Thank you so very much for the feature article on pain management by Sharon Morgillo-Freeman in the May/June 2006 issue. It confirms and supports all that we are doing at Stewart-Marchman Center in Daytona Beach, Florida.
We offer outpatient detox and pain management services to the community through our “Right Turn” program. I receive so many calls from individuals who want to come off their pain medication and appear to be highly motivated to do so, feeling that they can manage their pain after they have been detoxed. My stock question to them is, “What makes you think you can handle the pain afterwards?” Generally the answer is, “I don't care-I just want to be drug-free.” So we go ahead and detox them (usually using buprenorphine), with the cautionary statement that if the pain comes back after a period of time-and it usually does-we can then simply transfer them to our pain management clinic.
Most have erroneously come to believe that just because they might have abused pain medication previously, they now have either become addicts or, worse, can never safely use pain medication again. Thankfully, the days are over when the assumption was that anyone with a diagnosis of dependence (loss of control, compulsion) could not be placed on narcotics or, heaven forbid, benzodiazepines.
Having been in the field for close to 20 years, I find it so rewarding now to be able to administer whatever medication is deemed medically necessary, and to see that as no different from prescribing insulin to a diabetic. There is no difference between the chemically dependent individual who has no control over his/her use and the cancer patient who has no control over the growth of malignant cells in the body. There are going to be successful (remission) stages, lapse stages, and at times full-blown relapses, but all are eminently treatable. Again, thank you for such a timely and eloquent article on this topic.
Mike Malia, CAP, Senior Clinician, Stewart-Marchman Center, Daytona Beach, Florida