“Drug Seeking” in Health Care
Chronic pain affects a significant number of individuals living worldwide. The International Association on the Study of Pain [IASP] and the European Federation of the IASP Chapters [EFIC] indicates that one in five people suffer from moderate to severe chronic pain, and one in three are unable to maintain a lifestyle of independence due to their pain (World Health Organization [WHO], 2004). The WHO identifies that pain relief is an integral right for individuals to attain the highest level of physical and mental health (2004). The Committee on Advancing Pain Research, Care, and Education at the Institute of Medicine [IOM] (2011) examines pain as a public concern. The report concluded that chronic pain affects the lives of about 100 million US adults, “more than the total affected by heart disease, cancer, and diabetes combined” and is a national challenge (2011).
Pain is a subjective physiologic phenomenon that cannot be objectified or verified and is often un-assessed, un-diagnosed, and undertreated. This stands as a serious public health concern because individuals experiencing chronic pain are at great risk for decreased functional status and quality of life. Additionally, individuals living with chronic pain experience the common co-morbidities of depression, anxiety, and anger (Wilsey et al., 2008). The IASP/EFIC data from WHO (2004) concludes that one in four individuals experiencing pain, report that relationships with family and friends is “strained or broken.” Within the clinical setting, pain is a topic of great debate. The majority of health care professionals have fallen into the routine of branding and stigmatizing their clients as “drug seeking.” This term has been used for the last 25 years and implies that a client seeking medical attention is an addict out to obtain opioids, with the inclination that their pain is non-existent or not legitimate. Despite efforts implemented in a position statement issued by the American Society for Pain Management Nurses [ASPMN] in 2002 stating the term “drug seeking” not be used in practice because it “creates prejudice, bias, and barriers to care,” the term continues to routinely exist (McCaffery et al., 2005). Holding these negative attitudes toward clients and labeling them as “drug seeking” has generated a slippery slope. By categorizing and inadequately assessing, advocating, and managing client’s pain, health outcomes are negatively affected. In addition, health care professionals partaking in these unethical practices are not adequately practicing to their legal standards of care and are arguably liable for malpractice (Marquis & Huston, 2012). The mask behind this simple labeling of clients as “drug seeking” is directly related to the design of our healthcare system. Due to lack of nationalized healthcare, American citizens do not seek preventative care on a routinely basis which could greatly reduce the number of Americans suffering from chronic illness, including chronic pain. National Geographic created “The Cost of Care Graph” which illustrates the United States healthcare system in comparison to 20 other countries (Uberti, 2009). Through this graph it is evident that Americans visit their primary care physician on an average of zero times/year. Furthermore, the country has a below average life expectancy of 78 years, with an above average annual cost of $7,298/year per person for healthcare expenditures. In contrast, citizens of Japan have nationalized healthcare, with an average of 12 or more visits/year with their primary provider. Japan spends below average of $2,581/year per person on healthcare expenditures while holding the highest life expectancy than any country listed of 83 years (Uberti, 2009). Addiction is specifically a “neurobiologic disease” where genetic, psychosocial, and environmental factors influence its development and manifestation