One of the most frequent questions I’m asked at my trainings or workshops is “what is the major reason people abuse their pain medication?” In my opinion one end of the spectrum is under-treated pain, especially when we’re talking about chronic pain. For many of the chronic pain patients I’ve worked with, either they or their doctors were too afraid to prescribe opiate medication—opioid-phobia—or they wouldn’t prescribe a high enough dose.
Please check out my video to hear some of my ideas and then read the remainder of my post.
Now I know caution must be used when prescribing this type of medication, especially for someone with a history, or family history, of alcoholism or other addiction. But even for this population under-medicating my actually cause more damage bio-psycho-socially than using the medication, and for someone in addiction recovery it could lead to a relapse.
A big reason other chronic pain patients eventually get in trouble is due to too conservative treatment and being able to access effective pain management interventions. For example many of the injured workers who were on Workers Compensation Coverage weren’t given adequate treatment early on. In fact many times relatively inexpensive treatments were denied and later on it cost much more in the long run.
On the other end of the spectrum the big reason people develop substance use disorders when taking pain medication is they don’t do anything else for pain management. They become passive pill-taking recipients instead of proactive participants in their pain management.
Most of the research on best practice treatment for chronic pain recommends an integrated multidisciplinary approach—treating the whole person. Unfortunately, due to HMOs Managed Care and lack of insurance, pills are often used as the quick fix.
Some people abuse their pain medication because they don’t know any better. Today many pain management specialists take precautions to educate their patients when they are going to be prescribed opiate medications. Part of this education includes information about drug-interactions. For example many people still drink alcohol even when the medication label gives a warning.
In fact some people see a warning such as “Alcohol may intensify the effects” as an indication that drinking with the medication will give them better pain management. They don’t realize the synergistic effect on the liver and how the medication is not being metabolized like it should be. This can be lethal.
To learn more about workshops and trainings I’m conducting the first half of this year please go to our