It's not the morphine, it's the size of the cage: Rat Park experiment upturns conventional wisdom about addiction

It's not the morphine, it's the size of the cage: Rat Park experiment upturns conventional wisdom about addiction

http://bit.ly/1aUzVKW

The government (especially DARE) lied to us. Just like they did with cannabis. Does anyone remember the study that "proved" that cannabis kills brain cells? The one where they suffocated monkeys with smoke over and over again, then dissected their brains and pointed to the suffocation damage and said that cannabis kills brain cells, even though it actually heals the brain.

We really can't trust our government to study anything (CFIDS, cannabis, opioids, the majority of drugs approved by the FDA in the past decade).

Steve
IntractablePainKills@gmail.com

RSO/cannabis & other cancer cures

Cancer is worth more than our lives. Cannabis both prevents and treats cancer, including the most deadly childhood cancer, DIPA/DIPG

Essex tea is another potential treatment that got shut down.

Severe Flare

I want to amputate my legs right now. The pain is unbelievable. Nothing is helping. I'd give anything for relief. I'd give wanting to have an unravel pump, Actiq/OTFC/Fentora/Onsolis/Subsys/Lazanda/Abstral, and/or methadone (in addition to the Duragesic).

It is despicable that we must suffer when there are drugs and treatments that could help us, especially when we can pay for them.

It's hard to believe that we went from opioids being OTC (over the counter), to CII, and now to practically unattainable.

Steve

OT- Today in History

I know that this board it's supposed to be about pain, but I'm in too much pain to give the high quality posts that I'd prefer and we can all use some distraction.

Today is Friday, Sept. 13, the 256th day of 2013. There are 109 days left in the year. The Jewish Day of Atonement, Yom Kippur, begins at sunset.

Today's Highlight in History:

On September 13, 1788, the Congress of the Confederation authorized the first national election, and declared New York City the temporary national capital.

On this date:

In 1759, during the final French and Indian War, the British defeated the French on the Plains of Abraham overlooking Quebec City.

In 1803, Commodore John Barry, considered by many the father of the American Navy, died in Philadelphia.

In 1912, a state funeral was held in Japan for Emperor Meiji.

In 1948, Republican Margaret Chase Smith of Maine was elected to the U.S. Senate; she became the first woman to serve in both houses of Congress.

In 1959, Elvis Presley first met his future wife, 14-year-old Priscilla Beaulieu, while stationed in West Germany with the U.S. Army. (They married in 1967, but divorced in 1973.)

In 1962, Mississippi Gov. Ross Barnett rejected the U.S. Supreme Court's order for the University of Mississippi to admit James Meredith, a black student, declaring in a televised address, "We will not drink from the cup of genocide."

In 1970, the first New York City Marathon was held; winner Gary Muhrcke finished the 26.2-mile run, which took place entirely inside Central Park, in 2:31:38.

In 1971, a four-day inmates' rebellion at the Attica Correctional Facility in western New York ended as police and guards stormed the prison; the ordeal and final assault claimed the lives of 32 inmates and 11 employees.

In 1989, Fay Vincent was elected commissioner of Major League Baseball, succeeding the late A. Bartlett Giamatti (juh-MAH'-tee).

In 1993, at the White House, Israeli Prime Minister Yitzhak Rabin and PLO chairman Yasser Arafat shook hands after signing an accord granting limited Palestinian autonomy. "Late Night with Conan O'Brien" premiered on NBC.

In 1996, rapper Tupac Shakur died at a Las Vegas hospital six days after he was wounded in a drive-by shooting; he was 25.

In 1998, former Alabama Gov. George C. Wallace died in Montgomery at age 79.

Ten years ago: Angry mourners swarmed Fallujah (fuh-LOO'-juh), Iraq, a day after eight Iraqi police were killed in a friendly fire incident involving U.S. troops; the U.S. military apologized for the deaths. The California Democratic Party voted to endorse Lt. Gov. Cruz Bustamante (boost-ah-MAHN'-tay) while continuing to support Gov. Gray Davis in the October 7 recall election. Indiana Gov. Frank O'Bannon died at age 73. In Las Vegas, Sugar Shane Mosley beat Oscar De La Hoya, winning a close but unanimous decision to take the WBC and WBA 154-pound titles.

Five years ago: Rescue crews ventured out to pluck people from their homes in an all-out search for thousands of Texans who had stubbornly stayed behind overnight to face Hurricane Ike. After wild conjecture over who would play Alaska Gov. Sarah Palin on "Saturday Night Live," writer-performer Tina Fey returned to her old show for an opening sketch featuring her and Fey's former "Weekend Update" co-host Amy Poehler as Sen. Hillary Clinton.

One year ago: Chanting "death to America," hundreds of protesters angered by an anti-Islam film stormed the U.S. Embassy compound in Yemen's capital and burned the American flag. New York City's Board of Health passed a ban on the sale of big sodas and other sugary drinks, limiting the size sold at restaurants, concession stands and other eateries to 16 ounces.

Today's Birthdays: Actress Barbara Bain is 82. Actress Eileen Fulton ("As the World Turns") is 80. TV producer Fred Silverman is 76. Former White House spokesman Larry Speakes is 74. Actor Richard Kiel is 74. Rock singer David Clayton-Thomas (Blood, Sweat & Tears) is 72. Actress Jacqueline Bisset is 69. Singer Peter Cetera is 69. Actress Christine Estabrook is 63. Actress Jean Smart is 62. Singer Randy Jones (The Village People) is 61. Record producer Don Was is 61. Actor Isiah Whitlock Jr. is 59. Actress-comedian Geri Jewell is 57. Country singer Bobbie Cryner is 52. Rock singer-musician Dave Mustaine (Megadeth) is 52. Radio-TV personality Tavis Smiley is 49. Rock musician Zak Starkey is 48. Actor Louis Mandylor is 47. Olympic gold medal runner Michael Johnson is 46. Rock musician Steve Perkins is 46. Actor Roger Howarth is 45. Actor Dominic Fumusa is 44. Actress Louise Lombard is 43. Tennis player Goran Ivanisevic (ee-van-EE'-seh-vihch) is 42. Country singer Aaron Benward (Blue County) is 40. Country musician Joe Don Rooney (Rascal Flatts) is 38. Actor Scott Vickaryous is 38. Singer Fiona Apple is 36. Contemporary Christian musician Hector Cervantes (Casting Crowns) is 33. MLB pitcher Daisuke Matsuzaka is 33. Actor Ben Savage is 33. Rock singer Niall Horan (One Direction) is 20. Actor Mitch Holleman ("Reba") is 18.

Thought for Today: "Better to be without logic than without feeling." — Charlotte Bronte (BRAWN'-tee), English author (1816-1855).

Yesterday in History

Yesterday was Thursday, Sept. 12, the 255th day of 2013. There were 110 days left in the year.

Yesterday's Highlight in History:

On September 12, 1943, during World War II, German paratroopers took Benito Mussolini from the hotel where he was being held by the Italian government.

On this date:

In 1846, Elizabeth Barrett secretly married Robert Browning at St. Marylebone Church in London.

In 1888, entertainer Maurice Chevalier was born in Paris.

In 1913, Olympic legend Jesse Owens was born in Oakville, Ala.

In 1938, Adolf Hitler demanded the right of self-determination for the Sudeten (soo-DAYT'-un) Germans in Czechoslovakia.

In 1942, during World War II, a German U-boat off West Africa torpedoed the RMS Laconia, which was carrying Italian prisoners of war, British soldiers and civilians.

In 1953, Massachusetts Sen. John F. Kennedy married Jacqueline Lee Bouvier (boo-vee-AY') in Newport, R.I.

In 1960, Democratic presidential candidate John F. Kennedy addressed questions about his Roman Catholic faith, telling a Southern Baptist group, "I do not speak for my church on public matters, and the church does not speak for me."

In 1962, in a speech at Rice University in Houston, President John F. Kennedy reaffirmed his support for the manned space program, declaring: "We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard."

In 1963, "The Spy Who Came in from the Cold," a novel by John le Carre, went on sale in Britain.

In 1977, South African black student leader Steve Biko (BEE'-koh) died while in police custody, triggering an international outcry.

In 1986, Joseph Cicippio (sih-SIHP'-ee-oh), the acting comptroller at the American University in Beirut, was kidnapped (he was released in December 1991).

In 1992, the space shuttle Endeavour blasted off, carrying with it Mark Lee and Jan Davis, the first married couple in space; Mae Jemison, the first black woman in space; and Mamoru Mohri, the first Japanese national to fly on a U.S. spaceship.

Ten years ago: In the Iraqi city of Fallujah, U.S. forces mistakenly opened fire on vehicles carrying police, killing eight of them. The U.N. Security Council ended 11 years of sanctions against Libya. Typhoon Maemi (may-mee) slammed into South Korea, killing at least 117 people. Music legend Johnny Cash died in Nashville, Tenn., at age 71.

Five years ago: A Metrolink commuter train struck a freight train head-on in Los Angeles, killing 25 people. (Federal investigators said the Metrolink engineer, Robert Sanchez, who was among those who died, had been text-messaging on his cell phone and ran a red light shortly before the crash.) Hurricane Ike began battering the Texas coast. Grand Ole Opry star Charlie Walker died in Hendersonville, Tenn. at age 81.

One year ago: The U.S. dispatched an elite group of Marines to Tripoli. Libya, after the mob attack that killed the U.S. ambassador and three other Americans. President Barack Obama strongly condemned the violence, and vowed to bring the killers to justice; Republican challenger Mitt Romney accused the administration of showing weakness in the face of tumultuous events in the Middle East.

Today's Birthdays: Actor Dickie Moore ("Our Gang") is 88. Actor Freddie Jones is 86. Actor Ian Holm is 82. Actress Linda Gray is 73. Singer Maria Muldaur is 71. Actor Joe Pantoliano is 62. Singer-musician Gerry Beckley (America) is 61. Original MTV VJ Nina Blackwood is 61. Rock musician Neil Peart (Rush) is 61. Actor Peter Scolari is 58. Kansas Gov. Sam Brownback is 57. Actress Rachel Ward is 56. Actress Amy Yasbeck is 51. Rock musician Norwood Fisher (Fishbone) is 48. Actor Darren E. Burrows is 47. Rock singer-musician Ben Folds (Ben Folds Five) is 47. Actor-comedian Louis (loo-ee) C.K. is 46. Rock musician Larry LaLonde (Primus) is 45. Actor Josh Hopkins is 43. Actor Paul Walker is 40. Country singer Jennifer Nettles (Sugarland) is 39. Actor Ben McKenzie is 35. Singer Ruben Studdard is 35. Basketball player Yao Ming is 33. Singer-actress Jennifer Hudson is 32. Actress Emmy Rossum is 27. Actor Colin Ford is 17.

Thought for Today: "Find the good. It's all around you. Find it, showcase it and you'll start believing it." — Jesse Owens (1913-1980).

Update: Neurosurgeon

WARNING: NEGATIVE POST

After an hour waiting, I spent another 20 minutes listening to a neurosurgeon tell me that the tumor that's doubled in size over the past year could not possibly be causing my
Back pain
Neck pain
Leg pain
Headaches
Dizziness
Nausea
Vomiting
Wasting
Difficult swallowing
Vision problems
Loss of dexterity
...and every other symptom that every other doctor has attributed to the tumor.

He ignored all of my concerns and when I tried to explain how defeated I feel, he indirectly threatened me with involuntary committal.

Not wanting to fight cancer is not the same as suicidality.

I explained that I didn't want another fifty years of constant agonizing pain and all he had to say was that the tumor is likely an incidental finding. Even if the tumor is not the cause of the pain, the pain still plagues my life.

Have I contemplated suicide, absolutely! Would I go through with it and put my family through that, HELL NO! We have the right to abstain from treatment and wanting to die without a fight and that does not make us suicidal. Radiation and chemotherapy are pain inducing poisons.

Since chemotherapy kills more people than it saves, what's so crazy about wanting to die gracefully?

If they aren't going to treat the pain, why should I fight the cancer? I'll take my handful of semi-decent years, thank you. I have no interest in years of fighting a cancer that will eventually kill me. Even if they eliminate the cancer, the treatments will cause memory and other neurological deficits, unrelenting pain, CIN (chemotherapy induced neuropathic) and only God knows what else.

I'll stick with my nontoxic alternative treatments that allow mt daughter to have a father, not an unrecognizable chemotherapeutic husk.

How can they expect me to fight when my pain is so severely undertreated?

Steve, age 23
DIPG (inoperable brainstem glioma (cancer))
Intractable Pain

On the lighter side

Patriot Day

I want to take a moment to thank all of those rescue workers who selflessly risked their lives to save their fellow Americans. I especially want to thank those rescue workers who fled to NYC to save lives and where left without medical care.

While my blog is generally dedicated to chronic pain patients as a whole, but today I'd like to remind everyone that many of our heroes (from 9/11, the War in Afghanistan, and the War in Iraq) are needlessly suffering because the VA is instituting no opioids policies at many of their hospitals and even the few who can afford private practice physicians are finding that doctors who prescribe opioids are harder and harder find.

My best friend is an ex-cop, "ex" Marine who is without pain management after an IED took his eyes and left him with shrapnel around his spine. Without notice, his doctors dropped him and left him without pain relief, which has resulted in countless emergency room visits, intensive care admissions, and hospital visits. He's had organs shut down from untreated IP. And I know he's not the only one. If we can't give our heroes relief, what chance do the rest of us stand?

Steve

OT- Today in History

Today is Tuesday, Sept. 10, the 253rd day of 2013. There are 112 days left in the year.

Today's Highlight in History:

On September 10, 1813, an American naval force commanded by Oliver H. Perry defeated the British in the Battle of Lake Erie during the War of 1812. (Afterward, Perry sent out the message, "We have met the enemy and they are ours.")

On this date:

In 1608, John Smith was elected president of the Jamestown colony council in Virginia.

In 1846, Elias Howe received a patent for his sewing machine.

In 1912, the jungle character Tarzan made his debut as "Tarzan of the Apes" by Edgar Rice Burroughs was first published in The All-Story magazine.

In 1919, New York City welcomed home Gen. John J. Pershing and 25,000 soldiers who'd served in the U.S. First Division during World War I.

In 1939, Canada declared war on Germany.

In 1945, Vidkun Quisling was sentenced to death in Norway for collaborating with the Nazis (he was executed by firing squad in October 1945).

In 1962, the U.S. Supreme Court ordered the University of Mississippi to admit James Meredith, a black student.

In 1963, twenty black students entered Alabama public schools following a standoff between federal authorities and Gov. George C. Wallace.

In 1979, four Puerto Rican nationalists imprisoned for a 1954 attack on the U.S. House of Representatives and a 1950 attempt on the life of President Harry S. Truman were freed from prison after being granted clemency by President Jimmy Carter.

In 1983, John Vorster (FAWS'-tur), prime minister of white-ruled South Africa from 1966 to 1978, died in Cape Town at age 67.

In 1987, Pope John Paul II arrived in Miami, where he was welcomed by President and Mrs. Reagan as he began a 10-day tour of the United States.

In 1993, "The X-Files" premiered on Fox Television.

Ten years ago: Swedish Foreign Minister Anna Lindh, 46, was stabbed in a Stockholm department store; she died the next day. (Mijailo Mijailovic (mee-EYE'-loh mee-EYE'-luh-vich) was later convicted of murdering Lindh and was sentenced to life in prison.) The first video image of Osama bin Laden in nearly two years was broadcast on Al-Jazeera TV. Israel bombed the home of a Hamas leader, killing his eldest son and a bodyguard in retaliation for two suicide bombings.

Five years ago: The world's largest particle collider passed its first major tests by firing two beams of protons in opposite directions around a 17-mile (27-kilometer) ring under the Franco-Swiss border. Frank Mundus, the legendary shark fisherman said to have inspired the character of Quint in "Jaws," died in Honolulu at age 82.

One year ago: An airstrike killed al-Qaida's No. 2 leader in Yemen along with six others traveling with him in a breakthrough for U.S.-backed efforts to cripple the terror network's operations in the impoverished Arab nation. Chicago teachers walked off the job in what would become a seven-day strike, idling nearly 400,000 students in one of the nation's third-largest school district. Andy Murray became the first British man since 1936 to capture a Grand Slam title, beating defending champion Novak Djokovic, 7-6, 7-5, 2-6, 3-6, 6-2 to win the U.S. Open in five grueling sets.

Today's Birthdays: World Golf Hall of Famer Arnold Palmer is 84. Actor Philip Baker Hall is 82. Actor Greg Mullavey is 80. Country singer Tommy Overstreet is 76. Jazz vibraphonist Roy Ayers is 73. Singer Danny Hutton (Three Dog Night) is 71. Singer Jose Feliciano is 68. Actor Tom Ligon is 68. Actress Judy Geeson is 65. Former Canadian first lady Margaret Trudeau is 65. Political commentator Bill O'Reilly is 64. Rock musician Joe Perry (Aerosmith) is 63. Actress Amy Irving is 60. Country singer Rosie Flores is 57. Actress Kate Burton is 56. Movie director Chris Columbus is 55. Actor Colin Firth is 53. Rock singer-musician David Lowery (Cracker) is 53. Actor Sean O'Bryan is 50. Actor Raymond Cruz is 49. Retired MLB All-Star pitcher Randy Johnson is 50. Rock musician Robin Goodridge (Bush) is 48. Rock musician Stevie D. (Buckcherry) is 47. Rock singer-musician Miles Zuniga (Fastball) is 47. Actress Nina Repeta (NY'-nuh ruh-PEHT'-ah) is 46. Rapper Big Daddy Kane is 45. Movie director Guy Ritchie is 45. Contemporary Christian singer Sara Groves is 41. Actor Ryan Phillippe (FIHL'-ih-pee) is 39. Actor Kyle Bornheimer is 38. Rock musician Mikey Way (My Chemical Romance) is 33. Olympic bronze medal figure skater Timothy Goebel is 33. Rock musician Matthew Followill (Kings of Leon) is 29. Singer Ashley Monroe (Pistol Annies) is 27. Singer Sanjaya Malakar ("American Idol") is 24. Actor Chandler Massie is 23. Actress Hannah Hodson is 22.

Thought for Today: "History is the great dust-heap ... a pageant and not a philosophy." — Augustine Birrell, English author and statesman (1850-1933).

Update

As you might have noticed, I've given up on Adsense approving my application, so I've been piecing together some affiliate programs to create some revenue. I'd really like to expand this beyond the basic, everyday CP/IP blog and that takes capital, capital that I don't have.

If anyone finds the monetization intrusive or bothersome, please feel encouraged to send me feedback. This site is about helping other CP/IP suffers get through one day at a time, not money and while I believe that some revenue will allow me to help more people, I do not want the monetization to hinder my primary goal.

Today is another one of those days where the pain feels never-ending and I'm just doing my best to get through.

Please check back often and don't forget send feedback.

I'm very interested in articles that benefit CP/IP patients, family, friends, doctors, loved ones, and caregivers.

If anyone wants to share their story, including treatments tried, failed, and current, I'd love to give you your own page on my blog. Please consider including a picture of you, or a picture that represents you.

Steve
IntractablePainKills@gmail.com
http://bit.ly/IPkills

Amazon Prime

If anyone is interested, Amazon is offering Amazon Prime, including the VoD (Video on Demand, streaming) service free for 30 days.  It's a great resource while you're writhing in pain and need a good distraction.

http://amzn.to/1b22tBr

http://www.amazon.com/gp/video/primesignup?tag=ipki-20

If you're like me and forget to cancel free trials, you'll love this, Amazon allows you to (after signing up) go into settings, then Prime settings and tell it not to automatically renew. I highly recommend it. After all, you can always change it later or restart Prime later.

By using this link, Amazon will donate $2 to my blog (you have to sign up for the 30 day free trial of Prime, but you don't have to spend a penny), which will go towards improvements and everything remaining will be donated to various chronic pain charities.

Steve
IntractablePainKills@gmail.com
http://bit.ly/IPkills

Anytime you plan on making a purchase with Amazon, please use the link below.
http://amzn.to/13I04Hs

Cannabis

Cannabis is a miracle drug. It cures cancer, it reverses damage from and/or treats:
Cancer
Chemotherapy
Radiation
Multiple sclerosis
Alzheimer disease
Dementia
Pain
Neuropathy
ADHD
Asperger syndrome

You get the idea right?

Unfortunately, far too many pain patients must make the choice between cannabis and opioids. Even in states where medicinal and recreational cannabis is legal, patients are dismissed for having a positive urinalysis result for cannabis.

THC and CBD actually fight cancer cells. In DIPA/DIPG, the most deadly childhood cancer, they cause tumor cells to commit suicide and eat themselves. They can stretch out a six month prognosis into eight or more healthy years and, in rare cases, cannabis can be curative.

The federal government would have is believe that Marinol/dronabinol is a good alternative to herbal cannabis, but that's a bald-faced lie. Marinol is good for having a plausible reason for positioned urinalysis and to get way too high. Marinol only contains THC, no CBD and none of the other useful cannabinoids.

Even generic dronabinol is extremely expensive because it is synthetic THC created in a lab. The THC is suspended in deranged oil and encapsulated in gelatin. The oral route of absorption makes it extremely unpredictable.

Hopefully, Sativex will be approved soon because it actually contains two strains of cannabis, giving a roughly equal ratio of THC and CBD.

If our government approved Marinol (CIII), why are cannabis sativa and cannabis indica still CI?

Controlled Substance Summary
CI- high potential for abuse, no medical use, can't be prescribed (LSD, cannabis
CII- high potential for abuse (cocaine, codeine, methadone, morphine, fentanyl/Sublimaze/Duragesic/Actiq/OTFC/Fentora/Onsolis/Subsys/Lazanda/Abstral, alfentanil/Alfenta/Rapifen, remifentanil, sufentanil/Sufenta, oxymorphone/Opana, hydrocodone/Norco/Vicodin, hydromorphone/Dilaudid/Exalgo, oxycodone/OxyContin/OxyIR/Roxicodone, methamphetamine, amphetamines/Adderall, methylphenidate/Ritalin/Concerta)
CIII-moderate potential for abuse (Vicodin, Marinol/dronabinol)
CIV- low potential for abuse (alprazolam/Xanax, lorazepam/Ativan, diazepam/Valium
CV- codeine cough syrup, pseudoephedrine/Sudafed, Lyrica/pregabalin

Bad Days

I've been having bad days for almost a month straight. Opioid pain medications are great, when they're dosed properly, but when the DEA has doctors too afraid to prescribe adequate doses, patients suffer.

As I continue to suffer through a flare without the Actiq/OTFC (or Fentora, Onsolis, Subsys, Lazanda, or Abstral), I can comprehend why some people resort to street drugs. I, myself, am allergic to morphine, which is the major active metabolite of diacetylmorphine. I'm lucky in a sense because my allergy to morphine protects me from any temptation that might arise on days like this when my pain is unbearable.

No one should get their medication from the streets, whether it be heroin/diacetylmorphine/diamorphine, morphine, oxymorphone/Opana, oxycodone/OxyContin/OxyIR/Roxicodone, hydromorphone/Dilaudid/Exalgo, hydrocodone/Norco/Vicodin, codeine, methadone, fentanyl/Sublimaze/Duragesuc, sufentanil/Sufenta, alfentanil/Alfenta/Rapifen, or any other opioid. Medications should be taken EXACTLY as prescribed by your doctor.

Now that my public service announcement is complete, I'm going to take my full dose of lorazepam and tizanidine and pray for some asleep.

Some non-opioid pain relief options (depending on your pain type) include:
* Ice/cold packs
* Heating pads
* benzodiazepines (if prescribed)
* muscle relaxers
* Ibuprofen/Advil/Motrin
* hot shower or bath
* massage
* meditation
* distraction (TV, movies, etcetera)
* comedy (endorphins)
* sex/orgasm (endorphins)

-Steve

Remember that you can share my blog on chronic, intractable pain at
http://bit.ly/IPkills

I'm always open to comments and suggestions:
IntractablePainKills@gmail.com

Tolerance, physical dependence and addiction: Definitions, clinical relevance and misconceptions

Tolerance, physical dependence and addiction:
Definitions, clinical relevance and misconceptions

Health care professionals, patients and families have exaggerated concerns about opioids and their potential side effects, in particular tolerance, physical dependence and addiction. Therefore it is critically important to understand the meaning of these terms and their clinical relevance to the management of cancer pain.

TOLERANCE

Definition:
Tolerance is a physiological state characterized by a decrease in the effects of a drug (e.g., analgesia, nausea or sedation) with chronic administration.

Clinical relevance:
It is important to distinguish between tolerance to analgesia and tolerance to side effects.

(1) Tolerance to analgesia.
Patients with unchanging pain can have a consistent level of pain relief from the same dose of opioids over time. The need for higher doses of opioids is typically due to worsening pain and disease progression, rather than tolerance. If analgesic tolerance does develop, increase the dose until side effects are not tolerated.

(2) Tolerance to opioid side effects.
Tolerance usually develops to many of the side effects of opioids (sedation, nausea, itch) in a few days. Tolerance almost never develops to constipation. Constipation should always be anticipated and treated. If a patient does not tolerate the side effects of one opioid, another opioid should be tried.

Misconceptions:
To some, the need to increase the dose in response to the patient's report of pain is misinterpreted as a sign that tolerance may be developing. Unfortunately, this sometimes leads the physician to reduce the dose in a mistaken attempt to avoid or delay the development of tolerance. The appropriate response is to reassess the pain and increase the dose as indicated to relieve pain.

Sometimes, to prevent the development of analgesic tolerance, opioids are administered at intervals which are too far apart to maintain continuous pain relief. This practice is inappropriate because it subjects patients to needless cycles of pain and pain relief.

Often, health care professionals and patients are concerned about using opioids from the 3rd step of the WHO ladder, such as morphine, because of the mistaken belief that the medication will lose its analgesic effect; they want to save it until the pain is really severe. This concern about analgesic tolerance is unfounded and can lead to inadequate pain management.

Some health care workers and patients believe that using morphine for pain relief will suppress respiration and possibly cause death. In fact, clinically significant respiratory depression and sedation are very rare in cancer patients. This is because tolerance to the sedative effects of morphine develop rapidly, and because pain reverses morphine's depressant effects.

PHYSICAL DEPENDENCE

Definition:
Physical dependence is the physiological adaptation of the body to the presence of an opioid. It is defined by the development of withdrawal symptoms when opioids are discontinued, when the dose is reduced abruptly or when an antagonist (e.g., naloxone) or an agonist-antagonist (e.g., pentazocine) is administered.

Clinical relevance
Physical dependence is a normal and expected response to continuous opioid therapy. Physical dependence may occur within a few days of dosing with opioids, although it varies among patients. Physical dependence (indicated by withdrawal symptoms) does not mean that the patient is addicted.

Health care workers should advise patients to take their pain medication as directed, and that withdrawal symptoms may occur if they reduce their dose or stop taking the medication. Symptoms of withdrawal may include agitation, insomnia, diarrhea, sweating, and rapid heart beat. If the source of pain is successfully treated or removed, physical dependence is easily treated by gradually decreasing the opioid dose, e.g., reducing the daily dose by 10 to 25 percent every 2 days. When a daily dose of 10-15 mg of parenteral morphine (or its equivalent) is reached, maintain that dose for 2 days, then discontinue.

The development of physical dependence should not limit analgesic therapy. Antagonists and agonist-antagonists in the patient who is physically dependent should be strictly avoided because their use will neutralize the analgesic effect and cause a withdrawal syndrome.

Misconceptions:
Physical dependence is frequently equated mistakenly with addiction. It is incorrect to use the term 'physical dependence' (a physiological state) to describe addiction (a dysfunctional psychological and behavioral syndrome).

Patients who express concern about physical dependence should be given correct information and reassured. Example: "Do not to stop taking your medication abruptly or you will have symptoms of withdrawal. If you no longer need opioids for pain relief (for example after a course of radiotherapy), your physician can gradually decrease your dose over several days."

ADDICTION

Definition:
While tolerance and physical dependence are physical changes in the body, addiction is defined by aberrant changes in behavior. Addiction is compulsive use of drugs for nonmedical reasons; it is characterized by a craving for mood altering drug effects, not pain relief. Addiction means dysfunctional behavior, in sharp contrast to the improved function and quality of life that result from pain relief. Aberrant behaviors which indicate addiction may include: denial of drug use; lying; forgery of prescriptions; theft of drugs from other patients or family members; selling and buying drugs on the street; using prescribed drugs to get "high."

Clinical relevance:
Addiction is extremely rare in cancer patients who use opioids for pain (see abstracts). Biochemical, social and psychological factors are more important in the development of addiction. Opioids should not be withheld for fear that a patient will become addicted. If a pain patient requests a strong analgesic, it is likely that the patient has inadequate pain control.

Misconceptions:
People who fear addiction, yet desire pain relief sometimes think "So what if I get addicted, I am going to die anyway." Such thinking creates an unnecessary trade-off between addiction and pain relief; in fact, addiction is rare and should not be a worry when opioids are used appropriately to relieve pain.

Patients and family members who express concern about addiction should be given correct information and reassured. Example: "Sometimes patients taking opioids for pain relief are concerned about addiction. However, you are taking opioids for pain relief whereas addicts take drugs to get high. You are not an addict if you take pain medications to relieve your pain."

PSEUDO-ADDICTION

Definition
Pseudo-addiction describes what happens when healthcare workers perceive as addictive behavior a pain patient's requests for more or stronger pain medications. In fact, the patient's behavior may be a response to inadequate pain management. Pseudo-addictive behavior is pain-relief seeking behavior. Pseudo-addiction is an iatrogenic phenomenon, e.g. it is when problems result from the treatment efforts of health professionals.

Clinical relevance
Pseudo-addictive behavior may occur when analgesics are prescribed in inadequate doses or at dosing intervals that are longer than the duration of action of the drug. Pseudo-addictive behaviors are more likely to occur in patient care settings where health care professionals are inadequately trained in pain management and the rational use of opioids. The appropriate clinical response to pseudo-addictive behaviors is to reassess the patient's pain and to treat the pain adequately.

SAMHSA Report: Good and Bad News on Drug Use in America

My opinion on SAMHSA Report: Good and Bad News on Drug Use in America

Heroin (diacetylmorphine/diamorphine) use likely rose in all age groups except children because doctors aren't treating pain anymore.

If you have CIPN (Chemotherapy-induced Peripheral Neuropathy) or other IP (intractable pain), and cannabis doesn't help you and medications like Actiq, Duragesic, oxycodone/OxyContin/OxyIR/Roxicodone, oxymorphone/Opana, hydromorphone/Dilaudid/Exalgo, and morphine are no longer available, what choice do you have? For many, it's diamorphine or die. Untreated IP kills.

Thanks to the lack of access, many pain patients have had to make such troublesome decisions.

Even the increase in cannabis use can surely be linked to expanded medicinal use as more states come to their senses and legalize and also more pain patients are switching to cannabis as opioid medications are vilified by the media and made next to impossible to acquire.

Luckily, binge drinking and DUI have both decreased, although DUI has only decreased mildly.

Steve
Check out my new blog at
http://bit.ly/IPkills
Send feedback to
IntractablePainKills@gmail.com

SAMHSA Report: Good and Bad News on Drug Use in America
http://bit.ly/18MG1Gm

Deborah Brauser

Sep 05, 2013

The newly released 2012 National Survey on Drug Use and Health (NSDUH) report from the Substance Abuse and Mental Health Services Administration (SAMHSA) contains both good and bad news this year, especially with regard to adolescents and teens.

Rates of binge drinking and heavy drinking in the previous month continued to decrease in those between the ages of 12 and 17 years, although the rates of driving under the influence of alcohol by teens in 2012 were comparable to the rates found in 2011 (11.2% vs 11.1%, respectively). The rates were significantly lower, though, than the high of 14.2% in 2002.

In addition, use of tobacco products continued to drop for this age group, as did the rates of overall substance dependence or abuse.

Although the rate of marijuana use rose in almost every age group, and was up from 5.8% of all Americans in 2007 to 7.3% in 2012, use of this substance dropped slightly for those aged 12 to 17 years.

However, use of heroin by all individuals older than 12 years rose dramatically during the past 5 years, from 373,000 users in 2007 to 669,000 users in 2012.

"These findings show that while we have made progress in preventing some aspects of substance abuse, we must redouble our efforts to reduce and eliminate all forms of it throughout our nation," said SAMSHA administrator Pamela S. Hyde in a release.

"Reducing the impact of drug use and its consequences on our nation requires a robust public health response coupled with smart-on-crime strategies that protect public safety," added Gil Kerlikowske, director of the White House Office of National Drug Control Policy (ONDCP), in the same release

The National Survey was released at a press conference on September 4 in observance of the 24th annual National Recovery Month.

"Making a Difference"

"The annual survey is the largest of its kind and is the government's primary vehicle for determining how many persons are using illegal drugs, alcohol, and tobacco, as well as how many are misusing pharmaceuticals," reports SAMHSA.

The NSDUH had approximately 70,000 participants throughout the United States.

It showed similar, although slightly increased, rates between 2012 and 2011 of past-month nonmedical use of prescription medications by individuals between the ages of 18 and 25 years (5.3% vs 5.0%, respectively). Both rates were significantly lower than the 6.4% found in 2009.

"For the first time in a decade, we are seeing real reductions in the abuse of prescription drugs in America, proving that a more comprehensive response to our drug problem can make a real difference in making our nation healthier and safer," said Kerlikowske.

Marijuana was the most commonly used illicit drug in 2012, just as it was in 2011, with 18.9 million past-month users. Still, the rate of use dropped from 7.9% in 2011 to 7.2% in 2012 for those between the ages of 12 and 17 years.

Although the overall use of illicit drugs by persons older than 11 years "remained stable" between 2011 and 2012, the NSDUH reports that 23.9 million Americans used illegal substances last year.

More Needs to be Done

The report was a little sunnier when it came to tobacco use in the 12- to 17-year-olds. The rate of use was 8.6% in 2012 compared with 10% in 2011, and was significantly lower than the 15.2% rate found in 2002.

In addition, this age group showed a drop in past-month overall use of illicit drugs, with a 9.5% rate in 2012 and a 10.1% rate in 2011, as well as small drops in the specific use of hallucinogens and inhalants.

Not so rosy is the report that "many American needing treatment for a substance use disorder are still not receiving specialty treatment." In other words, 2.5 million Americans older than 11 years received specialized treatment in 2012 ― but more than 23 million needed it.

The most common reason given for not seeking treatment was having no health coverage because of cost, followed by not being ready to stop using substances and current health plan not covering treatment and/or costs.

"These statistics represent real people, families, and communities dealing with devastating consequences of abuse and addiction. We must strive to prevent further abuse and provide the hope of treatment and recovery to all people needing help," said Hyde.

"Expanding prevention, treatment, and support…will be our guide as we work to address emerging challenges, including the recent uptick in heroin use shown in this survey," added Kerlikowske.

The complete survey findings are located on the SAMHSA Web site .

Happy Birthday

I'd like to take a moment to wish my good friend, Custis, a happy 33rd birthday.

He's dealing with a lot, pain wise right now, so he can definitely use some strength and well wishes.

Steve
IntractablePainKills@gmail.com
http:/bit.ly/IPkills

Desperate for sleep

So, it's 9:20am and I'm finally getting sleepy thanks to my giving in to my body and taking lorazepam, oxymorphone, tizanidine, and Rozerem.

Sweet dreams to all.

Remember, I'm always looking for post ideas, suggestions, and/or questions.

Steve
IntractablePainKills@gmail.com