the problem with addiction to illegal narcotics is it lowers the quality of life of the user because they're constantly chasing their fix. it's a cycle. when you're organized with your appointments and getting your meds dispensed from a good physician, you won't have that problem. so you using prescribed opioids has no impact on your quality of life or any harmful cause to society. that's roughly how we measure addiction.
Sums up greatly what I think of this matter. Even in the US a medically supervised addiction to legally prescribed opioids is now considered acceptable harm reduction practice by many pain management specialists such as neurologists and anesthesiologists Not only does it deal with the pain but it avoids legal repercussions of chasing illegal drugs to treat a legit pain condition. The policies here in the US are still a far cry from Canada's approach to the matter but we're steadily gaining reasonable ground by removing the idea that any addiction is negative by definition. Restricting properly managed prescription of strong painkillers to hospice care is misguided, imho, because members of society that could lead productive lives if only their chronic pain could be alleviated with prescription opioids of sufficient potency are denied it based on pseudoscientific assumptions and moralistic holier-than-thou attitudes that have no place in proper pain management. One step forward would be an AMA's restriction that so-called "pain specialists" actually be that instead of self-appointed GP's.
Few neuros and anesthesiologists would risk losing their reputation and lucrative practice by doling out pain meds to random walk-ins, patients would need a referral stating their conditions and symptoms in detail before they could see the "real-deal" specialist for a thorough evaluation. That being said what frustrates me here in the US when compared with Canada (I share my time between both countries, I have dual citizenship by birth) is that HMO's will likely oppose this, or demand restrictive admission criteria because specialists charge more than fly-by-nite GP pill dispensers. So initially only those with independent health insurance and the wealthy can afford such a program, but at least it will demonstrate that managed addiction is not evil, by increasing quality of life and productivity in individuals who would otherwise drain resources from HMO's and state programs, or get into legal trouble. Ideally the FDA should require future DEA agents take a new course called "the legal and medical benefits of no-nonsense protocols in the treatment of chronic pain up to and including managed addiction". Addiction is only a problem when it requires obtaining substances from illicit sources, patients who obtain strong opiates from their doctor for legitimate chronic pain conditions don't end up in court, in fact they act normal being free of pain at last.
One real-life example of humane pain management. My Canadian grandmother took Dilaudid for almost a decade to treat a bone disease and I have never seen her acting "stoned" while on it despite doses that would have rendered me unconscious way beyond nodding. She was addicted evidently but as long as she had the med she was always her old self, busy as a bee doing paperwork in her home office and helping with the housekeeping, up until about a year before her passing at age 91. For that final year she was very weak and couldn't get out of bed. Her meds were switched to injectable Dilaudid and morphine which she administered herself using a "morphine pump" installed by an anesthesiologist and refilled every second day by a visiting practitioner nurse. "Grammy" usually stuck to Dilaudid during the day because she wanted to stay awake and interact with people, while morphine lulled her to sleep after diner. Once I bluntly asked about her pain level and she said "for a dying person, a lot less than I was expecting m'dear but it itches like a sonofabitch". Floored me. Grammy was an educated proper lady, a retired lawyer who would never use expletives so I called the nurse about the itch and she suggested Benadryl but I requested hydroxyzine (less side effects) instead and she phoned a script to a nearby pharmacy for it. Quick service, and it did do a lot of good.
Uncle asked me to dispose of leftover drugs which I did in the matter that you imagine. Never claimed to be an angel and didn't see why perfectly good opiates should be destroyed by taking them back to a pharmacy. Apart from the Fentanyl and morphine ampules there were leftover Dilaudid 4mg and 8mg tablets, almost 300 of them accumulated over 7 years because Grammy often skipped a dose when she was feeling ok but always refilled every month and stacked the leftovers from the previous month on a cupboard. This was to one and only time I developed a minor addiction to opiates, which I usually avoid due to nausea. Withdrawals lasted about 5 days alleviated with generous doses of temazepam.
I wasn't there during Grammy's final 2 months but was told by an uncle that they had switched her morphine for diacetylmorphine according to what he had read on the box containing refills. Heroin then, restricted to hospice care in Canada (Health Canada Schedule I, Restricted) but not yet legal here I believe. However what I saw when we cleared her room after the funeral was an unopened box containing refills of a Fentanyl solution not diamorphine even though uncle said there was some left somewhere. Never found it but maybe medical staff took it, don't know why uncle would have lied about it he knows nothing of drugs. Whether heroin or Fentanyl Grammy used it almost exclusively at first but as the end neared she was too weak to use the injecting device herself so my uncle and visiting medical staff used a standard maintenance dose until she peacefully passed away in her sleep, nurse at her side because they knew the end was near and did not want her to die alone, but my uncle was the only family member living locally and he couldn't sit there 24/7. Uncle says both him and dozing nurse were awoken when the heart monitor beeped a flatline. Grammy had been very clear about the "no revival" policy so nothing was attempted.
I can only imagine what her last years would have been if she had lived here and DEA-weary docs would have denied her the Dilaudid she needed to function normally, instead giving weaker PK's like hydrocodone and waiting until hospice care was required to finally provide sufficient relief. I think that would have caused her to lose a few years to constant pain gnawing at her. Quite frustrating that many irrelevant factors are still impeding this sort of approach. Oh well the logics of this country still evade the vast majority of us but yet we survive. In pain but alive, has a nice ring to it.
