Drugs are good!
Every quarter as I prepare to publish this magazine I turn to a good friend of mine to discuss health care. My friend, although not directly employed by the long term care industry, frequently works with seniors in a healthcare role.
He’s seen the good and the bad of the health care system on an almost daily basis and his knowledge of at least Ontario’s system is truly valuable to my understanding of this industry. And so it was with this quarter.
After reading my usual slew of studies and doing my usual research for this quarter, I turned to my friend to have our usual healthcare discussion.
We got on to the topic of administering drugs and more specifically pain medication. One of his statements this time really stuck with me: “You need to remind health care proivders that drugs are good.”
I looked at him like he had horns on his head!
“Well of course they’re good, that’s what they’re there for aren’t they? To help people cope with pain and to improve their daily quality of life,” I replied.
He explained that from a clinical perspective, pain is one of the most undertreated, and under-reported symptoms. My friend also pointed out that many clinicians are concerned about drug seekers.
This, of course, led me down another research route.
“What does he mean by a drug seeker?” I found myself thinking.
Okay so the basic definition that I uncovered through a quick web search (come on everyone does this…right?) is that someone by the name of Goldman back in 1999 defined drug seeking as “individuals who knowingly break the law by seeking and obtaining controlled drugs in order to sell them on the street” (p. 99).
He went on to identify three categories of drug seekers: (1) those with chemical dependency, (2) those seeking drugs to sell on the street, and (3) those hired by drug dealers to obtain prescriptions to be sold.
Okay, fair enough, but I don’t think the 85-year old lady down the hall is handing her NSAIDs over to her grandson for a quick buck. There has to be more to it.
Sure enough, two people by the names of Weaver and Schnoll define “drug seeking” even further with the following: “Drug-seeking may be seen with either active addiction or pseudoaddiction, or as part of deviant behaviour such as drug diversion. A way to distinguish between these conditions is by giving the patient appropriate pain medication...” (2002, p. 6).
Hm, another medical term… pseudoaddiction is defined as behaviours that appear to indicate addiction but actually reflect undertreated pain (Weissman & Haddox, 1989).
Okay, so granted there still might be some little old ladies who actually are abusing opioids but maybe that should be a risk that the long-term care community is actually willing to take in favour of giving meaningful pain management to those who would benefit from receiving the medication.
Another set of authors, Mitra & Sinatra, (2004) also identify what they call a subset of drug seekers who have undertreated pain, or pseudoaddiction. They state that in these patients drug-seeking behaviours may resemble addiction but actually reflects the patients’ efforts to seek adequate pain relief.
The term “drug seeking” is also defined by Compton (1999) as “a set of behaviours in which an individual makes a directed and concerted effort to obtain a medication... behaviours may include ‘clock watching,’ frequent requests for early refills, or hoarding analgesics” (p. 429).
Really, it’s a double edged sword. If you give an addict access to the medicine that feeds their addiction you’re not helping, but if you 2don’t give someone who really needs that same medicine a meaningful way to improve their quality of life you’re also not helping.
Either everyone gets pain relief or no one gets pain relief. This seems to be exactly what Ontario’s Office of the Chief Coroner is suggesting in the “Eighteenth Annual Report of the Geriatric and Long-Term Care Review Committee.”
The second recommendation of this annual report says:
“Health care professionals caring for elderly residents of long term care homes should be reminded that pain is one of the most common, treatble symptoms in the elderly. Some of the principles of good pain management include the following:
- Identification of the cause of the pain,
- Regular, not PRN administration of pain medications, beginning with non-narcotic medications such as Acetaminophen, followed by narcotic medications when and if the non-narcotic medications are no longer effective,
- Regular, ongoing careful assessment of the pain, including titration of the dosage depending on the patient’s response,
- Standardized assessment of the patient’s pain including both typical (complaints of pain), and atypical (agitation, loss of appetite), symptoms and signs,
- Utilization of physiotherapists or occupational therapists on alternative positioning in chair or bed to maximize comfort.”
Alright folks, there you have it. As my friend said to me, “drugs are good.” Don’t be afraid to treat for pain, but do so from the matrix of assessment, dosage monitoring and the wide range of other medical and non-medical professionals who can aide in a resident’s comfort.