Opioids can cause addiction even in patients with pain

EDITOR—McQuay in his editorial says that we know that if the opioid sensitive pain later resolves treatment can be stopped without patients becoming addicts.1 Does he mean that there is little or no chance of addiction or that occasionally the patient will not become addicted? There is no reference given for this statement.

As a medical student (long before evidence based medicine) I was led to believe that in this situation there was very little risk of addiction. But my faith in this comforting idea was shaken by my experience of being involved with the management of a mountaineer who had severe frostbite of the hands and feet in Nepal 40 years ago. When in hospital in Kathmandu the severe pain in his feet could only be controlled by opioids (pethidine). In discussions about the continued use of this drug I took a relaxed attitude because of the teaching I had received. The man later had to have both legs amputated below the knee. During this time he became thoroughly addicted to pethidine. The management of drug addition was less developed in those days and he decided to come off “cold turkey.” His experience in achieving this is graphically described in his book, No Place for Man.2

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