A Startling Injustice: Pain, Opioids, and Addiction
Authors: Jessica Gregg
Journal: Annals of Internal Medicine (2015)

Ideas and Opinions5 May 2015A Startling Injustice: Pain, Opioids, and AddictionJessica Gregg, MD, PhDJessica Gregg, MD, PhDFrom Hooper Detoxification and Stabilization Center, Portland, Oregon.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1396 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Like other residents and medical students in the late 1990s, I was taught to assess the “5th vital sign”—pain—and address it, usually with opioids. My colleagues and I were taught that the medical community had long ignored the treatment of pain and it was now time to redress that wrong. Our teachers, medical boards, and professional associations (and always in the background, the pharmaceutical companies) urged us to assess and treat pain aggressively (1).Thus, with no training in pain management, and no training in addiction, I was soon prescribing large doses of opioids to treat pain in patients who ...References1. Quality improvement guidelines for the treatment of acute pain and cancer pain. American Pain Society Quality of Care Committee. JAMA. 1995;274:1874-80. [PMID: 7500539] CrossrefMedlineGoogle Scholar2. Centers for Disease Control and Prevention. Vital signs: prescription painkiller overdoses in the US. Atlanta, GA: Centers for Disease Control and Prevention; 2011. Accessed at www.cdc.gov/vitalsigns/PainkillerOverdoses on 2 June 2014. Google Scholar3. Centers for Disease Control and Prevention. Home and recreational safety: prescription drug overdose in the United States: fact sheet. Atlanta, GA: Centers for Disease Control and Prevention; 2010. Accessed at www.cdc.gov/HomeandRecreationalSafety/pdf/poison-issue-brief.pdf on 2 June 2014. Google Scholar4. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013;132:95-100. [PMID: 23410617] doi:10.1016/j.drugalcdep.2013.01.007 CrossrefMedlineGoogle Scholar5. Kreek MJ, Nielsen DA, Butelman ER, LaForge KS. Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction. Nat Neurosci. 2005;8:1450-7. [PMID: 16251987] CrossrefMedlineGoogle Scholar6. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-30. [PMID: 19187889] doi:10.1016/j.jpain.2008.10.008 CrossrefMedlineGoogle Scholar7. National Center on Addiction and Substance Abuse at Columbia University. Addiction medicine: closing the gap between science and practice. New York: CASAColumbia; 2012. Accessed at www.casacolumbia.org/addiction-research/reports/addiction-medicine on 1 August 2014. Google Scholar8. Thomas CP, Fullerton CA, Kim M, Montejano L, Lyman DR, Dougherty RH, et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014;65:158-70. [PMID: 24247147] doi:10.1176/appi.ps.201300256 CrossrefMedlineGoogle Scholar9. Krupitsky EM, Blokhina EA. Long-acting depot formulations of naltrexone for heroin dependence: a review. Curr Opin Psychiatry. 2010;23:210-4. [PMID: 20224403] doi:10.1097/YCO.0b013e3283386578 CrossrefMedlineGoogle Scholar10. Fullerton CA, Kim M, Thomas CP, Lyman DR, Montejano LB, Dougherty RH, et al. Medication-assisted treatment with methadone: assessing the evidence. Psychiatr Serv. 2014;65:146-57. [PMID: 24248468] doi:10.1176/appi.ps.201300235 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Hooper Detoxification and Stabilization Center, Portland, Oregon.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1396.Corresponding Author: Jessica Gregg, MD, PhD, Hooper Detoxification and Stabilization Center, 1535 North Williams Avenue, Portland, OR 97232; e-mail, Jessica.[email protected]org.Author Contributions:Conception and design: J. Gregg.Drafting of the article: J. Gregg.Critical revision of the article for important intellectual content: J. Gregg.Final approval of the article: J. Gregg. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPain, Opioids, and Addiction Mitchel L. Galishoff Pain, Opioids, and Addiction Jessica Gregg Metrics Cited ByThe Addicts on Main StreetStrategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping ReviewThe Opioid Drug Epidemic and Sickle Cell Disease: Guilt by AssociationPain, Opioids, and AddictionMitchel L. Galishoff, MD 5 May 2015Volume 162, Issue 9Page: 651-652KeywordsBehaviorDisclosureHeart diseasesHeroinOpioid addictionOpioidsPatientsReflexesShoulders ePublished: 5 May 2015 Issue Published: 5 May 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...