Pain management in the chemically dependent patient.

The individual who suffers from chemical dependency has unique physiological and psychological conditions that make the management of acute and chronic disabling conditions challenging, frustrating or stressful, depending upon the experience of his primary attending physician. Several general principles are helpful in this situation. Special conditions, such as tolerance to opiate analgesics, and methadone maintenance, require special attention. The desire to treat the person who has an admitted or suspected history of chemical dependence presents conflicting interests for the attending physician. While there is the desire to provide the best possible care for any patient, this must be balanced against contributing to the patient's primary problem with drugs, and perhaps worse yet, the fear of being used by the patient to provide him with drugs to support his drug habit. The fear of dealing with a patient who is "running a scam" to obtain prescription drugs, or the anxiety of having to deal with an overly zealous DEA agent, further complicates the physician's role in the care of these parties.