Drugs pose challenge for doctors

By CHRIS MERRILL
Star-Tribune correspondent Wednesday, May 02, 2007

LANDER -- Medical professionals call it “narcotic-seeking behavior.” ER doctors see it almost every shift they work. It’s just one of the many manifestations of drug dependency.

A person comes into the emergency room with the chronic side-effects from addiction to methamphetamine, for example. He's suffering pain from dental deterioration. Or he's at the tail end of his “high” -- “tweaking,” physically exhausted, but anxious and unable to sleep, maybe feeling a little psychotic, and looking for something to help him “even out” so he can relax and finally get some rest.

Others are simply addicted to narcotics, legal or otherwise. They come to the ER with one goal in mind: Get some hydrocodone, oxycodone, some sort of opiate like those found in the brand name drugs Percoset and Vicodan.

It puts doctors in a tough spot. They have to learn to distinguish between the addicts and the rest. They have to become adept at differentiating between the side-effects of drug addiction, non-drug-related problems, and lies.

An analgesic that might be of great help to a normal patient might instead aid in furthering the problems of a chemically dependent person. This is why it is essential that an emergency doctor learn to identify the addicts.

“Obviously, we don’t want to feed their addiction -- we want to help people,” said Dr. Greg Clifford, head of emergency medicine at Lander Valley Medical Center.

The best way for a doctor -- in the context of the ER -- to help a drug addict is to refuse to prescribe narcotics, Clifford said. The physician must then try to explain to the individual about the risks associated with his or her drug dependency, give the patient information about treatment options, and hope that someday soon the person will decide to “get clean.”

More likely than taking the physician’s advice, the individual will probably just try another ER, or some other avenue for obtaining the drugs.

Until a chemically dependent patient desires to get clean, or until the individual is arrested, doctors must simply treat the side-effects of his or her addiction, and give the patient the medical information he or she needs in order to make an informed decision. The idea is that you never want to discourage people from seeking medical care, but if doctors were asked to “play cop” with drug users, the net effect would be to do exactly that.

“I don’t think it’s our job to be the law -- it’s our job to educate,” Clifford said.
The rest of the story here...

source: Jackson Hole Star Tribune