Doctors Diagnosing Addiction – Are the Blind Leading the Blind?
Main Article Content
Abstract
This paper addresses the questions, “are clinicians who treat patients in pain – or even specialists in addiction medicine -- appropriately prepared to accurately diagnose opioid use disorder? Further, is prevailing public policy on pain management employing opioid analgesics firmly grounded in science?” The author summarizes key findings from reviews of pertinent medical literature on pain treatment and diagnosis of substance use disorder.
Medical doctors are widely understood to be inadequately trained in diagnosis of both pain and addiction among their patients.
There is currently no consensus standard of practice to guide clinicians in either prescription of opioids or diagnosis of “substance use disorder” among patients treated for pain. Available medical literature and clinical experience do not support the thesis that clinicians prescribing in a continuing relationship with pain patients have contributed measurably to the widely discussed US “opioid crisis”
. General principles on the management of pain and the diagnosis of substance use disorder do exist but are not widely understood by practicing clinicians. Entry of a “substance use disorder” or “addiction” code in patient electronic medical records can be a literal “kiss of death” for ongoing treatment of severe pain. Thus it seems necessary to caution clinicians who treat pain - and policy makers who oversee them - that much of what they think they “know” about substance use disorder and its causes may no longer be current or may have been wrong in the first place.
Keywords:
Diagnosing Addiction, Doctors Diagnosing Addiction
Article Details
How to Cite
LAWHERN, Richard A.
Doctors Diagnosing Addiction – Are the Blind Leading the Blind?.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4726>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4726.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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https://www.frontiersin.org/articles/10.3389/fpain.2022.884674/full
2. Singer JA, Sullum JZ, Schatman ME. “Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder.” J Pain Res. 2019;12:617-620 https://doi.org/10.2147/JPR.S199750
3. Richard A Lawhern PhD, “Doctors Prescribing To Their Patients Did Not Cause the US Opioid Crisis” American Council on Science and Health, January 9, 2023, https://www.acsh.org/news/2023/01/09/doctors-prescribing-their-patients-did-not-create-us-opioid-crisis-16787
4. Jalal H, Buchanach JM, Roberts MS, Balmert L, Zhang L, and Burke DS, “Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016” Science,Vol 361, Issue 6408, 21 September 2018, https://www.science.org/doi/10.1126/science.aau1184
5. Volkow N and McMillan AT, “Opioid Abuse in Chronic Pain -- Misconceptions and Mitigation Strategies, ” New England Journal of Medicine, March 31, 2016, http://www.nejm.org/doi/full/10.1056/NEJMra1507771
6. Dydyk AM, Sizemore DC, Haddad LM, Lindsay L, Porter BR, NP Safe Prescribing of Controlled Substances While Avoiding Drug Diversion January 29, 2023, https://www.ncbi.nlm.nih.gov/books/NBK564518/
7. Gudin J, Fudin J. “Best Practices Are Still Largely Undefined in Task Force Report.” Pract Pain Manag. 2019; 19(4). https://www.practicalpainmanagement.com/resources/clinical-practice-guidelines/best-practices-are-still-largely-undefined-task-force-report
8. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. “CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022.” MMW Recomm Rep 2022; 71(No. RR-3):1–95.
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10. Beletsky, L and Nicholson KM “CDC's Updated Opioid Guidelines Are Necessary, but Not Sufficient” Medpage Today, November 18, 2022, https://www.medpagetoday.com/opinion/second-opinions/101825
11. Ghey N “The Other Opioid Crisis: How False Narratives Are Hurting Patients”, Discourse, July 18, 2022. https://www.discoursemagazine.com/culture-and-society/2022/07/18/how-false-narratives-about-opioids-are-hurting-patients/
12. Satel S, “The Myth of What’s Driving The Opioid Crisis,” Politico Magazine, February 21, 2018, https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034/
13. Lawhern RA, “We Need New Laws To Protect People in Pain - The CDC’s revised prescribing guidelines retain an anti-opioid bias and do nothing to reverse the harmful policies inspired by the 2016 version.” Reason Magazine, February 14, 2023, https://reason.com/2023/02/14/we-need-new-laws-to-protect-people-in-pain/
14. Darnall BD, Juurlink D, et al, “International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering,” Pain Medicine, Volume 20, Issue 3, March 2019, Pages 429–433, https://doi.org/10.1093/pm/pny228
15. Dowell D, Haegerich T and Chou R “No Shortcuts to Safer Opioid Prescribing”, New England Journal of Medicine, June 13, 2019, https://www.nejm.org/doi/full/10.1056/NEJMp1904190
16. Centers for Disease Control and Prevention, “CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain,” April 24, 2019, https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html
17. Maia Szalzvitz, “Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause -- Cracking down on highly effective pain medications will make patients suffer for no good reason” Scientific American, May 2016, https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
18. Nita Ghey, “The Other Opioid Crisis: How False Narratives Are Hurting Patients”, Discourse, July 18, 2022. https://www.discoursemagazine.com/culture-and-society/2022/07/18/how-false-narratives-about-opioids-are-hurting-patients/
19. Jacob Sullum, “Opioid Epidemic Myths” Reason Magazine, May 18, 2016, https://reason.com/2016/05/18/opioid-epidemic-myths/
20. Miranda Hitti, “Prescription Painkiller Addiction: 7 Myths”, WebMD, August 10, 2011, https://www.webmd.com/pain-management/features/prescription-painkiller-addiction-7-myths#5
21. Sally Satel, “The Myth of What’s Driving The Opioid Crisis” Politico Magazine, February 21, 2018, https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034/
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