How Closely Should Doctors Monitor Painkiller Use in Patients?

How Closely Should Doctors Monitor Painkiller Use in Patients?

Prescription opioid painkillers such as hydrocodone (Lortab, Vicodin), oxycodone (OxyContin, Percodan, Percocet) and hydromorphone (Dilaudid, Palladone) are very effective in treating pain, but they are also highly addictive and can cause death from overdose. Doctors are aware of this danger since they may be held liable for malpractice resulting from the prescription of opioids. Physicians must weigh the benefits of painkillers in terms of pain management against the potential risks to the patient. Doctors usually will not prescribe opioids to patients with a history of drug abuse or addiction, and they should monitor the use of opioids in all patients to avoid the development of addiction.

Opioids usually are prescribed for short-term use following injury or surgery. Physical dependence is unlikely to develop during the course of treatment in a person with no prior history; however, psychological addiction can develop quickly if the person finds that he or she enjoys the effects of the drug and seeks them out even when the pain is gone. Doctors should be alert to drug-seeking behavior that may include asking for refills when they should not be necessary, claiming to have lost prescriptions or pills, or attempting to talk the doctor out of samples in addition to the prescription.

Other Drugs that Are Cross-Tolerant with Opioid Painkillers

Doctors are advised not to prescribe opioid painkillers to anyone who has ever been addicted to any central nervous system (CNS) depressant. This is because all CNS depressants (including alcohol, opiates like heroin and morphine, opioids and benzodiazepine sedatives like Valium and Xanax) are cross-tolerant with one another. This has several ramifications for medical use of opioids: opioids will be less effective for anyone with a tolerance for CNS depressants, and the patients may respond by increasing the dose to dangerous levels; use of opioids by a recovering addict may constitute a relapse even if the opioid was not the person’s drug of choice; and use of opioids may trigger a relapse into addiction to the opioid or to the person’s drug of choice if it is something other than an opioid.

Finding Pain Management Alternatives for Recovering Addicts

In treating pain in a patient with a history of addiction, doctors will often seek alternatives to opioids, although unfortunately, any alternatives are likely to be less effective in pain management. However, in some cases physical therapy, exercise, stretching, yoga, acupuncture, or alternative medicines may be effective in providing pain management without the risk of addiction to those with a prior history.

Yet, a doctor may decide that the benefits to the patient in terms of pain management outweigh the risks, even if the patient is a recovering addict. A patient with severe, chronic pain or a terminal condition may find relief from pain only through powerful opioids. In such cases the doctor should monitor the patient’s drug use closely and help the patient find resources to deal with any addiction issues that arise.

Questions about Opioid Addiction?

If you have any questions about opioid addiction or the responsibility of doctors to help their pain patients avoid addiction, please call our toll-free 24 hour helpline today.