Mayo Clinic Proceedings: A Comprehensive Review of Addiction to Prescription Painkillers...

Mayo Clinic Proceedings: A Comprehensive Review of Addiction to Prescription
Painkillers Among Patients and Physicians

ROCHESTER, Minn., July 7 /PRNewswire-USNewswire/ -- Chemical dependency and
recovery in patients and physicians are closely examined in a series of
articles and editorials in the July 2009 issue of Mayo Clinic Proceedings. The
subject is especially timely. As the immense challenges, including potential
tragedies, of prescription chemical addiction and abuse are being discussed,
these articles offer crucial overview, direction and optimism.

Addiction to and abuse of prescription opioid drugs are prevalent, and they
exact an immense toll on patients, physicians and society, according to Steven
Passik, Ph.D., Department of Psychiatry and Behavioral Sciences, Memorial
Sloan-Kettering Cancer Center, New York, in "Issues in Long-Term Opioid
Therapy: Unmet Needs, Risks, and Solutions."

Opioid drugs have been used by humans for thousands of years and are the
longest continuously used class of medications, explains William Lanier, M.D.,
editor-in-chief of Mayo Clinic Proceedings. Dr. Lanier and Evan Kharasch,
M.D., Ph.D., Department of Anesthesiology, Washington University in St. Louis,
authored the editorial "Contemporary Clinical Opioid Use: Opportunities and
Challenges." It summarizes the recent increased interest in this drug
category.

Opioid medications are chemicals that work by binding to specific receptors,
particularly in the nervous system and gastrointestinal tract; decrease
perception of pain and reaction to pain; and increase pain tolerance. Side
effects include sedation, respiratory depression and constipation. When opioid
consumption is ongoing, physical dependence can and will develop. This, in
turn, can lead to problematic withdrawal upon abrupt discontinuation of
medication. Dependence, coupled with the feeling of euphoria these drugs can
produce, leads to abuse.

According to Dr. Lanier, the recent growing interest in opioids stems from
five sources: advances in the design of these drugs; expansion and innovation
in methods of drug delivery; increased public awareness of pain management
options and the appropriateness of aggressively treating pain as the "fifth
vital sign" and pain relief as a fundamental human right; growing recognition
of the serious consequences of opioid misuse, misadventure and addiction; and
medicolegal aspects of practitioners' prescribing practices and legal
consequences for under- or overprescribing.

In addition to individuals who have chronic pain, both cancer and non-cancer
related, anesthesiologists have the greatest risk of opioid dependence and
abuse among health care providers. Also in the high-risk group for health care
providers are nurse anesthetists and sedation nurses. Challenges specific to
these groups are discussed by Michael Oreskovich, M.D., Washington Physicians
Health Program in Seattle, and Ryan Caldeiro, M.D., Department of Psychiatry
and Behavioral Sciences at the University of Washington, Seattle, in
"Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return
to the Operating Room?"

Severe chronic pain includes that produced by cancer and such non-cancer
conditions as back injury and surgery. Opioids are a cornerstone of pain
management for individuals in these categories, according to Howard Smith,
M.D., Department of Anesthesiology, Albany Medical College, N.Y. In "Opioid
Metabolism," he writes that approximately 10 percent to 20 percent of
physicians will develop a substance abuse problem during their career, a rate
similar to or exceeding the general population. For anesthesiologists,
according to Drs. Oreskovich and Caldeiro, the increased risk is cited as an
occupational hazard because of the highly addictive medications they
administer to patients daily.

Health care professionals helping patients with chronic pain must balance
aggressive treatment with the need to minimize the risks of misuse and abuse,
according to Dr. Passik. In "A Comparison of Long- and Short-Acting Opioids
for the Treatment of Chronic Noncancer Pain," Charles Argoff, M.D., and Daniel
Silvershein, M.D., both from the Department of Neurology, Albany Medical
College, N.Y., write that management of chronic non-cancer pain, for example,
requires comprehensive assessment of each patient; the establishment of a
structured treatment regimen or program; ongoing reassessment of the pain
condition and the response to therapy; and a continual appraisal of the
patient's adherence to the treatment. Their colleague, Dr. Smith, stresses the
importance of understanding the metabolism of opioids in individual patients.

Keen awareness by family and friends of potential addiction is crucial for
physicians and other health care providers, not to mention the general public,
who might be at risk, according to "Chemical Dependency and the Physician" by
Keith Berge, M.D., Department of Anesthesiology, Mayo Clinic; Marvin Seppala,
M.D., Hazelden Foundation, Center City, Minn.; and Agnes Schipper, J.D., Mayo
Clinic Legal Department. Especially important is that family, friends and
co-workers of health care providers confront any suspected addiction and abuse
because of the potential harm that might befall the individual and his or her
patients. Health care facilities should have written policies and procedures
in place to assist when these highly emotionally charged situations involving
health care providers occur, Dr. Berge and his colleagues write. Long-term
recovery and sobriety can be achieved with appropriate treatment, aftercare
and monitoring, they add.

New opioid formulas designed to minimize abuse are now in late-stage
development and could help, Dr. Passik says. These drugs are chemically
designed to diminish euphoric effects, thus possibly reducing problematic use.
For now, responsibility coupled with expertise, insight, diligence and
compassion are among the components that can meet the challenges of opioid use
in pain management, the authors agree.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and
reviews dealing with clinical and laboratory medicine, clinical research,
basic science research and clinical epidemiology. Mayo Clinic Proceedings is
published monthly by Mayo Foundation for Medical Education and Research as
part of its commitment to the medical education of physicians. The journal has
been published for more than 80 years and has a circulation of 130,000
nationally and internationally. Articles are available online at
www.mayoclinicproceedings.com.

About Mayo Clinic
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in the world. Doctors from every medical specialty work together to care for
patients, joined by common systems and a philosophy that "the needs of the
patient come first." More than 3,300 physicians, scientists and researchers
and 46,000 allied health staff work at Mayo Clinic, which has sites in
Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz.
Collectively, the three locations treat more than half a million people each
year. To obtain the latest news releases from Mayo Clinic, go to
www.mayoclinic.org/news. MayoClinic.com (www.mayoclinic.com) is available as a
resource for your health stories. For more on Mayo Clinic research, go to
www.mayo.edu.

SOURCE Mayo Clinic

John Murphy of the Mayo Clinic, +1-507-284-5005 (days), +1-507-284-2511
(evenings), newsbureau@mayo.edu