Narcotic Survey (1999)
As we near the end of 1999, I
find that after 10 years of experience
in treating chronic pain many doors have been
opened which call for further exploration. So far the Internet tends to
be a forum for what we know and how proud we are of our presence on the
Web. However, I find many unanswered
questions about personality or character, motivation, belief and love as well
as the more technical questions concerning chronic pain.
It should be kept in mind that 90% of our active patients(406) are taking a
narcotic as part of their pain program. Some of these have been in the program
for 8 years. But what is even more
striking is the number of patients who find it necessary to take an
antidepressant because of chronic pain. So the question in my mind is how are depression and pain
linked biochemically and psychologically?
What are the consequences of
long term narcotic use for chronic non malignant pain?
Those patients who have no
problem with development of tolerance to
narcotics over a decade of use defy our conventional wisdom. How are these people
different from those who develop a pain problem that moves toward higher and
higher dose of narcotic?
The fallout of our work with
chronic pain has yielded a treasure of
questions and a few answers about what happens to people with unrelieved
chronic pain over a long period of time. We, in psychiatry, have been taught to
see the personality as fixed and immutable. But our work suggests that
personality can become damaged and can be repaired. So the use of narcotics in a person with severe
personality damage is very different than in one whose personality is intact. Can we treat
patients with narcotics who have severe personality damage successfully? What
are the traps and pitfalls?
When our patients with severe
personality damage and depression talk over their issues, the power of the
group and the “12 Steps” is always first in their mind. How does group therapy work in chronic pain? Is there anything special about
the Steps?
Since we have entered the
fray of the Internet it has been puzzling to find that there are extreme groups
concerning narcotics who see the problems as oppression by regulatory agencies.
Is the Internet
simply a way of illustrating extremes with poor resolution of the broad
middleground of knowledge? Can the
Internet evolve as a research tool?
We have in our midst several
problems of mishandling of narcotics by some of our patients. In most instances
the medication is obtained from more that one physician during the same time
period or medication is lost or stolen but in cloudy circumstance. We gave a
questionnaire to 111 of our chronic pain patients concerning handling of
narcotics. We asked 10 questions (yes or
no) and below we have listed the questions and a graphic of how the answers
fell out. We are exploring an area which might be best termed “shared
responsibility” keeping in mind that it is totally alien to a
current legal system. How can we investigate and illustrate shared
responsibility?
The 10 questionnaire as
follows. The N= 111. After the questions there is a graph which illustrates the
scoring by the patients.
1.
Do you think there is a serious medication problem
going on at Springer Group?
2.
Do you feel a responsibility about policing the
problem?
3.
Do you believe that issues of narcotic mishandling
should be brought up in Group frequently?
4.
Do you believe that we should confront each other in
group session about narcotic mishandling?
5.
Do you believe that patients should be terminated from
the program for narcotic mishandling?
6.
Do you believe that we need “hard evidence” to
determine if narcotic mishandling has occurred?
7.
Do you believe
that if your medication is stopped suddenly you will have serious medical
problems?
8.
Do you believe that failure to comply with the Program
should be spelled out in exacting detail before any action is taken?
9.
Do you believe that all patients should sign a
contract which specifies what will happen if there are breaches in the handling
of narcotic medication?
10.
Do you believe that this Program has become
too large to manage?
Our 111 patients scored the
following table which is represented by the graph. It appears from the results
that the majority favor;
1
discussion of narcotics in group,
2
confrontation in group,
3 favor a contract in detail,
4
But most importantly have a 50/50 split on whether someone should be terminated
from the program. Those most vocal against termination said that a second
chance would save a lot of people because it saved them. It is noteworthy that
only 18 thought the program was too large!
|
|
Questionnaire results
|
|
|
|
no
|
yes
|
|
1
|
70
|
41
|
|
2
|
21
|
74
|
|
3
|
25
|
88
|
|
4
|
36
|
88
|
|
5
|
57
|
53
|
|
6
|
39
|
77
|
|
7
|
29
|
87
|
|
8
|
32
|
78
|
|
9
|
31
|
83
|
|
10
|
91
|
18
|
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