Opioid (Narcotic) Analgesics I: Opioid Agonists
The role of the physician in initiating drug dependence is of concern not only to physicians and patients but also to legislative bodies. Since the beginning of the twentieth century, federal legislation has been directed toward monitoring physician prescription of dependency-producing drugs without seriously restricting access to appropriate therapies. The narcotic agonist-antagonists are prescribed freely by many physicians without concern of addiction. Physician's prescribing behavior has been described as consisting of an intermix of three components or modalities: instrumental, command, and customary. The epitome of iatrogenic drug dependence is the drug-dependent physician. Long working hours, stresses inherent in dealing with acutely ill patients, and the difficulty encountered in accepting personal limitations, accompanied by the unique availability of mood-altering drugs, predispose physicians toward the use of these agents to facilitate coping with prevailing life stresses. Therapeutic success is usually related to underlying psychological disturbance rather than to the drug abused or intensity of dependency.