1.28 Opioids/Opiates are controlled substances in the US. They are commonly used to control pain, control cough and sometimes diarrhea. Dependence on them is commonly encountered but statistics are in favor of prescribing them rather than not for the fear of addiction. Addiction takes place in less than 1% of patients with acute pain and less than 6% of patients with chronic pain.

Addiction manifests as need for higher doses and using them to the point of sedation. When one treats someone with pain, one must advise the patient that the purpose of the medicine is not to completely take away the pain but to make the patient functional with only a small amount of pain remaining.

Of note in this regard is that the typical signs of acute pain are tachycardia, sweating and hypertension but these are absent in the patient with chronic pain.

Opioid withdrawal has the following features: Sweating, diarrhea, nausea, abdominal cramping, nightmares, paranoia and GOOSEBUMPS (this is described in almost every case)

Treatment is by introduction of small doses of opioids. Typically methadone is used in a supervised setting.

Frequent follow-up with the doctor are required. Once a week is adequate and at each of those visits, the patient is to climb down on the dosage of the drug. Random drug screening for illicit drugs is done.