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Ask the Doc: Opioids

Ask-the-Doc-OpioidsWhile opioids have relieved pain for millennia, people can become addicted. Doctors grew wary and laws restricted their prescription which unfortunately left many in needless distress. Pharmaceutical companies leapt into this complex clinical dilemma offering a simplistic and wrong solution: they suggested long acting agents eg Oxycontin were lower in addictiveness and so were safer to prescribe.   Thanks to direct marketing to patients and primary care physicians Oxycontin became a blockbuster seller. It was immediately clear that it could cause a massive high and many became hopelessly addicted or overdosed. In some places, Oxycontin surpassed heroin as the drug of choice for those entering treatment. Similar drugs include vicodin, percocet, and methadone. The problem is that pain is not just about injury. Feelings, context, purpose and sense of control play important roles. Opioids are psychic as well as physical pain dullers: they make pain OK because endorphins mediate attention to what is important and relatedness. Interfering with this system can cause permanent changes to how we sooth, make attachments, and persevere instead of suffer.

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