A Physician's Perspective on Miners' "Drug Abuse"

Howard A. Heit, MD and a pain management specialist at Georgetown University offers an informed perspective on "painkiller abuse" among coal miners, in response to the Washington Post's article "A Dark Addiction."  He writes:

"I don't believe the majority of these miners have the disease of addiction....[instead they] are seeking medications appropriately or inappropriately as a result of significant undertreatment of pain."

Dr. Heit's letter to the editor reads:

 "'A Dark Addicition' [front page, Jan 13] documented the experience of miners in western Virginia who work under conditions that cause musculo-skeletal injuries resulting in chronic pain. The article portrayed the miners as addicted to pain medications that were either prescribed by physicians or obtained illegally. They have to drive hours to a methadone clinic to treat this addiction so they can continue to work.

As a pain-management physician, I don't believe the majority of these miners have the disease of addiction. Rather, they have pseudoaddiction, which is characterized by seeking medications appropriately or inappropriately as a result of significant undertreatment of pain. When pain is treated in the proper manner, inappropriate behavior ceases.

Pain is the most common presentation to a physician's office. Yet physicians receive little training in the management of pain or addiction.  As a result, the methadone clinic becomes the last resort for pain medication. It is not surprising, therefore, that drug misuse, addiction or diversion is a major social, legal and medical problem in western Virginia.

Until society approaches pain and addiction as a medical problem, not as a law enforcement problem, the miners and their community will continue to suffer."

Thank you Dr. Heit.