Narcotics

Narcotic Use

Narcotics or opioid analgesics are widely used for the treatment of pain. Most of the time narcotics are used for acute pain and prescribed for only a brief period of time. Patients dying of cancer or another terminal disease are often prescribed narcotics to relieve end-of-life suffering. However, the use of narcotics on a long-term basis to treat chronic nonmalignant pain is still controversial. Nevertheless, pain specialists believe that selected patients can benefit from long term narcotic use. When used appropriately, patients taking narcotics can experience sustained pain relief with tolerable side effects and little risk of developing addiction. As pain relief improves, patients may be able to function better and experience a much improved quality of life.

Dependence

Some patients confuse physical dependence to narcotics, which is the occurrence of withdrawal when the drug is stopped, with narcotic addiction. Withdrawal is a physical phenomenon that means that the body has adapted to the narcotic in such a way that a "rebound" occurs when the narcotic is suddenly stopped. The kind of symptoms that occur during withdrawal include rapid pulse, sweating, nausea and vomiting, diarrhea, runny nose, "gooseflesh," and anxiety. All people who take narcotics for a period of time can potentially have this withdrawal syndrome if the narcotic is stopped or the narcotic dose is suddenly lowered. Physical dependence is entirely different from addiction.

Addiction

Narcotic addiction is defined by a loss of control over the narcotic, compulsive use of the narcotic, and continued use of the narcotic even if it is harming the person or others. People who become addicted to narcotics often deny that they have a problem, even as they desperately try to maintain the supply of the narcotic. Studies of patients with chronic pain taking narcotics indicate that the risk of addiction among patients with no prior history of substance abuse who are given a narcotic for pain is very low. A prior history of substance abuse does not always mean that a patient should never get a narcotic for pain, but does suggest that the doctor must be very cautious when prescribing and monitoring narcotic use.

Tolerance

Tolerance to narcotics occurs frequently. Tolerance means that taking the narcotic changes the body in such a way that the narcotic loses its effect over time. If the effect that is lost is a side effect, like sleepiness, tolerance is a good thing. If the effect that is lost is pain relief, tolerance is a problem. The treatment may not be to increase the narcotic, but to eliminate the narcotic. Many patients on narcotics have had their dose ratcheted up because of narcotic tolerance, only to find themselves dependent and still seeking pain relief.

Mental Side Effects

Narcotics sometimes can make people sleepy and cloud their thinking; however, this side effect is usually temporary and long-term narcotic use is usually associated with normal thinking. Many patients fear that taking a narcotic will cause them to be unable to function even if the pain is relieved. However, studies show that patients can take narcotics for a long period of time and be mentally normal. Patients who have been stabilized on narcotics are usually quite clearheaded and can drive, work, and do whatever else is necessary. Long term use of narcotics can be associated with increasing depression. The treatment may not be anti-depressants but a discontinuation of narcotic use.

Other Side Effects

By far the most common side effect of narcotic use is constipation. Severe constipation can be a serious medical problem and may represent an ileus or a shutting down of the bowels. Some patients experience nausea or even vomiting from narcotics. Other patients develop itching. Dry mouth is also a side effect. Some patients will note an unusual sense of hyperawareness rather than sedation; they feel "wired" rather than relaxed, even if their pain is controlled. Chronic narcotic use can also lower testosterone levels with occasional significant negative results in male patients.

Narcotic Trial

Patients who receive a trial of a narcotic should expect to be carefully monitored by the doctor. Any patient given narcotics to treat pain should follow the doctor's prescription exactly. Patients should never increase the narcotic dose on their own. Patients should never go to another doctor to get narcotic prescriptions. Patients should always be completely honest in reporting their use of narcotics, the benefit or relief of pain from narcotics and any side effects produced by the narcotic. The doctor will ask about pain relief; side effects; the ability to function physically, psychologically and socially; and the occurrence of any behavior that suggests problems in controlling the narcotic. For some patients, very intensive monitoring is appropriate; for others, monitoring can be less intensive.

Narcotic Contract

The doctor may want the patient to agree to a written contract that describes the patient's responsibilities when taking the narcotic. The doctor may even want to monitor the patient's urine to make sure that the patient is taking only the narcotic that should be taken. The doctor may want these things to feel secure in the knowledge that the patient is appropriately using the narcotic. When the doctor is able to have this security, he is free to act in the patient's best interests. A good relationship between the doctor and patient is needed for long term narcotic therapy to be successful.

Narcotics

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