"Frank B. Fisher, M.D." wrote:
> Dolores,
>
> Just keep talking to people about the problem with pain management and
> law enforcement. When a critical mass of people become aware of it,
> it will change. Winning my case will have a large impact because it
> will reveal that law enforcement actually impedes pain management.
> Hardly anyone believes this yet.
>
> I have pasted on some basic information you might already know. It
> might be useful to circulate it.
>
> Frank
>
> Opioids
> Patient and Family Information
>
> Opioid analgesic pain medications are recognized by the Medical Board
> of California as the cornerstone of treatment for chronic pain. Their
> use is limited mainly by widely held beliefs about their dangers, most
> of which are false. What follows is basic information about these
> substances and their role in the treatment of chronic pain. This
> information is directed to patients and the people who associate with
> them.
>
> Addiction
> This is the bogeymman. It is generally feared that exposure to
> opioids will invariably lead to addiction and this would be so
> terrible that many terminal cancer patients refuse morphine and die in
> agony as a result. Large studies have repeatedly revealed that this
> is simply not the case, and that addiction to opioids in pain patients
> is actually rare. Addiction is defined as the combination of cravings
> for a substance combined with self destructive behaviors leading to
> harm, with continuing use in spite of the harm.
>
> Dependence - This term means the fact that if a patient has used
> opioids they are likely to have a flu-like withdrawal reaction if they
> stop the medication abruptly. This can prevented by gradually
> tapering the dose of the medication. Dependence does not signify
> addiction as it occurs in almost everyone who takes opioids.
>
> Respiratory Depression/Tolerance - When an individual unaccustomed to
> taking opioids takes too large a dose it can slow or even stop
> breathing. When a patient has had their dose of opioids gradually
> raised, they can and do take dosages that would kill an individual not
> accustomed to these doses. This is called respiratory tolerance.
> Pain also promotes respiration, making it doubly hard for opioids to
> harm a pain patient.
>
> Tolerance also quickly develops to the "high" caused by opioids.
> Within as couple of days to weeks the patient returns to feeling
> completely normal, although they may be taking enormous doses of
> medication.
>
> Titration - This term describe the process of gradually raising the
> dose of opioids until the patient reaches their best level of
> functioning. Fortunately, once this is established it is seldom
> necessary to keep raising the dose as not much tolerance to the pain
> relieving properties of opioids occurs. Most patients will require a
> variation is their dosage from day to day depending on their pain
> levels and activities. The range of possible doses needed to control
> pain varies from one patient to another more than with any other drug
> in the entire field of Medicine, which means that some patients will
> receive dose of a size that is staggering to the uninformed observer.
>
> Alcohol/Tranquilizers - It is dangerous to drink alcohol or overdose
> on tranquilizers such as Valium or Xanax while taking opioids because
> these substances reduce respiratory tolerance. The majority of deaths
> attributed to opioids actually occur in combination with these other
> central nervous system depressants.
>
> Security/Diversion- Opioids present a public health risk when they are
> diverted into the hands of non-patients who intend to abuse them.
> These individuals are often not protected by either tolerance of pain
> against the respiratory depressant effects of opioids and are likely
> to combine them with the depressants mentioned above. The results can
> be tragic. For these reasons the bulk of a patient's supply of
> opioids must be kept locked in a safe and never given, sold, or traded
> to anyone else.
>
> Toxicity/Side Effects - Opioids are not toxic to any organ system in
> the body. They do not do any damage even with long term use. While
> an array of different side effects is possible in a patient taking any
> given medication, the only side effect commonly observed is
> constipation, which is easily anticipated and treated.
>
> Pain Relief/Functioning - Opioids reliably reduce pain levels in
> chronic pain patients, however they seldom make the pain go completely
> away as they do in patients with acute pain who do not have a
> tolerance. Patients can live with this residual pain as long as their
> dose is titrated to a level where they can function. The way this
> works is that at higher levels opioids act as antidepressants in
> chronic pain patients, and although they can still feel the pain if
> they think about it, the depression cause by the pain is alleviated
> allowing them to carry on with the activities most of the rest of us
> take for granted. This is the major benefit of opioids in chronic
> pain. They allow the patient to function is spite of the pain.
>