* Our lizard brain -- addiction affects the most primitive structures using the mesolimbic dopaminergic system
* Try to hate the drugs, not the patient -- animal studies have repetitively shown that drug seeking behaviors are easily reproduced
* May be self medication -- chemical coping for psychiatric disorder or pseudoaddiction
* Yeah, I've heard that story -- behaviors more predictive of abuse are not that surprising. The more one has, the more likely it is opiate use disorder
* "Nah, I don't want that" -- diversion patients will be uninterested in alternative therapies. People in actual pain will try anything just to feel relief (ketamine, nerve blocks, acupuncture)
* We've all heard "avoid opioids for acute pain", but the chronic pain patient presents the greatest challenge
* I want to relieve your pain, but... -- Have a script / set expectations with the patient -- there is little use in arguing if someone is in pain or not.
* Hyperalgesia -- chronic pain can worsen not despite opioids but because of opioids creating new pain pathways
* The emergency department is just a step in the process of recovery. We're not here to win the game for the patient to change but to at least get it started
* Evidence is limited, but some suggest that PO Morphine less euphoric than oxycodone or hydrocodone with similar analgesic efficacy
* Communicate! -- judging drug seeking behavior from a history is relatively unreliable, use the drug database, use past records, call pharmacies and send messages in Cerner
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