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There are two ways in which dependence can create trouble for patients:

It can make stopping drugs hard

The most obvious problem occurs when the time has come to stop a drug, but withdrawal symptoms make doing so difficult. This doesn’t happen to everyone, but it happens, and you’ll have a hard time finding a more vivid description than that provided by Dr. Travis Rieder, an Assistant Professor of Bioethics at Johns Hopkins. For those without access to the Washington Post, he also has a TED talk, but here’s the summary: A young man is seriously injured in a motorcycle accident. Over the course of three hospitalizations, his mangled foot is saved by a series of operations. Two months after the accident, his surgeon tells him (regrettably, with a hint of tsk tsk) that he’s on a high dose (about 115 milligrams of oxycodone per day) and that it’s time to come off. Lacking further guidance, he decides to taper by 25% per week. He soon becomes miserable: crippling insomnia, inability to function, low mood with bouts of spontaneous crying, and—within a matter of weeks—thoughts of suicide.

This story should be required reading for any clinician who prescribes opioids. Seriously, spend the five minutes. You owe it to yourself and your patients. You can read about dependence all you want in textbooks and articles and blog posts hastily written by pointy-headed academics, but it takes an account like this to hammer home just how malignant dependence can be. I mean, here’s a smart young professional with a promising career, a family and a very good indication for opioid analgesia who literally contemplated ending his life because of what two months of opioids had done to his neural circuitry. Just imagine if he’d been less resilient, had fewer supports, or more in the way of life’s other challenges.

…continue reading ‘Dependence Isn’t Addiction, But It’s Still A Problem’

Image via Flickr Attribution Some rights reserved by KSRE Photo

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Tox and Hound

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