication is often seen as the best or only option to relieve suffering.
In Chapter 4 of ADWP, I say, “Those doctors who are reluctant to prescribe them are labeled ‘opiophobic.’ In this decade, there has been a proliferation of pain clinics notorious for overprescribing large amounts of painkillers without proper evaluation and follow-up. Impediments to the use of opioids include concerns about addiction, side effects, tolerance, and possible problems with regulatory agencies for overprescribing.”
As the article explains, many people die from misuse of such medications before finding their way into treatment. The article goes on to say that over 5,000 people begin to abuse prescription painkillers every day—a dismal statistic. Doctors should use caution when prescribing pain medications. As a specialist in addiction medicine, I treat many individuals who develop an addiction to prescription pain medication. Some people can’t recognize the problems associated with prescription drug abuse and other people and their families simply don’t know what to do about it. After all, “I take these medications as prescribed and I have pain! If I stop, what will I do about the pain.”
Professionals often disagree about the best course of action, so often, doctors just continue prescribing. When prescribing pain medications doctors should always ask critical questions such as:
How much of the drug does the patient need to relieve/manage pain?
What is the best way to screen for and prevent the development of addiction?
If addiction occurs, what is the best way to deal with it?
How do I ensure I comply with safeguards to prevent medication from falling into the wrong hands?
How do I maintain control without causing an unnecessary burden for those who need the medication and use it responsibly?
If a patient is getting worse functionally, am I prepared to facilitate withdrawal of opioid medications?
Am I familiar with alternative physical and emotional approaches to chronic pain (see chapters 6, 7, 8, and 10 in ADWP).
These are important considerations. And while no one has all the answers, this article suggests that the nature of the opioid problem has the attention of key national agencies. I am hopeful that the need for a balanced approach is recognized and that national strategies can be implemented for prescription drug abuse and that needless deaths can be reduced in the future.

Buty the Book! A Day Without Pain (Revised)

This blog post was written by Mel Pohl, MD, FASAM, author of the book, A Day Without Pain (Revised)