subject: Helping Patients Who Are Addicted To Medications [print this page] But the reality is that because of drug tolerance, these patients may need much more medication to control acute pain than opioid-naive patients. Many healthcare practitioners think giving pain killers to a patient addicted to them is a high-risk practice, but every patient has a right to adequate pain relief.
The American Society of Pain Management Nurses has issued a position statement affirming that patients with a history of addiction need to have their pain treated and that they'll need higher doses of medication for pain. Patients actively using illicit substances or misusing prescription drugs and patients with a history of addiction can expect to have a difficult time when they have pain unless the healthcare providers understand the issues surrounding addiction and pain relief.
This article will dispel misconceptions and provide guidelines for managing pain in these patients. In the United States, many patients with chronic pain take medications regularly.
Are they becoming addicted through routine use of pain killers? Yes and no.
A small percentage of patients become addicted, but not nearly as many as healthcare professionals may assume. Many patients who do become addicted had some previous exposure to opioid use.
Determining the rates of addiction with long-term use in the healthcare setting is difficult. In a study of 800 primary care patients taking drugs, the rate of addiction was roughly 4%.
In another review study involving patients with various pain complaints, the rate of addiction was found to be less than 1% for patients who'd never used opioids previously and about 4% for patients who'd been exposed to them previously. Even in pain clinic patients who were taking drugs regularly for pain relief, research indicates that 40% will exhibit aberrant behaviors, 20% will abuse or misuse their medications, and 2% to 5% will become addicted.
These statistics highlight the number of patients using medications who don't become addicted but use their medications responsibly to manage pain. The low incidence of addiction in patients taking pain killers consistently shows that regular use for pain control isn't an indicator of addiction.
A patient who becomes addicted is a patient with different needs who comes to the experience of drug use in a completely different way. Addiction, dependency, and tolerance are different states that are still widely misunderstood by healthcare professionals.
The key to treating pain in a patient with a history of addiction is to develop a trusting relationship so the patient is comfortable sharing accurate information about past and current drug use. Many patients who abuse drugs have had negative experiences with healthcare providers, so don't be surprised if your patient resists suggestions about pain relief.
Maintain a nonjudgmental attitude and try to persuade the patient that you want to help. In turn, the patient may respond more positively to you.
Setting boundaries for providing pain medications and requests for dose increases should be clearly identified and discussed with the patient. For example, the patient may request the medications when they're scheduled, but the patient should understand that medications won't be given at other than the specified time except for a clinical reason, such as a change in the patient's condition.
No one, including a patient who's addicted to drugs or has a history of substance abuse, should suffer from unrelieved pain. By providing ongoing pain assessments and working with the patient, you can help deliver the best level of pain relief possible.
If you can establish a therapeutic relationship with the patient and follow the established plan of care with treatment goals, the patient should progress through hospitalization with the fewest possible problems. Caring for a patient with drug abuse problems can be time-consuming, but easing the suffering of a challenging patient is extremely rewarding.
Dependence is a normal physiologic response to chronic drug use. If a pain killer is abruptly withdrawn from a patient on long-term therapy, the patient will experience a withdrawal syndrome with signs and symptoms such as nausea/vomiting, chills, changes in vital signs, and diarrhea.
Nurses and other healthcare providers should be very careful not to label an drug-dependent patient as addicted. Tolerance occurs as the body adapts to chronic opioid use.
Because of tolerance, the medication's effects-both positive and negative-tend to lessen over time. Most adverse reactions such as nausea and sedation diminish, but so does pain relief.
The patient who's becoming tolerant to an drug will report more pain despite receiving the usual drug dosage. As you can see, these patients require special care-a good nurse will be willing and able to provide the patience and help for a patient in need.
