Summer 2001 ~ Newsletter
Pain Management
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Are You at Risk for Addiction When Taking Pain Medicine just because you have CF?
by Sandra Frazier, MD
I am the medical director of the Addiction Recovery Program at UAB. My specialty is addiction medicine, so I treat alcoholics and addicts and also used to run an adolescent program. I have been doing this for approximately 10 years and have seen a few Cystic Fibrosis patients over the years.
People that have chronic pain obviously get focused on pain and many physicians have difficulty prescribing pain medicine adequately. In particular, in a pediatric population, doctors are very reluctant to prescribe pain medication. Therefore, many times people with chronic diseases or diseases that cause pain will be under-treated so they will tend to escalate their doses of medication because they still hurt. This in turn can result in a cycle of self-medicating and escalating their own dose causing them to run out of their prescriptions early. This cycle of inadequate pain treatment prompts patients to manage their own pain.
If you have a chronic disease then certainly substance abuse lowers your immunity, which could lead to an increased risk of pneumonia and infections even if you are not using a drug that you smoke.
The issue associated with addiction is people in the population who have a genetic predisposition to addiction. In other words, there is some family genetic predisposition history in becoming an alcoholic. This is why alcoholism can be labeled a disease. There is something different about the brain chemistry in someone predisposed to addiction.
Sometimes medications can trigger the brain cascade in that pathway. This may put patients at risk when they say, "Gosh, this feels good, I like this..." They may start taking the medication simply because it makes them feel good. So it is a complicated issue in that all of this is related under treatment of pain - it makes them feel good, it makes them feel normal, so it is always a risk situation.
Abusing substances certainly affects organ systems. They younger and healthier a patient is, the harder it is to determine the medical consequences. If you have a chronic disease then certainly chronic substance abuse lowers your immunity, which could mean an increased risk of pneumonia and infections even if you are not using a drug that you smoke. For general health, and overall health, substance abuse negatively affects a CF patient's health much more than a normal healthy teenager. Smoking cigarettes and smoking marijuana would be more damaging and chronic abuse of any substance will lower immunity. It also generally affects nutrional status because of appetite changes. If you are abusing a pain medicine in high doses, another side effect to be aware of is respiratory depression. Certainly, that affects the CF patient. If you abuse pain medicines, it can also cause constipation. This can be a horrible problem for a CF patient. So, as you can see, there are very specific ways that substance abuse negatively impacts a CF person's health status.
Pain is a serious issue and is growing within the Cystic Fibrosis population. Don't just assume that patients with CF will mention their pain if it is not severe. Be careful when you treat a CF patient with pain medicine, because there are so many other issues to consider. If they have taken drugs during their teenage years, they may be more prone to abuse pain medicine than if they have never taken medicines of this type previously.
I would be happy to answer any questions about addiction, or risky behavior, or provide the names of some adolescent counselors who may be valuable resources.
If I can be of service to anyone, or answer any questions, my office is located in the Birmingham, AL area. You can reach my office by calling (205) 975-7696.