As someone with (mild) chronic pain, who expects her pain to get worse over time; and someone with a father in (serious) chronic pain, I am deeply, deeply concerned about the idea, now current, that Wanting To Not Be In Pain Means You Are An Addict.
But why should I make this case, when people who deal with patients in real life do such a great job making it for me?
Here is Scott Alexander: AGAINST AGAINST PSEUDOADDICTION
Case 6: Sandy is a middle-aged woman on benzodiazepines, a potentially addictive anti-anxiety medication. She has been stable for twenty years. She switches doctors. The new doctor has heard that Benzodiazepines Are Bad And Addictive, so he discontinues them over her objections. Sandy becomes a miserable wreck and has panic attacks basically all the time for a few months. Whenever she tries to mention this to the doctor, he accuses her of being an addict and trying to con him into giving her drugs. After a few months of this, she leaves that doctor and switches to me. I put her back on her previous dose of benzodiazepines, and within two days she feels perfectly normal and gets on with her life.
That sounds like a typical stupid case of inexcusable medical malpractice, as has become common. How common? Well, how about this even more extremely obvious malpractice:
Case 3: This one courtesy of Zvi. Zvi’s friend is diabetic. He runs out of insulin and asks his doctor for more. The doctor wants to wait until his next free appointment in a few weeks before prescribing the insulin. Zvi’s friend points out that he will die unless he gets more insulin now. The doctor gets very angry about this and spends a long phone call haranguing Zvi’s friend about how inconvenient it is that he’s demanding the insulin now rather than at a more convenient time. Zvi’s friend has to threaten the doctor with a lawsuit before the doctor finally relents and gives him the insulin. I like this story because, again, insulin is not addictive, there is no way that the patient could possibly be doing anything wrong, but the patient still gets treated as a drug-seeker. The very act of wanting medication according to the logic of his own disease, rather than at the doctor’s convenience, is enough to make his request suspicious.
Bold is mine, not that I needed to bold anything, as surely those sentences leaped out enough on their own.
Today’s post brought to you on behalf of everyone unnecessarily suffering because of the current fad terror of painkillers. Especially 85-year-old people with chronic pain who have to jump through hoops over and over to continue perfectly reasonable, not to say humane, painkiller regimes.
This is Scott Alexander we’re talking about, so much, much more at the link.
Plus an ending quote because it’s a perfect summation so again, I don’t have to write a perfect summation of my own:
The opioid crisis is really bad. I nevertheless think pseudoaddiction is the most obviously true medical concept this side of Hippocrates. The denial of its existence is a failure of national epistemics that deserves more scrutiny than it’s getting.