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Howard Hughes and Pseudoaddiction

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Howard HughesWith the emergence of opioid treatment of intractable pain (defined here as incurable, severe, and constant), there is great interest in the long-term survival of patients who require such treatment. At this time, there are no published reports of opioid-treated, intractable pain patients who have survived over a decade.

Because of a combination of fame and wealth, the revisiting of the Hughes case was made possible due to the volume of detailed public records available. Underneath the glamour, glitz, sex, money and politics that surround the saga of Howard Hughes, there is a serious and tutorial medical story from which all concerned parties can benefit. Hughes lived 30 years while taking high dosages of codeine in an average daily dosage between 20 and 45 grains a day. He survived a plane crash in 1946, developed intractable pain, and died 30 years later in 1976 due to specific anti-inflammatory agents that, over time, produced kidney failure.1-3

This author was contacted in 1978 by the U.S. Drug Enforcement Agency to be a consultant on Hughes. I was given copies of Hughes’ autopsy report, post-mortem toxicology analysis, birth certificate, death certificate, a 1958 memo written by Hughes involving medication acquisition, and a daily log of medication administration kept by his aides and dated October 31, 1971 through July 1, 1973. These materials were presented in a public trial and are not confidential documents.3 This log, covering his habits and behavior in detail, was in the 25th and 26th year after his plane crash and continuous consumption of opioids. It is very revealing as to how he treated his pain and continued to function.

In September 1978, this author compiled a written report for the U.S. Government based on the aforementioned documents. In addition, this author appeared as an expert witness in the Ogden, Utah, Federal trial, U.S. vs. Thain (Hughes’ physician in the last years of his life)3 and was able to interview two of Hughes’ now-deceased, personal physicians about Hughes’ medical history and treatment.

It is cogent to point out that in 1978, this author was fully vested in addiction research and treatment and had only begun to research and treat intractable pain patients with opioids. Consequently, the resulting 1978 analysis of this matter, including terminology and biologic concepts, were archaic given the monumental, historic, and scientific breakthroughs in the understanding of addiction and pain that have occurred since 1977.

Due to the great interest in the long-term survival of pain patients treated with opioids, a re-analysis and report of Hughes at this time is most informative and instructive for physicians and patients. This re-analysis incorporates many of the current terms, concepts, and scientific advances that have emerged in the past 30 years. To provide perspective on how pain management has matured since that time, some relevant terms are shown in Table 1.

Table 1. Some Pain Treatment Changes in Terminology and Concepts During the Past 30 Years





An addict was anyone who took a prescription drug in dosage above the usual frequency or for an extended duration

An individual who compulsively uses a substance for non-pain purposes


Term not used

Syndrome in which an individual who seeks drugs for pain relief since their pain is out of control


Term not used

Incurable, severe, constant pain

Breakthrough Pain

Term not used

A flare of pain above the usual baseline pain level

Short and Long-acting Opioids

Term not used

Usual treatment for severe intractable or persistent pain is a long-acting opioid plus a short-acting one for breakthrough pain

Pain Characterization

Essentially none

Common classes include neuropathic, myofacial, and reflex sympathetic dystrophy

Effect of Renal Failure on Drug Serum Levels

Little understanding

Poor renal clearance may greatly raise serum levels of therapeutic drugs

Morphine Equivalency

Unheard of

Pain potency of all opioids are equated to the effect of 1 mg of morphine

Precipitating Cause of Pain and Initiation of Opioid Treatment
Born in 1905, Hughes was a world-recognized, pioneering entrepreneur engaged in diverse businesses that included chemicals, plastics, moving pictures, entertainment, and aircraft design and development. In 1946, at the age of 41, Hughes solo-tested an experimental reconnaissance plane known as the XF-11. Shortly after take-off from the Santa Monica, California, airport, he crashed. He miraculously survived the crash and was immediately hospitalized at Good Samaritan Hospital in downtown Los Angeles. His injuries were numerous and included multiple fractures and third-degree burns (see Table 2). He required three chest drainings, since he recurrently bled into his left chest cavity. Four skin grafts were required to close a large third-degree burn extending from his shoulder to hip. He remained at Good Samaritan Hospital for about 5 weeks between July 7 and August 11, 1946. Hughes was given morphine while hospitalized and was discharged on codeine. A detailed list of Hughes’ injuries are listed in Table 2 to emphasize that essentially no one can survive these injuries without developing intractable pain.

Last updated on: November 21, 2011
First published on: July 1, 2007