COMMENTARY

Addiction, Empathy, and Opioid Alternatives

Helen Riess, MD

Disclosures

April 06, 2016

Introduction

It's not news that we're in the midst of a national opioid epidemic. According to figures compiled by the American Society of Addiction Medicine, 1.9 million American citizens are presently living with prescription opioid abuse or dependence, while another 517,000 Americans are living with heroin addiction. The human toll is catastrophic—both for those in the grips of addiction and for those who know someone affected. Recently Massachusetts Governor Charlie Baker signed a new law aimed at stemming Massachusetts' opioid addiction crisis that will limit prescriptions and mandate student screenings, substance abuse evaluations in emergency departments, and monitoring programs to reduce doctor shopping. As the rate of opioid addiction—and opioid-related deaths—has skyrocketed, these measures must go hand in hand with new trainings for healthcare workers in productive and potentially life-changing conversations that will transform how drug-dependent patients are treated. The finger pointing at both patients and doctors has become rampant. This type of thinking is counterproductive. As hospital visits for opioid use soar, medical professionals need to be equipped with communication toolkits that will truly benefit patients.

First, a little background.

Since the 1990s, society has castigated physicians for minimizing the pain expressed by patients. As a result, pain management became a primary target for physician training, which resulted in overprescribing rather than withholding or underprescribing pain medications.[1,2] Opioids are medications that work by reducing the intensity of pain signals reaching the brain. By diminishing the effects of painful stimuli, they also affect brain areas controlling emotions associated with pain. For some patients, once introduced to a dramatic disappearance of pain, their desire to remain pain free—both physically and emotionally—can lead to overwhelming addiction, with its many associated antisocial behaviors. Oftentimes with drug-addicted patients, there is an additional undercurrent of problems: sexual and physical abuse, depression and mental illness, socioeconomic hardship, and more.

Patients struggling with addiction are some of the most difficult patients to treat—and even for seemingly impenetrable physicians, a stigma surrounding addiction persists. Empathic, skilled conversations by medical professionals with their patients can help save many lives of patients who are facing potentially hopeless and devastating futures. However, most physicians aren't trained to enter into productive and empathic conversations with drug-addicted patients. These patients are often viewed as weak, self-indulgent, and lacking willpower and therefore refusing to help themselves.

Additionally, drug-addicted patients often use manipulative tactics to get the substances they crave. Manipulative tactics usually backfire, leading medical professionals to further distance themselves and dislike the patients who employ them. The helplessness in the addict gets transferred to helplessness in the physician caring for the addict. Therefore, physician training in these difficult conversations is essential. Too often, more prescriptions become the "solution" to mediate the helplessness that is at the core of the drug-addicted individual and their physicians.

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