The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72622

Nancy J. Kennedy, DrPH, Office of the Director, Center for Substance Abuse Prevention/SAMHSA/DHHS, 5600 Fishers Lane, Rockwall II, Suite 900, Rockville, MD 20857, 301-443-9453, NKennedy@SAMHSA.gov

Almost everyone has experienced pain—pain that usually lasts from a few days to several weeks. For many individuals, physicians prescribe opioid medication to address the attendant pain. As the pain subsides, the injury heals, the problem resolves and the need for medication ceases. The problem of becoming addicted to the prescribed opioid medication is rare; nonetheless, physicians experience trepidation prescribing these drugs to patients for any extended period of time. The reasons for such trepidation are both historical and regulatory. For some individuals, approximately 100 million, the pain is not acute but chronic and unrelenting. For these patients, physicians are even more wary of prescribing opioid medications, creating an unfathomable dilemma for the individuals in pain. The patients feel helpless, depressed and suicidal. The insensitive statement that many non-malignant chronic pain patients are told by some well-meaning health care providers is that “it’s all in your head.” Such a remark triggers rage and possibly other inappropriate behaviors. The implication is that this is a characterterologic disorder rather than a medical, potentially fatal, problem. This scenario sounds reminiscent of how individuals with addictive diseases were once viewed. But, the irony is that some of those 100 million individuals with chronic pain also are persons in recovery from addictive disorders. This subset of those in recovery have ignited a controversy of whether they should be treated any differently those people in chronic pain without a history of addiction. This session examines the challenges and possible resolutions for both providers and consumers.

Learning Objectives:

• Describe the nature and magnitude of the problem of prescribing opioid medications for this sub-set of persons in recovery
• Identify the historical and regulatory challenges for providers in prescribing opioid medications to this population
• Describe various approaches for persons in recovery who have chronic pain chronic pain from abstinence approaches

Keywords: Prescription Drug Use Patterns, Special Populations

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment