in the brain that causes a person to compulsively use a drug, even when that drug is causing them great harm. A person can also develop a tolerance to a drug, meaning that over time the individual needs higher doses of the drug for it to be effective, without becoming addicted. While doctors say people dealing with chronic pain can safely take opioid analgesics for years, even decades, Kathryn Hahn, Pharm.D., a pharmacy manager in Springfi eld, Oregon, adds that it’s not uncommon for patients to tell her that their doctors are nervous about prescribing opioids long- term, which could mean anything beyond a month or two. Some doctors prefer to avoid the situation altogether, according to Hahn. “More and more these days, if a doctor knows you have a chronic pain situ- ation, they may not take you on,” she says. “The system is just against pain patients right now.” WHAT YOU CAN DO: If you’re concerned about the risk of addiction or other potential side effects of opioid analgesics, discuss them with your doctor. If you’re not sure your provider is up to speed on ad- diction (and how it differs from dependence and tolerance), use this National Institute on Drug Abuse site to educate yourself and those caring for you: drugabuse.gov/scienceofaddiction. Building a relationship with your pharmacist can
be another great source of information and support. Experts say, too, that patients should be screened for addiction risk before taking the drugs and then monitored carefully while on them to check for signs of abuse and to determine whether the drugs are really helping. Keep in mind that there could be other treatments, including other medications that may work well for you. And if you think your doctor may be avoiding prescribing you the medication you need because he doesn’t understand addiction risk or fears getting into legal trouble, you may need to initiate an open conversation about his concerns.
REASON
Your health insurer doesn’t cover some or all of your pain medications.
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concept of addiction is often not understood among health professionals,” Gilson says. “Physical depen- dence does not, by itself, mean that a person is ad- dicted.” If you take an opioid for a while and then stop, it’s not uncommon to experience the with- drawal symptoms of physical dependence, such as nausea and vomiting; these can be mistaken for ad- diction, particularly if you stopped the drug abrupt- ly. Addiction, on the other hand, is a disease rooted
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Even if you’re lucky enough to have health coverage, it doesn’t necessarily mean you’re going to get the drug your doctor prescribes. Insurers may decline to pay for certain pain medications, particularly expensive brand-name pain relievers like Percocet and OxyContin, and instead substitute cheaper ge- neric versions. Some insurers even require that you try entirely different drugs fi rst and “fail” on several drugs before you’re covered for the medication your doctor prescribes. This cost-saving policy by health insurers is called “step therapy.” (A similar practice,