Pain and Addiction

Opioid (narcotic) dependence is a serious and growing problem in the United States.  Over 4.4 million people use prescription pain relievers nonmedically.  An estimated 2.4 million have used heroin at sometime in their lives.  In 2001, an estimated 2.4 million used pain relievers nonmedically for the first time-up from 628,000  in 1990.  An estimated 1.9 million people 12 years of age and older have used oxycodone nonmedically.  In the general population, approximately 6-15% of patients suffer from the disease of addiction

The number of people using prescription pain relievers nonmedically is increasing dramatically.  This, added to the level of established heroin dependence, has set the stage for a critical shortage of qualified opioid dependence treatment physicians.

Chronic pain affects millions of people United States and costs of approximately 120-$150 billion annually.  Untreated chronic pain often leads to substance and alcohol abuse.  Over 80% of Americans will experience back pain at sometime in their life.

The problem that we are facing in the United States is one in which pain patients are presenting with substance dependence or addiction problems.  Since the incidence of addiction in the general population is 6-15%, the number of patients with chronic pain and addiction can be quite high.  Many physicians with good intentions treat these patients with narcotic painkillers.  However, they often overlook the signs and symptoms of opioid dependence and addiction. 

Furthermore, some patients treated with opioid painkillers can develop hyperalgesia, which is a state of heightened pain.  One might consider opioid hyperalgesia a form of super tolerance, which is simply that more and more drug is required to a effectively treat the pain. At some point even huge doses of narcotic pain medications can lead to hyperalgesia and simply be ineffective. Often these patients will be receiving very large doses of narcotic painkillers with marginal control of pain.  These patients may or may not present with signs of addiction or opioid dependence.  They are simply being treated with large doses of narcotic painkillers by their physicians and their opioid hyperalgesia is overlooked or not diagnosed.

A New Opportunity to Provide Office-based Treatment for Pain and Addiction

Suboxone, a relatively new drug contains buprenorphine, a partial MU receptor agonist that addresses the biological basis for drug dependence.  Basically, this drug binds to the same receptors in the brain as does morphine, oxycodone and other opioids.  However, buprenorphine not only binds to the receptor but blocks it, which shuts down the cravings, and desires to continually use opioids and also prevents hyperalgesia.  On the other hand, morphine and oxycodone continually activate the receptors, which may lead to tolerance and hyperalgesia in certain patients.  In certain genetically predisposed patients, this will lead to substance dependence and addiction.

The Drug Addiction Act of 2000 (DATA) passed by Congress allows qualified physicians to treat opioid addiction in an office-based setting with the use of suboxone.  Prior to this, opioid addicted patients had to be treated with methadone in federally licensed and operated methadone clinics. These clinics often were in less than desirable neighborhoods and were quite stigmatized. With the passage of DATA, qualified physicians and can treat opioid addiction in their offices on an outpatient basis.

At Comprehensive Pain Medicine we treat both chronic pain and opioid addiction.  With the use of suboxone we are able to treat not only opioid addicted patients, but patients who present with hyperalgesia.  We believe that there are thousands of patients treated with opioids that have developed this syndrome of hyperalgesia and are desperate for an alternative.  In the safety, comfort and privacy of our office environment we can detoxify these patients from their opioid medication and treat their pain with non- opioid medication and other techniques such as interventional pain management, psychological therapies, and acupuncture.  We've been very successful in treating motivated patients who want to get off the opioid pain medications and feel that the quality of their life has not been improved by opioid therapy.  It should also be pointed out that there are many patients who can be treated successfully with opioid therapy and we have many of these patients in our practice.  But for those patients who have developed hyperalgesia or even substance dependence or addiction, there is an alternative.