Compassionate, informed advice about healthcare decision making

published by Hank Dunn - October 31st, 2017
Opioid Crisis and Terminally Ill Patients

I am changing my mind…AGAIN!

I wrote last about changing the question “What does the patient want?” Kiss that question good bye.

This time it is on pain control. I am changing “Medications used to control pain DO NOT become addictive to people who have not had addictions problems in the past.” For 16 years you could find this in my book, Hard Choices for Loving People (see page 47).

I came by the statement honestly. Several pain control experts helped me write that sentence. It was backed up by research at the time. I always thought it was curious that people would be concerned about terminally ill becoming addicted. Really? So what if they do … they are dying.

But on top of that, the research at the time said that if you are taking drugs to address pain they do not become addictive. Now the opioid crisis in this country calls that statement into question. People do become addicted. By the thousands.

We are addressing SERIOUSLY ill patients.

I went back to some experts on pain management in hospice and palliative care. In our discussion I was reminded who exactly we are addressing in Hard Choices for Loving People. SERIOUSLY ill patients. These are not the people who take a medication for back pain then become addicted. The patients I am trying to reach in my book are in the last days, weeks, or months of life. My hope is that they will get the help they need to manage all their symptoms including pain.

So here’s the new statement in the book:

“For patients with a serious, life-limiting, or terminal illness, the small risk of addiction is usually of little medical concern. For most of these patients, the benefit of strong pain medication outweighs the risk of addiction. A clinician who specializes in palliative care and pain management can help assess this risk.”

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