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Opioids (narcotics) and Addiction


Opioids:
These are medications are derivatives of opium that are either morphine or morphine like substances. See list and pictures


Addiction:
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.

Note
. 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 doctors prescription. 

Analgesic Tolerance: 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.

Note.
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 time.

Physical Dependence: 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 addiction. 

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.

Pseudoaddiction: 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 pain.

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: 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.

Chronic Pain: A 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.

 

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