Experience in the Management of Patients Medically Addicted to Narcotics

While narcotic analgesics are of unquestioned value in the practice of medicine, the occurrence of narcotic addiction in the course of treatment for illness is acknowledgment of therapeutic failure. Indeed, prolonged, regular administration of narcotics by the physician to the point of addiction is a last resort in cases in which diagnostic procedures and specific methods of treatment have been exhausted, apparently without adequate effect, on a disease process associated with severe pain. The physician feels that to withhold narcotics from such patients would be unkind, sometimes humanely impossible. This is the basis for the belief, widely held by physicians and occasionally printed in textbooks,1that medically addicted patients should not be withdrawn from narcotics so long as the underlying illness has not been corrected. Furthermore, it is felt that the withdrawal process itself is a form of stress to which the sick person should not be subjected. It