Reality and responsibility: A commentary on the treatment of pain and suffering in a drug-using society

Steven D. Passik, PhD; Howard Heit, MD, FACP, FASAM; Kenneth L. Kirsh, PhD

doi:10.5055/jom.2006.0020

Authors

Steven D. Passik, PhD
Howard Heit, MD, FACP, FASAM
Kenneth L. Kirsh, PhD

DOI:

https://doi.org/10.5055/jom.2006.0020

Keywords:

opioids, pain management, prescription drug abuse, prescription drug diversion

Abstract

While opioids are a necessary part of the armamentarium of pain management, there has been a growing trend toward prescription drug abuse and diversion in our society. Meeting the goal of treating pain while not contributing to drug abuse and diversion requires vigilance and education. Physicians and patients have been singled out as the main players in the societal problem of diversion of prescription drugs. In fact, the problem can only be overcome when not only physicians and patients but also healthcare practitioners, third-party payers, law enforcement agencies and regulators, the pharmaceutical industry, and the media finally work together to prevent it, instead of fingering any one party for the blame.

Author Biographies

Steven D. Passik, PhD

Associate Attending Psychologist, Memorial Sloan Kettering Cancer Center, New York, New York.

Howard Heit, MD, FACP, FASAM

Georgetown University School of Medicine, Washington, DC.

Kenneth L. Kirsh, PhD

Assistant Professor of Pharmacy Practice, University of Kentucky, Lexington, Kentucky.

References

Dembe AE, Himmelstein JS, Stevens BA, et al.: Improving workers’ compensation health care. Health Aff. 1998; 16: 253-257.

Osterweis M, Kleinman A, Mechanic D: Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Report of the Committee on Pain, Disability, and Chronic Illness Behavior, Institute of Medicine, National Academy of Sciences. Washington, D.C.: National Academy Press, 1987.

Verhaak PFM, Kerssens JJ, Dekker J, et al.: Prevalence of chronic benign pain disorder among adults: A review of the literature. Pain. 1998; 77: 231-239.

Glajchen M, Fitzmartin RD, Blum D, et al.: Psychosocial barriers to cancer pain relief. Cancer Pract. 1995; 3: 76-82.

Ramer L, Richardson JL, Cohen MZ, et al.: Multimeasure pain assessment in an ethnically diverse group of patients with cancer. J Transcult Nurs. 1999; 10: 94-101.

Ward SE, Goldberg N, Miller-McCoulry V, et al.: Patient-related barriers to management of cancer pain. Pain. 1993; 52: 319-324.

Colliver JD, Kopstein AN: Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Publ Health Rep. 1991; 106: 59-68.

Gfroerer J, Brodsky M: The incidence of illicit drug use in the United States, 1962-1989. Br J Addict. 1992; 87: 1345-1351.

Regier DA, Meyers JK, Dramer M, et al.: The NIMH epidemiologic catchment area program. Arch Gen Psychiatry. 1984; 41: 934-941.

Rinaldi RC, Steindler EM, Wilford BB, et al.: Clarification and standardization of substance abuse terminology. JAMA. 1988; 259: 555-557.

Hancock CM: OxyContin use and abuse. Clin J Oncol Nursing. 2002; 6: 109.

Hays L, Kirsh KL, Passik SD: Seeking drug treatment for OxyContin abuse: A chart review of consecutive admissions to a substance abuse treatment facility in the bluegrass region of Kentucky. J Natl Compr Canc Netw. 2003; 1: 423-428.

Joranson D, Ryan K, Gilson A, et al.: Trends in medicaid use and abuse of opioid analgesics. JAMA. 2000; 283: 1710-1714.

Weinstein SM, Laux LF, Thornby JI, et al.: Medical students’ attitudes toward pain and the use of opioid analgesics: Implications for changing medical school curriculum. South Med J. 2000; 93: 472-478.

Weissman DE: Understanding pseudoaddiction. J Pain Symptom Manage. 1994; 9: 74.

Schlaepfer TE, Strain EC, Greenberg BD, et al.: Site of opioid action in the human brain: Mu and kappa agonists’ subjective and cerebral blood flow effects. Am J Psychiatry. 1998; 155: 470-473.

Passik SD, Weinreb HJ: Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids. Adv Ther. 2000; 17: 70-83.

Joranson DE, Carrow GM, Ryan KM, et al.: Pain management and prescription monitoring. J Pain Symptom Manage. 2002; 23: 231-238.

Hill CS: Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin. J Pain Symptom Manage. 1996; 11: 287-298.