“Thank you for treating me as someone struggling with pain and not as a former drug addict who could not be trusted with strong pain medication”  – a note I recently received from one of my patients.

A patient with a history of drug abuse may be fearful that their past will prevent adequate treatment for a serious painful condition. My patient imagined that I would not be respectful of his suffering and his commitment to sober living. He received the pain medication that allowed him to go through a series of medical and dental procedures without suffering. He was grateful.

Concerns about opioid misuse have made physicians wary of  prescribing potentially habit-forming pain medication. Illicit prescription drug use is a growing problem in the USA and is actually the preferred street drug aside from marijuana. However in treating patients in pain, two basic American traditions should be the guiding principles with patients who have a history, or who test positive on a written test to determine the risk, of drug abuse:

1. Innocent until proven guilty; and

2. in the words of Ronald Reagan, Trust but verify. Those patients who have problems properly using pain medication need extra attention, not condemnation. They may be more difficult to treat, but that is why there are specialists to deal with complex pain problems.