Opioids: Addiction vs. Dependence
One of the greatest obstacles chronic pain patients face in their quest for adequate pain relief is the widespread misunderstanding of the difference between physical dependence on a drug and addiction. Many patients, the general public, and sadly even some physicians fear that anyone taking opioid medications on a long-term basis will become addicted. As a result, pain patients are often labeled as “drug seekers” and stigmatized for their use of opioid medications. Worst of all, their pain frequently remains under-treated.
Understanding the Terminology
Before we can adequately discuss this topic, it is important to clearly define the terms we will be using.
Addiction is a neurobiological disease that has genetic, psychosocial, and environmental factors. It is characterized by one or more of the following behaviors:
- Poor control over drug use
- Compulsive drug use
- Continued use of a drug despite physical, mental and/or social harm
- A craving for the drug
Physical dependence is the body’s adaptation to a particular drug. In other words, the individual’s body gets used to receiving regular doses of a certain medication. When the medication is abruptly stopped or the dosage is reduced too quickly, the person will experience withdrawal symptoms. Although we tend to think of opioids when we talk about physical dependence and withdrawal, a number of other drugs not associated with addiction can also result in physical dependence (i.e., antidepressants, beta blockers, corticosteroids, etc.) and can trigger unpleasant withdrawal symptoms if stopped abruptly.
Tolerance is a condition that occurs when the body adapts or gets used to a particular medication, lessening its effectiveness. When that happens, it is necessary to either increase the dosage or switch to another type of medication in order to maintain pain relief.
Pseudoaddiction is a term used to describe patient behaviors that may occur when their pain is not being treated adequately. Patients who are desperate for pain relief may watch the clock until time for their next medication dose and do other things that would normally be considered “drug seeking” behaviors, such as taking medications not prescribed to them, taking illegal drugs, or using deception to obtain medications. The difference between pseudoaddiction and true addiction is that the behaviors stop when the patient’s pain is effectively treated.
Can a chronic pain patient become addicted to opioid drugs? Although most chronic pain patients who take opioids on a long-term basis will become physically dependent on them, very few will ever become addicted to them. The rare few who do develop a problem are often highly susceptible to addiction due to a genetic predisposition. In a review of 24,000 patients who were medically prescribed opioids, only seven could be found who got into trouble with them. So a chronic pain patient becoming addicted to opioid medications is definitely the exception rather than the rule.
How can you tell if someone is addicted to an opioid drug?
People who become addicted to opioid drugs usually report getting a feeling of euphoria or being “high.” They soon need increasing amounts of the drug to maintain that same high feeling. Unfortunately, this frequently leads to an ongoing and often desperate search for more of the drug through whatever means possible - legal or illegal.
Some behaviors that may be suggestive of possible addiction include:
- Taking medications more frequently or at higher dosages than prescribed.
- Ingesting drugs in ways other than directed, such as crushing, snorting, or injecting.
- Frequent reports of lost or stolen prescriptions.
- Doctor shopping.
- Using multiple pharmacies.
Following are some of the key differences between addicts and pain patients:
Addicts take drugs to get high and avoid life
Pain patients take drugs to function normally and get on with life.
Addicts isolate themselves and become lost to their families.
When pain patients get adequate relief, they become active members of their families.
Addicts are unable to interact appropriately with society.
When pain patients get adequate relief, they interact with and make positive contributions to society.
Addicts are eventually unable to hold down a job.
When pain patients get adequate relief, they are often able to go back to work.
The life on an addict is a continuous downward spiral.
When a pain patient gets adequate relief, their life progresses in a positive, upward direction.
The American Academy of Pain Medicine, The American Pain Society and the American Society of Addiction Medicine. (2001). Definitions related to the use of opioids for the treatment of pain. Retrieved December 1, 2008, from American Pain Society Web site: https://www.ampainsoc.org/advocacy/opioids2.htm
The National Institute on Drug Abuse. Addiction vs Dependence. Retrieved December 1, 2008 from Our Chronic Pain Mission Web site: https://www.cpmission.com/main/addiction.html
© Karen Lee Richards 2008 Updated 12/1/2008
Karen is the Co-Founder of the National Fibromyalgia Association. She wrote for HealthCentral as a patient expert for Pain Management.