Pain management in a drug-oriented society.

A drug-oriented society promotes drug treatment of illness but responds with restrictive legislation and mores when faced with serious drug abuse by the populace. Narcotics are currently controlled because of their history of abuse and associated crime, and when their use, for whatever purpose, is suspected of abuse. Inadequate treatment of cancer pain with narcotics may stem, in part, from these events. Its major causes are confusion of legitimate and illegitimate narcotics use by society in general and health care providers in particular, combined with undefined terms (e.g., addicts, habitual users) primarily in state statutes, which should be revised and standardized. These factors intimidate physicians from prescribing rationally. For example, a prescription for an extremely large dose, and ordering an adequate quantity of a drug to have at home for a reasonable period of time, as is often required for the control of severe pain, may be perceived as an invitation for investigation of the physician's legitimacy. The real or imagined fear of an investigation encourages him or her to write prescriptions for multiple narcotics, each at the "acceptable" dosage, rather than for single narcotics in larger doses, which is simpler for the patient and preferable from a medical standpoint. Drug abuse is not generally a problem among cancer patients with pain. Physicians should strive to change social attitudes toward pain control with narcotics by enlisting the support of colleagues and, if necessary, by political activism.