http://www.nytimes.com/2002/01/22/health/anatomy/22BROD.html?ex=10131908 76&ei=1&enºa9c35fc871f0a9 .....(I was unable to access this article at this Url.)
Abundance of Misinformation
Far too little has been done to correct the misunderstandings of both patients and doctors that stand in the way of using opioids to control chronic pain. Nowadays, doctors are more inclined to use narcotics for pain relief in patients with advanced cancer, assuming erroneously that "since they're dying anyway, it won't matter if they become addicts." But the reluctance to use opioids for noncancer-pain patients persists, and patients are equally likely to resist taking them should they be prescribed.
"Like most doctors, most patients are relatively uninformed about the safety of using narcotics for pain, thinking they're dangerous drugs that will do bad things to them," Dr. Schneider explained. "They don't understand the difference between physical dependence and addiction, and as a result they're afraid they'll become addicts."
As Dr. Henry McQuay, a pain specialist at the University of Oxford in England, put it: "Opioids are our most powerful analgesics, but politics, prejudice and our continuing ignorance still impede optimum prescribing. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The medical use of opioids does not create drug addicts, and restrictions on this medical use hurt patients."
In three studies involving nearly 25,000 patients treated with opioids who had no history of drug abuse, only seven cases of addiction resulted from the treatment.
Dr. Schneider was distressed last month by a segment of "48 Hours" on CBS depicting a woman who had been taking the sustained-release opioid OxyContin. The woman said that although the drug had relieved her chronic pain, she stopped taking it because she feared becoming an addict. But instead of tapering off gradually, she quit cold turkey. As any pain expert would predict, she suffered withdrawal symptoms typical of physical dependence on a narcotic: aches all over, tearing eyes, runny nose, abdominal cramps and diarrhea.
Physical dependence, whether to an opioid or to an immune-suppressing drug like prednisone, involves reversible changes in body tissues. To avert withdrawal symptoms, the medication must be stopped gradually. Addiction is mainly a psychological and behavioral disorder.
Dr. Schneider described the hallmarks of addiction, whether to alcohol or narcotics, as loss of control over use, continuing use despite adverse consequences, and obsession or preoccupation with obtaining and using the substance.