Meperidine addiction or treatment frustration? Ching-I Hung, M.D. a , Chia-Yih Liu, M.D. a, *, Ching-Yen Chen, M.D. a , Ching-Hui Yang, R.N. a , Eng-Kung Yeh, M.D. b,c a Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan b Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan c Taipei Medical College, Taipei, Taiwan Abstract There have been few studies of the psychiatric characteristics of analgesics addiction. The physician’s perceptions that patients were addicted to analgesics might be partially attributable to frustration with poor response to treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addiction to meperidine by general physicians. The most common medical diagnosis among these patients was chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during the index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chronic intractable pain; 2) poor staff–patient relationship; 3) lower pain threshold or tolerance due to anxiety or depression; 4) patients with a history or tendency of substance abuse; 5) placebo use and inadequate analgesics regimen. The findings of this study suggest that the importance of the following diagnostic and treatment procedures in these patients: 1) suicide risk should be evaluated; 2) cormorbid psychiatric diseases should be treated; 3) factors that cause a vicious cycle in pain control should be identified; 4) misconceptions of opiate analgesics among medical staff should be discussed; 5) poor staff–patient relationship should be managed aggressively; and 6) “addiction” is a critical diagnosis that should be avoided if possible. © 2001 Elsevier Science Inc. All rights reserved. 1. Introduction Meperidine, a synthetic opioid, provides analgesia for most moderate-to-severe pain syndromes. The clinical fea- tures of analgesia, tolerance, and dependence produced by meperidine are similar to those of other opioids such as morphine. The half-life of meperidine is 2.5 to 4 h after therapeutic dosing. Intramuscular doses of 75–100 mg (1– 1.5 mg/kg) of meperidine are equianalgesic to an intramus- cular dose of 10 mg of morphine. And doses less than 50 mg are usually ineffective. Unfortunately, surveys suggest that wide-spread undertreatment occurs in many patients when meperidine is used for analgesia [1]. Moderate-to-severe uncontrollable pain is normal for hospitalized patients [2]. However, there are studies indi- cating that patients receive inadequate medication for their pain [3]. Inadequate pain control might result from misper- ceptions and phobia about addiction to analgesics, which affect not only medical staff, but patients as well [4]. Ac- cording to the definition of the American Pain Society [5], addiction is a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief. Porter and Jick [6] found that only four cases of reasonably well-documented addiction in patients who had no history of addiction among 11,882 patients who received at least one narcotic prepara- tion. However, Lander [2] reported that most nurses be- lieved that addiction was very likely to occur with regular but short-term administration of a narcotic. The reasons for the differences concerning beliefs about addiction among two studies needs to be clarified. Acute pain causes anxiety, chronic pain causes depres- sion [7], and chronic pain is also a risk factor for suicide [8,9]. Suicide, anxiety, and depression are important issues for psychiatrists. Moreover, psychiatric consultations at general hospitals often involve evaluation of suspected an- algesic addiction or psychiatric symptoms resulting from pain. Therefore, psychiatrists in general hospitals need to have a thorough understanding of pain and pain control. Although the fallacies and phobias about addiction have been rather thoroughly investigated [2– 4], there have been few reports about analgesic addiction in psychiatric consul- * Corresponding author. Tel.: +88833-3281200, x2439; fax: +88633- 3280267 (C.-Y. Liu). General Hospital Psychiatry 23 (2001) 31–35 0163-8343/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S0163-8343(00)00105-5