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Poorly managed pain relief can have devastating consequences for addicts

Posted on 13/06/2013
Pain Management Report

Research led by King's College London's National Addiction Centre (NAC) calls for systemic attempts to reduce stigma and raise awareness amongst healthcare professionals when treating current or former addicts

The mismanagement of pain in current and former addicts can have disastrous, life-threatening consequences, according to a report published today by researchers from King’s NAC.

The report, which was commissioned by Action on Addiction and is endorsed by the Royal College of Psychiatrists, warns that current and former addicts are at risk of relapse to addiction, compromised medical care and potentially fatal overdose when being treated for pain in hospitals and doctors’ surgeries. The report, entitled The management of pain in people with a past or current history of addiction, identifies the stigma surrounding addiction as the main barrier to safe and effective pain relief.

The report highlights the dangers facing A&E patients with past problems of addiction, for whom exposure to strong analgesics and failure to provide adequate pain relief can result in relapse, with potentially tragic consequences. It warns that a community fear and disapproval of addiction amongst health-care professionals, shame and guilt felt by addicted individuals, and a mutual distrust between health-care professionals and addicted patients prevent hospital staff from identifying a patient’s history of addiction and place these individuals at serious risk when undergoing emergency medical procedures.

The report also highlights the problem of managing pain in people with a current addiction, but in whom their addiction is not recognised, warning that doctors may inadvertently be maintaining patients in a cycle of pain and misery as a result of addiction and may even be contributing inadvertently to a black market in opioid drugs. With addiction to prescribed painkillers now the largest drug-related problem in the USA – causing more deaths annually than heroin and cocaine combined – and prescribed narcotics on the rise in the UK, the report warns that this is fast becoming a serious health issue.

The researchers propose measures for minimizing the risks of poorly managed pain in current and former addicts, underlining the necessity of combating the stigma associated with addiction and stressing that the improvement of practitioners’ knowledge and skills alone will not solve the problem.

The recommendations include:

  • Improving communication and collaboration between health professionals; in managing complex patients whose treatment is markedly outside the usual experience of hospital staff, access to addiction specialists is essential
  • Introducing addictions consultation-liaison services in all large hospitals, to provide training and assess and advise on management of complex patients
  • Putting support systems in place to ensure health-care professionals develop the knowledge, skills and attitudes to enable them to deal with complex, stigmatised patients
  • Providing health-care professionals with access to skilled practitioners to serve as educators and role models and assist in the management of complex cases
  • Ensuring that GPs, as the people with prime responsibility for coordination of care, have basic competence in both addiction medicine and management of pain

Dr James Bell, from King’s College London’s National Addiction Centre and lead author of the report, said: “Relapse to addiction can be life-threatening and a source of on-going incapacity and distress for the individual, as well as the people surrounding them.

“Empathetic, non-judgmental attitudes towards those undergoing treatment, and good communication between different professionals involved in their care, are essential to the effective treatment of pain in people with a past or current history of addiction and can reduce the risk that they will face the devastating consequences of mismanaged pain.”

Nick Barton, Chief Executive of Action on Addiction, said: “People suffering from addiction or people in recovery from that condition face a variety of challenges including, in many cases, in their interactions with healthcare services. Many of these challenges may be attributed to the stigma that still clings to addiction.

“This report helps to identify gaps in knowledge, understanding, skill, practice and culture, pointing the way to how these deficiencies might be remedied and offering a good prospect of making a difference to the lives of people with active addiction or in recovery. It is in this context that Action on Addiction supports this research.”

For further information, please contact Seil Collins, Press Officer, Institute of Psychiatry, King's College London, email: seil.collins@kcl.ac.uk or tel: (+44) 0207 848 5377

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