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Why Don't Patients With Pain Become Addicted to Morphine?

Why Don't Patients With Pain Become Addicted to Morphine?

GLASGOW-Pain specialists continually stress the message that clinicians should not fear prescribing adequate doses of opioids for pain patients, since such patients are not at risk of becoming "addicted."

Now a study from the University of Glasgow confirms what pain specialists intuitively know: Pain patients do not become psychologically dependent on drugs because they are taking narcotics to relieve their pain and for no other reason; drug abusers, on the other hand, use narcotics strictly for mood alteration or to induce sleep.

The researchers surveyed three groups who were receiving narcotics: cancer pain patients (14 subjects), patients with chronic nonmalignant pain (27 subjects), and drug addicts enrolled in a methadone maintenance program (30 subjects).

The cancer pain patients had been using opioids for a mean of 6 months; the chronic pain patients for 2.2 years; and the drug abusers for 13 years. Median daily morphine equivalent doses were much higher in the cancer patients (1,320 mg) than in the chronic pain patients (700 mg) or the drug abusers (160 mg).

Patients' drug use and reasons for varying the dose were recorded daily for a week, then weekly for a month, then once monthly for 3 months, via structured questionnaires and semi-structured interviews, Dr. Marie Fallon, of the Division of Palliative Medicine, reported in a poster session at the 8th World Congress on Pain in Vancouver.

The results showed that pain patients are not psychologically dependent on strong opioids. "They have a need to use them for pain, and when that pain isn't there, they basically don't need them," Dr. Fallon said.

The cancer pain patients reported taking extra opioids when their pain was poorly controlled, and the chronic pain patients said they took extra doses when pain was more distressing, but, Dr. Fallon said, the drug abusers' use of extra narcotics beyond what they were getting in the maintenance program appeared to be based on drug availability.

 
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