Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Pain & Narcotics

From the 1980s to the mid 1990s, narcotic pain medication was chiefly used for malignant (cancer) pain. However, in the mid-90s a series of scientific articles recommended these agents for some patients in chronic benign (nonmalignant) pain.

At the time, narcotic abuse was predicted to occur in only 5% of these patients, and restricting access for those who would not abuse them was deemed cruel and unwise.

However, by 2002, prescribed narcotic abuse had increased by 71% and has now increased each quarter for the past 3 1/2 years.

Here are some of the more obvious signs of abuse:

Àô Patient caught selling prescribed narcotics

Àô Patient caught forging prescriptions

Àô Patient found to be stealing drugs

Àô Patient injecting oral medications

Àô Patient obtaining drugs from multiple providers

Àô Patient concurrently abusing alcohol and/or street drugs

Àô Patient increasing dosage levels even though warned not to do

Àô Patient reports “losing” medication

Àô Patient seeks medication from Emergency Rooms between appointments

Àô Patient displays personal deterioration seen in drug abuse cases

Here are factors that, when combined, are often associated with risk for narcotic pain medication abuse:

1. History of drug and/or alcohol abuse with consequent arrests for DUI or other crimes

2. Cigarette smoking

3. Under 25 years of age

4. Males

5. History of psychological care

6. Presence of anxiety and/or mood disorders

What to do? To detect the potential for a patient to abuse prescribed medication, too many clinicians use their “gut feeling” based upon experience. This fragile approach may fail to predict some cases and falsely identify others.

There are research-based screening tools that are excellent at revealing potential and ongoing medication abuse. But remember that just because a patient falls into a higher-risk category does not mean he cannot be medicated with narcotics. It simply means the prescribing clinician needs to notice when the patient deviates from the expected course of recovery.

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