Category: Substance Use Disorders

“The practice of medicine IS the practice of harm reduction. It is a fundamental principle of medical care that the patient has the right to disagree, to be non-compliant, to choose a path or a goal other than the one we might desire for them. The physician’s job is to do everything possible to help such a patient do the best he can, to minimize harm since, at least temporarily, it cannot be eliminated. Only in addiction medicine is it insisted that patients and staff hew to a ‘philosophy’ of ‘total abstinence’ rather than support appropriately individualized goals.”

youTube music video of the a group named Morphine playing a song called “Cure for Pain” live. Beautiful sound, good lyrics; RIP, Mark Sandman.

Unrelieved pain has a devastating impact on the physical, emotional, social, and economic well being of patients and their families. Diagnosing and treating pain is, therefore, fundamental to the public health. Terminology is review, myths identified, and medical understanding is stated.

Abstract of peer-reviewed article reporting multicenter outcomes for safety and analgesic efficacy of high-dose, transdermal buprenorphine in the treatment of chronic pain, and brief comments on same by Dr. Alex DeLuca, and with links to related discussions on the Pallimed blog.

Experts: Untreated pain as serious a problem drug abuse. By Tristan Scott of the Missoulian. With the specter of prescription drug abuse looming large, health care workers stressed Friday that untreated pain in Montana is a public health crisis commensurate to that of addiction.

It seems to me an uncivilized and insane notion that just because someone in current moderate to severe pain had a history of an alcohol or drug problem, or even a current substance abuse problem, that you would deny them opioid therapy if that was the best medication to relieve their suffering. But this seems to be a point of confusion that increasingly comes up from patients, doctors, and regulators alike. So, in this post, let me make the medical standard of care in this situation perfectly clear. [...]

Article by Dr. DeLuca regarding Jacob Sullum\’s comments about a recent SAMHSA analysis showing low addiction rates for most substances of abuse, and also discusses Hurwitz\’ excellent 2005 analysis of Government data, the peer reviewed

Blog post about an example of war on doctors Trash Journalism, which is analyzed. Excerpt: “So what is the message? Well one clear message to me is that the line between pain patient and ‘addict’ – that pitiable dregs of humanity; the walking dead; that criminal scourge; is thin and vague. In fact it is presented as the slippery slope if not an inevitability – people on chronic opioid therapy are, or will become, addicts. Pain patient, drug addict, who cares? Drug are bad, people who use them are bad, you and I are better than that; they deserve what …

In this full text medical journal article, Joranson, in response to Paulozzi (below), describes a basic public health approach to the ‘drug abuse crisis.’ One wonders whether the combined brain power of the NIH, CDC and FDA would not have accomplished this, except for the imperatives of the drug war. Hurwitz 2005 (see below) is an example of the sort of creative analysis we should expect, but never get, from our academic and federal patriarchs.

Blog post about a Letter to the Editor (LTE) to an Alabama paper entitled, ‘Answer to methadone is God’. Begins, “What is interesting about the LTE reprinted in full below, is that the writer, a nurse, is describing behavior that any reasonable person can imagine, and would excuse, a chronically undermedicated person with severe chronic pain for displaying. [...]”

Full text of blog post about arrest of Gore’s son on drug charges: Al Gore’s son was arrested for possession of prescription drugs. The timing was uncanny. Just as it was appearing Gore might announce his candidacy, we hear the news that his boy has a drug problem. Next come the predictable barrage of articles about how his arrest highlights the problem with prescription drugs. Does anyone wonder why members of Congress have been reluctant to take up the insanity of this drug war….it is simply too personally dangerous to do so. — This is Rush Limbaugh redux. I can’t …

Wow. “Drug addiction” must be as bad as being “gassed at Aushwitz, slaughtered in Armenia, raped in Rwanda.” Yeah, yeah, yeah. But. It. Isn’t. Oh how we love to dramatize “addiction.” Everybody is an expert – and exactly to that extent the word and concept have become meaningless. Which doesn’t stop drug war prosecutors putting juries with no medical training in the position of deciding life and death, literally, on the basis of a distinction not even medical experts can make with assurance: the difference between a ‘drug seeker’ and a ‘pain patient.’

Evidence for Controlled Heroin Use? (full text) Shewan and Dalgarno, British J. Health Psychology, 2005. Posted: 2006-02-17. Comment (DeLuca): In this study, subjects had occupational and educational status comparable to that of general UK pop. Ongoing problems were rare; heroin was not a significant predictor. Use frequency data suggests importance psych factors. The pharmacological properties of opioids, per se, do not inevitably lead to harmful use patterns. See also: Occasional and Controlled Heroin Use – Not a Problem? – Warburton et al., report from The Rowntree Foundation, 2005. Some Eminent Narcotics Addicts, and: The Heroin Overdose Mystery – Edward Brecher; Chapters 5 …

An Evaluation of Fitness-for-Duty Testing (full text) – Debra R. Comer; 103rd Annual Convention of the American Psychological Association, NY; 1995-08-15.

Comment (DeLuca):
Excellent, important, review of fitness-for-duty testing of employees – a field not rich in well-designed, clear-cut research. Document greatly revised: 2006-02-06, including the addition of an interactive Table of Contents.

See also:
A Critical Assessment of Workplace Drug Testing – Alexander DeLuca, M.D., 2002.

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