What about addiction?
Most people actually do not understand addiction. They equate addiction with “withdrawal symptoms.” Actually, addiction has two separate components:
Loss of control, and
Use despite harm
For example, consider a chocolate addiction. I have a personal example: Please never bring me a box of chocolates. It is impossible to eat just one. I have no control over my craving for this tasty treat. This is the loss of control that patients with substance addiction experience.
The substance abuser usually recognizes that continued use is harmful but continues its use. That is "use despite harm.”
Substance addiction in any form (tobacco, food, drugs, etc.) is fairly common occurring in about 2 of every 10 individuals. Addiction is a disease unto itself and requires the recognition of the problem by both the treating provider and the patient.
We monitor patients closely for behavior that might indicate addiction to prescribed analgesics. Our goal is to offer referral for addiction treatment when this behavior is recognized. In any case, we do not prescribe controlled substances to those suffering from active substance addiction.
Medical Marijuana and Alcohol
We, as healers, are very concerned about the potential for us to provide care that may cause harm.
Both marijuana and alcohol interact with opiate analgesics and benzodiazepines to cause impairment in both judgment and reaction time.
Marijuana is detectable in body fluids for six weeks after cessation in chronic use. Unlike alcohol, which is eliminated fairly rapidly, the effects of marijuana are long term. We will prescribe opiate analgesics in the presence of marijuana only in those patients who do not drive and who have failed more traditional treatment options.
The interaction of ethanol (alcohol) and opiate analgesics not only result in impairment in judgment and reaction time but also causes severe respiratory depression leading to death. Opiates and Benzodiazepines do not mix with alcohol.
Will my pain medicine lose effectiveness: What is Tolerance?
There has been a lot written about tolerance to opiate analgesics. According to the NIH website (12/2015) “Tolerance is defined as a decrease in pharmacologic response following repeated or prolonged drug administration.” Patients report getting a good response to opiate based pain medication initially but over time feel that the pain reducing effect from opioid analgesics diminish.
In my experience with treating pain patients over the past 20 years, I find that tolerance to opiate analgesics does not occur. When I ask a patient to take a short holiday from their opiate analgesic it becomes very clear as to how much pain relief they are actually obtaining. Usually it’s quite significant.
Unfortunately no medicine will provide 100% pain relief. Our objective is for this class of medication to provide 50-70% pain relief allowing reasonable degrees of function. Once patients are on a level of analgesics that achieves these pain and functional goals, they become used to this new, reduced, level of pain. They forget about how much pain they used to be in over time and are unsatisfied with the pain that they must continue to bear. This is understandable because no one should have to live with any pain. Unfortunately, our tools are not perfect and usually no treatment provides complete relief of pain.
I do find that either with disease progression or with increased functional demands the intensity of pain will increase over and above the baseline established prior to these changes.
Because medications cannot be expected to provide complete pain relief it is important for patients to consider other non-medication methods of treatment and to be willing to try what is available to improve their function and quality of life.