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Unformatted text preview: October 2001 www.aafp.org / fpm F A M I L Y P R A C T I C E M A N A G E M E N T 37 Pain must be regarded as a diseaseand the physicians first duty is action heroic action to fight disease. Benjamin Rush F amily physicians are on the front lines in the war on pain. It is estimated that chronic pain may affect 15 per- cent to 30 percent of the general population of the United States as many as 70 million individuals. 1 For many of these patients, controlled substances such as opioid analgesics are the mainstays of therapy because of their efficacy and relative freedom from end-organ toxicities, such as the serious gastrointestinal complications that too often accompany long-term treatment with non- steroidal, anti-inflammatory drugs. However, these medications may be double-edged swords. Specifically, the role of opioid anal- gesics, such as OxyContin, in pain manage- ment is currently a topic of debate. The potential for misuse of opioid anal- gesics and other medications used to treat pain is high by patients who abuse their own medications or by pseudopatients or diverters who try to obtain these medica- tions under false pretenses for the illicit pur- pose of reselling the drugs to others. A 1999 survey by the Substance Abuse and Mental Health Services Administration revealed that approximately 4 million people in the Unit- ed States use psychotherapeutic drugs for nonmedical reasons nearly double their estimate of Americans who use heroin or cocaine. 2 Diversion and abuse of pain med- ications is costly to abusers and to society, and it endangers patients who are in pain. Although subtle, there is an important difference between patients who abuse their own medications and those who divert them. This article focuses on medication diversion, which has recently been a prob- lem with OxyContin in particular. Of course, many of the articles tips for diver- sion prevention may also apply to patients abusing their own medications. Dr. Cole is the director of Continuing Medical Educa- tion and administrator for the National Pain Data Bank and Pain Program Accreditation service of the American Academy of Pain Management in Sonora, Calif. Conflicts of interest: He is a member of the Speakers Bureaus of Purdue Pharma LP and Abbott Laboratories Inc. Dont let diversion of pain medication hamper your ability to treat chronic pain. B. Eliot Cole, MD, MPA Family physicians are on the front lines in the war on pain. Downloaded from the Family Practice Management Web site at www.aafp.org/fpm. Copyright 200 1 American Academy of Family Physicians. For the private, noncommercial use of one individual user of the Web site. All other rights reserved. Contact email@example.com for copyright questions and/or permission requests. Some physicians deal with medication diversion by simply refusing to treat any patients with opioid analgesics, but this harms honest patients who need these med-...
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