Opioids (narcotics) and Addiction
Opioids: These are
derivatives of opium that are either morphine or morphine like
substances. See list and
Addiction is a
neurobehavioral syndrome with genetic and environmental influences that
results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite
harm. Addiction may also be referred to by terms such as "drug
dependence and "psychological dependence. Physical dependence and
tolerance are normal physiological consequences of extended opioid therapy
for pain and should not be considered addiction.
only occurs in about 1% of patients using opioids for the treatment of
chronic pain. Persons
at risk include those with a family history of addiction, past addiction
and alcoholism. Addiction is rare in patients who adhere to their
Analgesic tolerance is the
need to increase the dose of opioid to achieve the same level of
analgesia. Analgesic tolerance may or may not be evident during opioid
treatment and does not equate with addiction.
Tolerance will occur in nearly all
patients being treated with long term opioids. This oftn necessitates an
increase in the dosage of opioid medication after a varying period of
Physical dependence on a controlled substance is a physiologic state
of neuroadaptation which is characterized by the emergence of a
withdrawal syndrome if drug use is stopped or decreased abruptly, or if an
antagonist is administered. Physical dependence is an expected result of
opioid use. Physical dependence, by itself, does not equate with
Note. Becoming dependant on an
opioid medication does not necessarily imply that you are addicted.
However, all patients who become addicted display both physical and
psychological dependency on continued use of opioids.
A pattern of drug seeking
behavior of pain patients, who are receiving inadequate pain management.
This is often mislabeled as "drug-seeking" behavior by health care
providers who are not providing skilled long term management of chronic
Note. Pseudoaddiction is
basically an intolerance of the treating physician to the continued
prescription of opioid medications, on the basis that in his/her opinion
the patient is displaying drug seeking behaviors. It maybe an excuse to
stop prescribing opioids.
Substance abuse is the use of
any substance(s) for non-therapeutic purposes; or use of medication
for purposes other than those for which it is prescribed.
Note. Persistent substance abuse is a typical behavior of the
addicted patient, and if not addicted will usually result in addiction.
pain state which is persistent and in which the cause of the pain
cannot be removed or otherwise treated. Chronic pain may be associated
with a long-term incurable or
intractable medical condition or disease.