Medically Induced Drug Addiction

Abstract

Iatrogenic, or medically induced, drug addiction is a problem affecting both patients and physicians. We describe the function of a new center devoted solely to managing iatrogenic addiction. The center accepts patients on physician referral only. The addiction usually arises as a complication of a medical disorder that is accompanied by pain and requires comprehensive and multidisciplinary evaluation and treatment. Detoxification from the offending medication, provision of chronic analgesia, and maintenance are managed with methadone. All appropriate modalities of treatment including psychotherapy, physical therapy, and relaxation techniques are employed.

A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy

“…The influence of opioid on escalation of adverse gastrointestinal symptoms has been recently reported. 5 Mercadante et al presented a prospective multicenter study, in which 22 patients who underwent NCPB were followed until death. NCPB was effective in reducing opioid consumption and gastrointestinal adverse effects for at least 4 weeks.…”

“…Although this approach should be applied in every case when no alternative is available, it should be mentioned that opiates present significant number of physical and psychological complications, including drowsiness, constipation, vomiting, deteriorated communication with family and depression. 4,5 In rare cases of longer survival, iatrogenic addiction can be observed, adding to the cachectic picture of the disease. 5 Thus, more invasive methods of pain control need to be considered in IPC patients, including neurolytic coeliac plexus block (NCPL) and videothoracoscopic splanchnicectomy (VSPL).…”

“…4,5 In rare cases of longer survival, iatrogenic addiction can be observed, adding to the cachectic picture of the disease. 5 Thus, more invasive methods of pain control need to be considered in IPC patients, including neurolytic coeliac plexus block (NCPL) and videothoracoscopic splanchnicectomy (VSPL). Both methods have been well evaluated and reportedly provide satisfactory long-term painrelief and decrease of the doses of opiates used.…”

Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review

“…An exemplar study reported that patients fell into three groups of pain types and locations (back pain, head pain and other) and a mean chronicity of pain of 8.6 years (SD 7.8) [ 92 ]. While most studies examined patients who had persistent pain despite continuous opioid use, some [ 47 , 52 , 56 , 57 , 69 , 73 , 76 , 93 , 103 , 112 ] attempted to examine specifically patients who had evidence of opioid use disorder in the context of chronic pain. Other terms used in the studies included opioid dependence, drug dependence/addiction, and narcotic addiction, but for the purposes of this paper we grouped these under opioid use disorder.…”

Neurolytic Sympathectomy in the Management of Cancer Pain—Time Effect: A Prospective, Randomized Multicenter Study

“…Also, iatrogenic addiction can be observed in patients with longer survival. 2,17 This study addresses an important issue about the best time to perform neurolytic plexus block to achieve effective control of abdominal or pelvic cancer pain. The authors postulated that sympathectomy before the Fig.…”