Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Dire Consequences of Oxycontin

Ideally, you know what kind of pill you are giving the patient, but do you know what kind of patient is taking the pill?

It is erroneous and dangerous to assume that because a patient eagerly takes Oxycontin that he/she is a good candidate for the drug.

For example, like many narcotic pain killers, Oxycontin can/does produce mood, sleep, anxiety and cognitive changes. Patients in pain sleep poorly, not only quantity of sleep but quality of sleep. What is the impact of Oxycontin on sleep architecture? Certainly the drug can produce drowsiness, but does it permit effective sleep_and what does the patient do when deprived of sleep? Often, they take more Oxycontin.

Additionally, what is your goal in the use of the drug? Is it to permit the patient reasonable pain management while he/she learns ways of coping with the pain without narcotics? Or is the medication prescribed, the patient merely warned not to take more than prescribed and then chastised when he/she calls between refills due to _running out of my medication._

Additionally, what plans are being made to wean the patient from the medication? They will eventual _settle_ their workers_ compensation claim. Are you expecting their family physician to prescribe, titrate and manage this drug?

What is the patient doing with his/her days; eagerly awaiting the next prescribed dose? This is not uncommon. Watching television, eating and gaining weight, depressed and lonely, fearful and helpless, they wait for the medication.

Are they sharing the medication with others? Do they have access from multiple sources? Do they visit the ER for supplemental pain management? Will Oxycontin instill in them a sense of direction, future, or goal setting?

In toto, who and what is this patient for whom you prescribe this narcotic? Is this a patient who is participating in his/her own rehabilitation, or is this a patient with family, marital, sexual, occupation, financial and social problems pre-existing as well as arising from injury?

Is Oxycontin a dangerous drug? Likely so. Is it being unwisely or inappropriately prescribed? Unquestionably so.

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