Opiophobia
Besides racism and sexism, opiophobia likewise causes opioid pseudoaddiction. Opiophobia is an unfounded fear of opioid use and resultant reluctance to prescribe, administer, or receive opioid analgesics despite the low risk of addiction. Opiophobia discourages patients, healthcare providers, and pharmacists from seeking, prescribing and dispensing opioid pharmaceuticals. Some patients are afraid to take any opioid medications for fear of becoming addicted. Many physicians are reluctant to prescribe opioid medication because of the largely unfounded fear of creating opiate addicts. Some physicians may opt to not even apply for a DEA license to prescribe opioid and other scheduled drugs. Some physicians put up signs in their reception areas indicating that they prescribe no opiates in their practice. Nurses also limit patient access to opioid medications by declining to administer opioid medications as prescribed for patient pain, both because of fear of creating opioid addicts and fear of opioid side effects. Pharmacists, likewise, may refuse to dispense opioid medication because of fear of patient drug-seeking, opioid abuse, and opioid diversion.
Opiophobia is not unique to America, but is particularly virulent in the United States, given the country's war on drugs. According to the DEA, six million Americans abuse various prescription drugs. The war on drugs has utilized media to broadly focus on the horrors of addiction while failing to distinguish between physical dependency and opioid addiction. Many Americans believe the urban myth that chronic opioid use must be avoided for fear of drug addiction. Opiophobia surpasses the legitimate fear of opiate side effects, such as respiratory suppression and the largely unfounded fear of opiate addiction in the pain patient.
Confusion frequently occurs among health care professionals and patients regarding physical dependence and psychological addiction. Physical dependence is not addiction but a state of adaptation . . . manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation [and] rapid dose reduction. Tolerance, which is also confused with addiction, is not addiction, but a need for increased doses of medication to achieve the same effect. Addiction, however, is characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving. Opioid patients are at very low risk of addiction unless they already abuse substances.
Patients may fear their use of opioid medications will cause others to view them as drug addicts. Likewise, patients and their families may falsely believe that opioid medications are likely to be addictive, causing drug-seeking behavior, or that opioid medications will cause feelings of being drugged, confusion, and disorientation. Instead, opioids properly used in the treatment of pain increase patients' levels of daily functioning in the home, community, and workplace.
Western culture's ambivalence toward pain contributes to opiophobia. Patients may believe that requesting pain medication is a sign of moral weakness, an inability to handle suffering. Pain and suffering in our culture has also been seen as a punishment for disobedience to God, and therefore as something to be experienced, not avoided. Western culture views pain as the ultimate ontological fact of humanity, a human experience of a flawed or corrupted universe. Even the word patient comes from the Latin patior--to endure suffering and pain. John Stuart Mill saw pain as the ultimate basis for all human motivation. Western culture furthermore sees pain as building character and perhaps even salutary. Given our culture's deeply entrenched ambivalence towards pain, the prevalence of opiophobia is not surprising and affects every aspect of pain recognition and treatment.
Some pharmacies refuse to fill prescriptions if they have merely been approached by the DEA regarding a particular prescriber. These pharmacies are fearful of being involved in a DEA investigation and will cease filling a doctor's prescriptions if they sense the possibility of a DEA investigation. Such practices make it difficult for patients to find a convenient pharmacy that will fill their prescription for opioid medication. It is not unusual for patients to go to a dozen pharmacies in search of one that will fill their opioid prescriptions.
The prevalence of opiophobia is rampant among physicians, pain patients (especially geriatric pain patients), and society at large. Furthermore, opiophobia causes the chain of events, which leads to opioid pseudoaddiction.
