What ’s our goal with opioid treatment?

When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids but were unable to tolerate severe cravings in addition to withdrawal. Getting off opioids seemed impossible. Instead of being part of the solution, I felt like I was part of the problem. I wasn’t really helping these patients achieve a higher quality of life. Then I was introduced to Suboxone (buprenorphine/naloxone), and I thought perhaps this was something that showed promise, something I could wrap my arms around. Maybe we had finally discovered the “magic pill.” Now after twelve years of using buprenorphine and hundreds of patients later, I have made two significant observations. One of those observations is that although most patients vocalize a sincere desire to be completely free of opioids and stay that way, the sad reality is that most will not be successful. Many patients are unable to completely wean, yes, even from buprenorphine. For those who do wean, relapse rates are high. So although a complete weaning from opioids plus long-term abstinence is a worthy goal, it is not something most patients achieve. Gi...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Pain Management Primary Care Source Type: blogs