If not addiction, then what is this complex neuroadaptation to long-term exposure to opioids? In a 2012 commentary article from JAMA Internal Medicine, Doctors Ballantyne, Sullivan, and Kolodny referred to it as “complex persistent opioid dependence” (JAMA Internal Medicine September 24, 2012, Vol 172, No. 17):
Dependence on opioid pain treatment is not, as we once believed, easily reversible; it is a complex physical and psychological state that may require therapy similar to addiction treatment, consisting of structure, monitoring, and counseling, and possibly continued prescription of opioid agonists.
But I am suggesting, as do Doctors Ballantyne, Sullivan, and Kolodny, that the better therapeutic approach may be to view their care through the lens of Addiction Medicine in addition to that of Pain Medicine.
And so you can see, the Pied Piper of Addiction Medicine (not a real medical specialty), Andrew Kolodny, has hypnotized other doctors into believing that pain patients should be treated as addicts — because there is an awful lot of money in a whole new patient population.
I found this link on a the Kentucky Pill Mill facebook page, and it appears they follow Dr. Murphy and agree with his writings. And if I were to guess, it’s because Dr. Kolodny has created a new condition for pain patients — complex persistent opioid dependent patients (“CPOD”) — which consists of “possible” treatment with continued opioids. Of course the condition is is not “easily reversible,” and includes long-term (expensive) treatment.
Heck, most pain patients don’t care what you call it, they just want adequate treatment. You want to say I have CPOD and will treat me with opioids? Instead of treating my pain with opioids? Sure, fine, whatever.
I have no doubt that there are some pain patients on opioid therapy who might benefit from being treated for addiction or “CPOD,” but it’s a very small percentage. Nah, this won’t help most pain patients — it only labels them — for life.