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Newsweek recently ran a story interviewing several of the people I work with at the pain foundation. One of them sent me an e-mail with a link to a response to that story which worries that comments made in the Newsweek piece about new, addiction-resistant pain meds somehow sets us back in the struggle to differentiate between ‘addiction’ and ‘dependence’.

Excluding a brief, sadly unrequited correspondence with Edward Albert when I was a teen and hopelessly in love with him, I don’t send fan mail. I don’t write letters to my favorite stars and despite having a lot to say, I don’t write letters to the editor. I almost never respond to magazine articles. However, the Stats piece seemed to me to be missing the point.

So.

“Dear Sirs and/or Madams,

Re: your recent story “Newsweek’s Painful War on Pain”, I agree that there is a difference between ‘addicted’ and ‘dependent’ and that we need to work hard to disabuse doctors and lay people of the notion that one equals the other or we will never remove the stigma of drug-seeking, self-indulgent whininess so many pain patients face when trying to get some relief. As the mother of a child with a pervasive pain disorder, I’ve watched doctors who should know better apply those stigmas and labels to my child, suggesting she was an addict when all she wanted was to stop hurting. The way pain patients are treated today, if my daughter had become ill as a small child and I asked for Dilaudid or Vicodin, I would likely have been branded with Munchausen’s Syndrome and investigated. Lucky us – my daughter was a teen so it was naturally assumed she was just a junkie and often left to suffer with nearly unbearable pain. So trust me. I KNOW how important it is to educate about the difference between addiction and dependency.

However, it is important to note that being dependent on a drug rather than addicted to it does not necessarily protect a patient from the physical or emotional effects of addiction. It doesn’t always. My teen age daughter first became sick in December of 2004. She was a good student, in honors in some subjects, tutoring kids in others and active in school clubs and activities. Despite nearly daily calls from me asking if there was an opening, a cancellation, anything, we would take anything at all, it wasn’t until October of the following year that we were able to get her in with a pediatric pain clinic. During that time, as she was shuffled from one doctor to the next, one hospital stay to the next, as we tried one less benign med after another with no effect, she became dependent on the only medications which stopped the pain, all narcotics.

In the months it took us to get her to the right specialist and in the months of trial and error that followed as we tried to find out why she hurt, my daughter took a lot of narcotics. It was a miracle to watch my daughter stop hurting when she took one of the pills, but it was a miracle that came with a high price tag. First, as her disease progressed, it took more and more pills to see the look in her eyes that signaled pain relief, because the longer you take the med, the more you need of it to get any effect. What started as one pill soon became two and four. Then there was the toll it took on her digestive system. On top of her initial disease, she developed problems with her stomach and colon, problems which caused terrible pain of their own and which came with solutions that could best be described as humiliating. You get more narcotics for that, too.

Then there was the emotional effect of being told, in words and oh, the endless gestures, that she’s a junkie, that nothing is really wrong with her but self indulgence and addiction. Being told that if she really cared about her family, she would stop ‘acting out’ or that if she really wanted to stop hurting, she could make herself stop hurting. You can’t imagine what it’s like to watch your child try to force herself out of hurting, only to be unable to and, as she reaches for the pills, tell you she’s sorry she’s a junkie. She’s sorry she’s ruining your life. She’ll try harder not to hurt. Never mind that she had a real disease and she wasn’t drug seeking or a junkie and certainly not ruining anyone’s life. The doctors told her so, see. “You’re my Mom,” she tells me – “you have to tell me I’m not a junkie.” She trusted the doctors to give her the truth unvarnished by love for her and what she got was a bunch of prejudiced malarkey that did as much harm as the disease itself was doing.

Eventually, at the pain clinic, we found a terrific doctor with experience and sense and compassion and humor. She had us try every alternative, non-medication therapy you can think of: acupuncture, bio-feedback, cranio-sacral therapy, hypno-therapy and Chinese herbalists and when those didn’t work, it took months more to find a new med that relieved my daughter’s pain and wasn’t a narcotic. When we succeeded in that, we had to wean her off the ‘junkie’ drugs and she went through the same withdrawal symptoms any real addict in rehab does as they detox. We got her through that but she is still, two and a half years after she first got sick, battling the stomach and emotional problems the narcotics caused her. Worse, she tends to think in terms of a pill for every twitch her body makes. I worry about possible addiction issues for her down the line.

So let the drug companies make new, better, more effective addiction-resistant drugs. New addiction resistant meds are important not primarily because of the addict but to protect the dependent patient who may later need to be weaned from them. I laud any company who can find a way to give pain patients relief that won’t cause as much harm as the conditions they are trying to treat."