Doctors Diagnosing Addiction – Are the Blind Leading the Blind?

Abstract

This paper addresses the questions, “are clinicians who treat patients in pain – or even specialists in addiction medicine -- appropriately prepared to accurately diagnose opioid use disorder? Further, is prevailing public policy on pain management employing opioid analgesics firmly grounded in science?” The author summarizes key findings from reviews of pertinent medical literature on pain treatment and diagnosis of substance use disorder.  Medical doctors are widely understood to be inadequately trained in diagnosis of both pain and addiction among their patients.  There is currently no consensus standard of practice to guide clinicians in either prescription of opioids or diagnosis of “substance use disorder” among patients treated for pain.  Available medical literature and clinical experience do not support the thesis that clinicians prescribing in a continuing relationship with pain patients have contributed measurably to the widely discussed US “opioid crisis” .  General principles on the management of pain and the diagnosis of substance use disorder do exist but are not widely understood by practicing clinicians. Entry of a “substance use disorder” or “addiction” code in patient electronic medical records can be a literal “kiss of death” for ongoing treatment of severe pain. Thus it seems necessary to caution clinicians who treat pain - and policy makers who oversee them - that much of what they think they “know” about substance use disorder and its causes may no longer be current or may have been wrong in the first place.