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Drug use and abuse- an article summary.

happyHBmomhhappyHBmom Posts: 2,070
edited 06/11/2012 - 8:47 AM in Pain Medications
I am reading a medscape article called "Detecting and Dealing with Substance Abuse Disorders in Primary Care."

I think it's useful as a user of addictive drugs to understand warning signs, so yes I do read these things. I am not sure whether it's OK to post, however, although there are no ads.

So I'll give a little summary and link to anyone who PMs me. Medscape requires free registration.

Anyway, surprised to read that 20% of primary care patients are thought to have substance abuse problems, while only 5-9% of primary care visits involve substance abuse issues. People seldom admit substance abuse issues.

I liked a quote regarding physical dependence vs. addiction:

This form of dependence differs from addiction in that there is no loss of control over the intense drive to take the medication despite negative consequences. Therefore in this setting, tolerance and dependence can be viewed as normal adaptations to daily medication use rather than as evidence of substance abuse or addiction.

(personally, I have no intense drive to take any of my medications if there's a negative consequence).

Pseudoaddiction is another form of common drug-seeking behavior. A pattern of pseudoaddiction develops when a patient with inadequate pain control engages in addict-type behaviors, such as clock watching, frequent requests for higher analgesic doses, attempts to obtain drugs illegally, and an overall obsession with pain medications. In contrast to addicts, whose drug seeking continues regardless of the absence of pain, pseudoaddicts' drug-seeking behavior resolves as soon as their pain is adequately treated.

This makes total and complete sense to me, since addicts are fighting against the drive to take, and pseudoaddicts are fighting against pain.

Genetic factors account for 40-50% of the risk for substance abuse disorders. Some mental disorders increase risk. And chronic pain is listed as a risk factor for non-medical use.

Their diagnostic was aimed at the primary care, not pain management, sector, so was more aimed at finding out if people are using drugs than finding the "seekers. I liked that they had several warnings to not confuse real pain with drug seeking, however.

Hope you liked my essay. Do I get an A?

p.s. I can't get my quotes to work, and not comfy enough to sit here and figure out why. Sorry!


  • Hiya, not quite sure how to respond! Where it says about pseudoaddiction,one who seeks higher doses. What if the doctor can not find a pain relief stong enough to hit the spot of the pain? so therefore the patient is still in pain and has to ask the doctor for a stronger pain relief! Would that be classed as someone who has an addiction? Very interesting though!!!

    Angie :? :H

  • Well, I'm not a doctor so I can't tell you. But what we've experienced is that some doctors see that as a sign of addiction.

    But the article defined addiction as a loss of control over use of the drug. I personally can tell you I've asked for higher doses of medication for pain, and I have no loss of control over use of my pain meds. I never have had an urge to take one that didn't involve pain. Even still, I've always stuck to my prescriptions (of course it's tempting when you're in pain to take extra, but I tell myself it might hurt me a lot in the long run to do so).

  • Hiya :) I have to agree with you :? I think most people here have been in the situation, where we have to request higher dose of our meds :? We are generally told by our doctors to take these meds at certain times, this is generally due to the doses we take, because we do have to take care not to take too much, and you are right, it is tempting too take that extra dose on bad days @) I have googled this and its very interesting :? Well Done !!! :D

    Angie :H
  • One of the defining characteristics of pseudoaddiction among pain patients is that the aberrant behaviors cease when the patient's pain is effectively managed.

    Whether seeking a higher dose or more potent medication is a sign of addiction or pseudoaddiction depends on wholly on the outcome of the change, which creates a catch 22 situation.

  • happyHBmom.............i thought loads of people would have given there opinion on this subject :? :? >:D<

    Angie :H
  • I have to agree with you, on the premise of pseudo-addiction and honestly, physicians have an awful time trying to resolve that specific issue. I will comment, that from the lit I have come across, the actual dosages of meds, are the give away, as to whether they are dealing with addiction verses Pseudo. With this, relief was achieved with increases of 25 to 50%.

    Across the board, on the addict side, the increases to achieve analgesia was 10 to 20 times, that of therapeutic dosages.

    As an example - lets say that therapy was achieved with 200 to 300mg of Morph a day, and agreed to incremental increases as a cooperative relationship.
    Addicts were at the level of 2000 to 4000mg per day, without the back-up damage to support those levels of medication and thier method of dose increases was to demand them.

    There is a whole science and history that goes with this. The psychology and other disciplines that allow for a fully rounded understanding of the issues and allow us as patients and self-advocates, let us present ourselves as someone who does understand all of the ramifications, of using these meds, when we really would rather not, given a choice.

    With them, I still work. albeit - I am in late today, because my Dr has told me to rest and take my time, when needed. I DO NOW! Work has become most understanding, and given a lot of leeway to accommodate myself.

    Without them, I was months away from going out on LTD, as my Dr was about to put me out.

    BTW - no - I am not defending use of them or not. It is my decision to use them.

    I do hope you all have a great day! Cheers
  • The obvious point is that if someone comes in seeking drugs, they need to look at 2 very strong motivators- one being addiction, and the other being pain.

    Because if anyone ever said that people in pain will just sit there and take it without ever requesting relief? They were probably completely nuts. If I'm in intense pain and I know the doctor has relief and isn't giving it to me, eventually the top's gonna blow off of that little can of self control= pain is one of the body's primary punishers. Meaning, we are born with the instinct to avoid pain at all costs, it's not a learned condition. So just based on my understanding of human nature, it shouldn't be rocket surgery to figure out that people will push REALLY hard to get out of pain.

    And if a person knows one pain medication works better than another? Of course they are going to request that one. Imagine the fear of leaving the office with a medication you know will not work. So, I don't think the "suggesting medications" is going to be 100% for finding addicts either.

    No, most of the current "science" doesn't fit with basic knowledge of human response to stimulus. I just hope they fix it :(
  • BionicWoman said:
    One of the defining characteristics of pseudoaddiction among pain patients is that the aberrant behaviors cease when the patient's pain is effectively managed.

    Whether seeking a higher dose or more potent medication is a sign of addiction or pseudoaddiction depends on wholly on the outcome of the change, which creates a catch 22 situation.

    P.S. So great to see a post from you. I miss seeing your name and your posts. Hope all is going well with you.
  • i think u hit the bone on a spur here" lol spinny joke there, i think u made a wonderful point,and it brings up something we all maybe cld do im not sure as i dont know much about this topic so i will inform myself so i can giv my input, and also based on my own relationship with medications, i think we wld be the perfect ppl to help devise a guide for doctors to use, if thy wld use it, i think we all cld be the steeping stone for this issues to taken care of once and for all, iv been reading horror stories of ppl who lose their meds for wrong reasons, or cant get them when they do need them for chronic pain issues, and the talk around water coolers is the same , people r scared, for many reasons , iv just begun to resech this, i read on fb posts fam members of people who a crominc pain suffer'r comited suicide, to me that is horifiying, i wld like to help make a diffrnce in this mater, for us who really do suffer, its pure hell,but i agree their way of telling how ever they decid seems so wrong and not a complete formula. why can t we help, it cant hurt to try,, we have first hand exp when it comes to feeling pain, thats a good place for them, being doctors to begin, dont u think, i read a yr ago when reading about medical injurys a site tht was a doctor website a diff term on how thy deice who is drug seeking,ect, i hope u guys can folow me, i hav emory issues from a rare diease, getting tired, will reply to my own posts so i can fin later, need rest for now, bbk fellow spinmnneys
  • My injury was 10 years ago, and dealing with chronic pain is my full time job.
    If I go on the internet to research the best course of action, the doctor looks at it as "drug seeking", because I'm well informed.

    As it was once explained to me, someone in chronic pain is addicted to getting rid of it. The end result is being normal.

    An addict is someone who starts out normal, and it addicted to getting "high".

    The bottom line if you suffer from real chronic pain, The doctor controls your quality of life.
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