“.. IT’S NOT SAFE TO SELF MEDICATE..”
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NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA, AISHA GARDNER, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
INTRODUCTION
DOCTORS DIAGNOSING ADDICTION-ARE THE BLIND LEADING THE BLIND?
“Medical doctors are widely understood to be inadequately trained in diagnosis of both pain and addiction among their patients.
There is currently no consensus standard of practice to guide clinicians in either prescription of opioids or diagnosis of “substance use disorder” among patients treated for pain.
Available medical literature and clinical experience do not support the thesis that clinicians prescribing in a continuing relationship with pain patients have contributed measurably to the widely discussed US “opioid crisis”
General principles on the management of pain and the diagnosis of substance use disorder do exist but are not widely understood by practicing clinicians. Entry of a “substance use disorder” or “addiction” code in patient electronic medical records can be a literal “kiss of death” for ongoing treatment of severe pain.
Thus it seems necessary to caution clinicians who treat pain – and policy makers who oversee them – that much of what they think they “know” about substance use disorder and its causes may no longer be current or may have been wrong in the first place.”
discussion
“The definition of addiction, now called substance use disorder, has varied greatly over time.
The first edition of the Diagnostic and Statistical Manual, from 1952, didn’t include specific diagnostic criteria for this condition. Over the next sixty years the DSM went through six revisions, with a slow evolution of the terms substance “abuse” and “dependence”.
The first being limited to substance use causing social and occupational problems, while the last was reserved for compulsive use and physiological symptoms.
This distinction is very important, as many states have outlawed the use of controlled medications to treat “chemical dependence” This latter phrase was considered synonymous with addiction in the minds of most doctors.
But could be confused by others, including some medical board members and especially law enforcement, as being synonymous with physical dependence. And then we come to the fifth edition of the DSM, published in 2013.
Which brought about a substantial reimagining of substance-related disorders. It moved away from the terms “substance abuse” and “substance dependence,” which were criticized for not adequately capturing the complexity of the problem. Instead, the DSM-5 introduced the unified term “substance use disorder” and a criteria-based approach for diagnosis.
This criteria-based framework for diagnosing substance use disorder included eleven criteria.
These eleven criteria are:
1) impaired control,
2) social impairment,
3) risky use,
4) pharmacological indicators,
5) time spent acquiring,
6) giving up activities,
7) physical and psychological problems,
8) attempts to cut down,
9) desire and effort to control use,
10) time spent recovering, and finally,
11) reduced social, occupational, and recreational activities.
You have just perfectly described almost every patient with chronic pain. When someone is in agony, they have a very hard time controlling their use of pain medication. “
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