Quote:
Originally Posted by frozenchief
You say I am wrong when I have consistently said that risk is low. You say I am wrong when you cite a study that did not discuss drug-seeking behavior. it merely described use, which could be because of drug-seeking behavior and could be someone is seriously injured.
Here are two scenarios:
1. Person is prescribed opioids by physician. Person takes them long enough to develop drug-seeking behavior. Because of that drug-seeking behavior, that person is still using opioids 1 year after initial prescription.
2. Person is prescribed opioids by physician. Person continues to be in great pain because they suffered tremendous injuries. Because those injuries cause that person pain a year later, that person continues to use opioids a year after initial prescription.
The article you gave made no effort to distinguish between scenario 1 and scenario 2, yet that is a significant distinction on this topic. The article only notes "drug use" when the distinction between those two scenarios is indeed significant.
It also noted that taking opioids for longer than 30 days is a sign of a risk that someone will keep taking them. That is consistent with what I said.
OP is concerned about being addiction. Fine. That is a good sign. It shows that he has some positive incentives to avoid drug-seeking behavior and lowers the risk that he will wind up demonstrating drug-seeking behavior. This is something that is taught frequently in drug-counseling treatment: if you don't want to change, you won't. If OP doesn't want to be an addict, he has a powerful incentive to avoid such. And taking opioids for a few days is a low (emphasis on low) risk. So is riding in a car. So is flying on a Boeing 737-Max. So is drinking booze. So are a lot of things.
I get that there are few ways to ruin your life than by abusing controlled substances. and I agree that you shouldn't take opioids longer than necessary for a whole bunch of reasons (one reason why marijuana can be a good idea for persons with pain management issues). But paranoia/hysteria about addiction does not help the situation at all.
Part of my issue is I do not like the CDC or the DEA. I think it is not the government's business what medications someone is on. And from my side of the fence, I see a lot of harm done in the name of harm prevention, including people addicted to opioids. And an inordinate focus upon the negative without putting it into context is a way to do harm in the name of harm prevention.
As an example, are you familiar with the death of Jonathan Swift? I give his death because it is historically documented. Modern medicine might have been able to treat him but his is a case in which concern for addiction should go right out the window. And I've seen the DEA prosecute physicians for "over-prescribing" in similar situations. A friend of mine represented a physician who took pain patients few other physicians would. He would not accept patients who demonstrated drug-seeking behavior. If you went to another physician or to a pharmacy other than the one agreed upon between his client and the patient, the patient was kicked out. Many of his patients had suffered severe injuries or were in chronic pain for other reasons. The DEA arrested him. His patients had nowhere to go. I know of one patient who killed herself because of the pain. All so the DEA could show that they were serious about stomping out 'drug abuse'. He was acquitted at trial, but he had learned his lesson.
I think that is inhumane and I think DEA policies are more designed to make sure the populace knows the government is in charge than for any of our well-being. If the DEA was truly concerned about over-prescription of drugs, they would focus upon over-prescription of antibiotics because that creates a much greater public health issue than over-prescription of opioids.
Apparently we are not going to agree. That is fine. I will stipulate that you do not accept my qualifications and that you think I am wrong.
|
I am not talking about drug seeking behavior because that is extremely hard to study. I am talking about risk of developing an opiate dependence, which goes up the longer you are on the medication and which the study clearly demonstrates.
Opiates have consistently failed to demonstrate long-term benefit in chronic musculoskeletal pain, which is why as a prescribing physician I'm trying to minimize the risk that a patient will end up dependent on the medication long-term. from a prescribing point of view there is little reason to distinguish between the two situations. My goal is for my patients to not be on chronic opiate therapy for musculoskeletal pain, because their use in this situation is not evidence driven. I am not discounting the fact that in a small minority of patients it will be necessary to be on opiates long-term for their musculoskeletal pain, merely stating that this is the exception rather than the rule.
also, 30 days or more is not consistent with what you said. Will you please address the fact that you said it takes "months or longer" to develop opiate dependence. This is the crux of my disagreement with you
OP should definitely continue his prescription as his pain dictates, but there is definitely risk involved in even short term prescriptions. In OPs case the benefits definitely outweigh the risks.