COMMENTARY

Addiction, Empathy, and Opioid Alternatives

Helen Riess, MD

Disclosures

April 06, 2016

Opioid Alternatives

What gets lost here is the desperation, shame, and self-loathing that accompany drug addiction. Medical doctors must not lose sight of the desperate person behind the behaviors, which can be extremely off-putting and lead to feelings of disgust, helplessness, and even contempt for the drug seeker. Empathy is crucial. Training programs are available and must be prioritized by medical institutions to address this culture-made crisis. When medical professionals aren't equipped with the tools and skills to meet the desperate person behind the wall of addiction, conversations are abruptly ended, and relationships are severed, often before the problem is named and a dedicated team is mobilized to help the individual.

True empathy does not mean continuing to write prescriptions. Empathy means asking questions and humanizing the patient, which can result in finding hope for a drug-free future by showing an alternative pathway to recovery. These alternatives will not immediately be desired or accepted by drug addicts. However, when there is a uniform message throughout the medical world that recovery is attainable by addressing the underlying anxiety, fear, and hopelessness that drug addicts face, there is hope for a new future.

Studies show that opioids are not always the best treatment for chronic pain.[3,4] Rather, for some patients, mind-body states achieved through a variety of practices such as meditation, breathing exercises, mindful living, self-empathy,[5] spiritual practices, and yoga are safer means of managing physical and psychic pain. Additionally, access to mental health services, group treatments, substance abuse services built on platforms of abstinence such as Alcoholics Anonymous and Narcotics Anonymous, and empathic and/or spiritual communities are essential for managing chronic states of pain and anxiety associated with drug abuse.

The new 2016 Centers for Disease Control and Prevention (CDC) guidelines emphasize use of nonopioid therapies, such as exercise and cognitive behavioral therapy, alone or in combination with nonopioid pharmacologic therapies for first-line management of chronic pain. Furthermore, when opioids are used, the CDC recommends combining them with nonpharmacologic or nonopioid pharmacologic therapies, such as anti-inflammatory agents. The CDC also recommends prescribing the lowest possible effective dose with immediate-release opioids rather than extended-release/long-acting opioids and providing only the quantity needed for the expected duration of pain. Regular monitoring and tapering and ultimate discontinuation of opioids are recommended.[6]

Additional tried and true remedies for pain reduction include ice and elevation of affected joints, physical therapy, acupuncture, spinal adjustments, and portable transcutaneous electro-nerve stimulator units, which use pads placed on the skin surrounding the painful area to provide stimulation and may alleviate some types of pain syndromes.[7]

In Massachusetts, the crisis has reached fever pitch. Last year, Governor Charlie Baker convened a task force to make recommendations on the crisis—and one of those must be empathy training for physicians dealing with drug-addicted patients. There is hope for patients and physicians when these vital skills are learned, and it is time to make this learning a national priority.

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