By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on July 8, 2009

A timely series of articles and editorials on chemical dependency and recovery in patients and physicians appears in the July 2009 issue of Mayo Clinic Proceedings.

The papers discuss the potential tragedies of prescription chemical addiction and abuse and offer crucial overview and direction.

Addiction to and abuse of prescription opioid drugs are prevalent, and they exact an immense toll on patients, physicians and society, according to Steven Passik, Ph.D., in “Issues in Long-Term Opioid Therapy : Unmet Needs, Risks, and Solutions.”

Opioid drugs have been used by humans for thousands of years and are the longest continuously used class of medications , explains William Lanier, M.D., editor-in-chief of Mayo Clinic Proceedings.

Dr. Lanier and Evan Kharasch, M.D., Ph.D., Department of Anesthesiology, Washington University in St. Louis, authored the editorial “Contemporary Clinical Opioid Use: Opportunities and Challenges.” It summarizes the recent increased interest in this drug category.

Opioid medications are chemicals that work by binding to specific receptors, particularly in the nervous system and gastrointestinal tract; decrease perception of pain and reaction to pain; and increase pain tolerance.

Side effects include sedation, respiratory depression and constipation. When opioid consumption is ongoing, physical dependence can and will develop. This, in turn, can lead to problematic withdrawal upon abrupt discontinuation of medication.

Dependence, coupled with the feeling of euphoria these drugs can produce, leads to abuse.

According to Dr. Lanier, the recent growing interest in opioids stems from five sources: advances in the design of these drugs; expansion and innovation in methods of drug delivery; increased public awareness of pain management options and the appropriateness of aggressively treating pain as the “fifth vital sign” and pain relief as a fundamental human right; growing recognition of the serious consequences of opioid misuse, misadventure and addiction; and medicolegal aspects of practitioners’ prescribing practices and legal consequences for under- or overprescribing.

In addition to individuals who have chronic pain, both cancer and non-cancer related, anesthesiologists have the greatest risk of opioid dependence and abuse among health care providers. Also in the high-risk group for health care providers are nurse anesthetists and sedation nurses.

Challenges specific to these groups are discussed by Michael Oreskovich, M.D. and Ryan Caldeiro, M.D., in “Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?”

Severe chronic pain includes that produced by cancer and such non-cancer conditions as back injury and surgery. Opioids are a cornerstone of pain management for individuals in these categories...