Management of Malignancy Pain: Compound Abusers. in requiring more drug to elicit the same physiologic response. Physical dependence and tolerance to opioids are normal and predictable physiologic events that are natural effects of chronic opioid use. Their development can be expected after prolonged use of these medicines (several days to 2 weeks) and does not imply the presence of substance abuse or an addictive disorder.13 Table 2. Substance Abuse Terminology BMS 299897 Open in a separate window BMS 299897 Substance abuse is definitely defined as use of any illegal drug (cannabis, cocaine, heroin) or improper use of a controlled substance. In addition to the procuring of medications through nonmedical sources (e.g., buying medicines on the streets), another example of substance abuse would be the use of an opioid left over from a earlier prescription for alleviation of a subsequently developed emotional pain. In this article, the word refers to the condition of both a person who is currently active in their habit Rabbit Polyclonal to MPRA (active habit) and a person who is in recovery using their habit (recovery). The presence of active habit may be difficult for the physician to determine. Active habit is frequently characterized by the presence of potentially maladaptive, drug-seeking behaviors (Table BMS 299897 3).14 Physicians should familiarize themselves with these behaviors, because the presence of these behaviors can be instrumental in differentiating between drug-seeking individuals and pain reliefCseeking individuals. Most important is the presence of a pattern of behaviors rather than the isolated presence of a behavior.14 Table 3. Maladaptive Behaviors Suggestive of Active Addictiona Open in a separate window However, adding to the already difficult task of determining the presence of active habit is definitely a phenomenon called pseudoaddiction, which may mimic active habit. Out of fear of not receiving adequate pain medication, individuals may hoard medication or ask for amounts that seem out of proportion to their pain.15 This behavior may be particularly evident in individuals who have previously experienced the prescribing of inadequate amounts of pain medication by physicians who fear using opioids in patients with substance abuse disorders.13 ACTIVE Dependency VERSUS RECOVERY Active dependency can pose clinical problems distinct from those encountered with patients in drug-free recovery and those in methadone maintenance programs. Attempts to provide compassionate treatment to these challenging individuals may be skillfully subverted by patients seeking to obtain narcotics for purposes other than pain relief.16 Addicts, especially opioid addicts, often require larger opioid doses and more frequent dosing intervals than nonaddicted patients to adequately control their pain. Ben’s need for what seemed to his physician to be excessive pain medication may have been due to a similar increased opioid requirement to relieve his pain. Narcotic withdrawal symptoms can interfere with attempts to BMS 299897 control pain. BMS 299897 The time for detoxification is not when pain management is needed but rather when opioids are no longer medically indicated. For acute pain situations, opioids should be administered in doses adequate to prevent withdrawal and afford effective pain relief. The best analgesia is usually achieved when withdrawal states and stress related to inadequate pain relief are prevented. One way of controlling opioid withdrawal symptoms while maintaining effective pain control is the use of methadone, 15C20 mg/day, to control withdrawal symptoms, while additional opioids can be given for control of pain at their usual therapeutic doses.3 Methadone maintenance patients should be given their usual daily dose of methadone in addition to the opioids required for effective pain management. Methadone may also be used in increased doses (10C20 mg every 3C4 hours) for pain management in these individuals; however, the dosing intervals are adjusted for effective pain control because the pain-relieving effect of methadone may last only 4 to 6 6 hours. Because of the potential to.