Further Reading

Can people use narcotics safely, even with benefits, for years?

Dear Stanton,

I'm a psychiatrist, and recently saw the following person in consultation:

A 47 y.o successful, professional, married, caucasian male was referred for medication follow up after moving to this location. He reports that 4 years ago he began taking 40-50mg percocet daily in divided doses for the treatment of chronic, non-surgical lower back pain.

Since then, he has been essentially pain-free; his alcohol consumption has gone from 4-5 oz. daily, to an occassional glass of wine with meals; his sex life has improved; he has lost 20 lbs. of excess weight; his relations at work and in the family have improved; he no longer needs any sleep medications, and discontinued anti-depressants about 2 years ago with no adverse effect.

Efforts to lower his percocet have resulted in recurrent pain, irritability and increased self-medication with alcohol. He is careful to get regular physical checkups, and to date there is no sign of any liver-kidney complications from the medication. All of this history is confirmed by his referring physician (a colleague i know well, and respect his work).

Obvious question: what are the risks of percocet "maintainence" in this specific individual?

Dr. [...]

Dear Doctor:

I am not a physician, and so I can’t say anything about what long-term deleterious effects Percocet has on the body.

However, I suspect that, in contacting me, you are most concerned about addictive consequences.

You are aware that Percocet is a narcotic analgesic (it contains Acetaminophen and Oxycodone, a narcotic). References thus caution “Percocet contains a narcotic and, even if taken only in prescribed amounts, can cause physical and psychological dependence when taken for a long time.”

However, many people (and often physicians) use narcotic maintenance dosages. This has been true for more than a century. Of course, methadone is prescribed for maintenance. In addition, in several countries around the world, experiments are being considered with heroin maintenance. In Britain, private physicians maintained their patients on heroin until the second half of the last century, while earlier in the century, there were heroin clinics throughout the U.S. which were shut, sending habitués into the streets.

All indications are that many people have been safely maintained on narcotics, including the most powerful illicit drugs. It is probably our modern view (and fear) of addiction which caused this to end, and which must be fought when trying to re-introduce the idea of narcotic maintenance.

But your patient seems like a case study of the value of such maintenance. It seems as though he maintains a relationship with a physician (who referred him to you), so that he is being monitored for any potential physical complications.

But, in terms of life management, over four years of use you report (with back-up from this physician) that (a) the man has not increased his dosage, (b) he has successfully managed his chronic back pain, (c) he has reduced his drinking, (d) he has eliminated sleeping medications and antidepressant use without problems, (e) he has lost weight, (f) he has improved relations at work and at home, and (g) his sex life has improved! This appears to be one of the most successful examples of (self)medication in medical history. One is tempted, based on an experience like this, to recommend Percocet for all of one’s patients! This reminds us that, for every new miracle drug report, that many existing drugs produce similar benefits for some people.

My guess is that you have written me because you are concerned about continuing maintenance of this patient, which is why the patient was referred to you by his doctor. Your own diagnosis is that Percocet has been and continues to be a highly successful therapy. I concur.

Stanton Peele