Many of those with addiction may not have the power or influence to bail themselves out of prison or pay tens of thousands of dollars in court costs. It also makes it more difficult for people with severe pain to receive the care they deserve, whether their abuse is caused by addiction or, as is often the case, a symptom of undertreated pain. But conflating his drug abuse and associated illegal activities with the opinions he expressed about social issues harms people who suffer from the disease of addiction. Some people may agree with Limbaugh's political and social views, and others may not. And, increasingly, patients cannot access the opioids they need due to misguided polices and regulations. Sometimes, opioids fail to provide adequate relief for them. Limbaugh exemplifies the type of patient most physicians face when treating serious pain conditions. The answers to these questions - about his history of drug abuse, mental health and motivation - would have told us whether his opioid use disorder (OUD) was treatable with better pain control or, tragically, was an incurable disease. What we didn't know, and perhaps now can never ascertain, is whether Limbaugh had an addiction or an undiagnosed psychiatric disorder (although some may argue his professional conduct was evidence of a disturbed personality). We also can't know whether his main motivation for using drugs was to control physical pain, to mask emotional pain or stress, to seek a "high," or some combination of those reasons. I wrote about Limbaugh's prescription drug problem in my book, "Avoiding Opioid Abuse While Managing Pain." What we knew about Limbaugh's problem, as I said at the time, was that he abused large quantities of prescription opioids for several years kept his abuse secret from family, friends and colleagues entered a rehabilitation program twice, but relapsed each time remained successful without a visible reduction in functioning while he used drugs and was suspected of buying drugs illegally. He was eventually arrested on drug charges - specifically, charges of fraud to conceal information to obtain prescriptions, also known as "doctor shopping." In exchange for having the charges dropped, Limbaugh agreed to undergo drug treatment and pay $30,000 in court costs. He posted $3,000 bail and was released. Limbaugh began abusing prescription painkillers after his spinal surgery in the 1990s.
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