Addiction vs Dependence and Opiods.....thank you Mikie

Discussion in 'Fibromyalgia Main Forum' started by Lynna62, Dec 10, 2006.

  1. Lynna62

    Lynna62 New Member

    This is so important I think it deserves a post of it's own where it can be easily found. I have even handed out copies of this article to well-meaning but uneducated friends and relatives, as well as Doctors. I have been fortunate enough to have a Rheumy that has prescribed opiates to me for 13 years now. Yes, I am somewhat dependent, but NOT addicted. I had an AWESOME summer and was able to go 109 days without a Vicodin, without even weaning off of them. Unfortunately it didn't last but I am so grateful for the "normal" summer I had. Thank you to Mikie for posting the original.
    ------------------------------------------------------------

    Definitions Related to the
    Use of Opioids for the Treatment of Pain



    The American Academy of Pain Medicine, The American Pain Society and the American Society of Addiction Medicine

    Consensus Document

    BACKGROUND

    Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction, especially in situations in which opioids are used, or are being considered for use, to manage pain. Confusion regarding the treatment of pain results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals.

    Many medications, including opioids, play important roles in the treatment of pain. Opioids, however, often have their utilization limited by concerns regarding misuse, addiction and possible diversion for non-medical uses.

    Many medications used in medical practice produce dependence, and some may lead to addiction in vulnerable individuals. The latter medications appear to stimulate brain reward mechanisms; these include opioids, sedatives, stimulants, anxiolytics, some muscle relaxants, and cannabinoids.

    Physical dependence, tolerance and addiction are discrete and different phenomena that are often confused. Since their clinical implications and management differ markedly, it is important that uniform definitions, based on current scientific and clinical understanding, be established in order to promote better care of patients with pain and other conditions where the use of dependence-producing drugs is appropriate, and to encourage appropriate regulatory policies and enforcement strategies.


    RECOMMENDATIONS

    The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definitions and recommend their use:

    ADDICTION

    Addiction is a primary, chronic, neurobiologicneurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

    PHYSICAL DEPENDENCE

    Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

    In the case of sedative drugs, spontaneous withdrawal may occur with continued use. Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.


    DISCUSSION

    Most specialists in pain medicine and addiction medicine agree that patients treated with prolonged opioid therapy usually do develop physical dependence and sometimes develop tolerance, but do not usually develop addictive disorders. However, the actual risk is not known and probably varies with genetic predisposition, among other factors. Addiction, unlike tolerance and physical dependence, is not a predictable drug effect, but represents an idiosyncratic adverse reaction in biologically and psychosocially vulnerable individuals. Most exposures to drugs that can stimulate the brain's reward center do not produce addiction. Addiction is a primary chronic disease and exposure to drugs is only one of the etiologic factors in its development.

    Addiction in the course of opioid therapy of pain can best be assessed after the pain has been brought under adequate control, though this is not always possible. Addiction is recognized by the observation of one or more of its characteristic features: impaired control, craving and compulsive use, and continued use despite negative physical, mental and/or social consequences. An individual's behaviors that may suggest addiction sometimes are simply a reflection of unrelieved pain or other problems unrelated to addiction. Therefore, good clinical judgment must be used in determining whether the pattern of behaviors signals the presence of addiction or reflects a different issue.

    Behaviors suggestive of addiction may include: inability to take medications according to an agreed upon schedule, taking multiple doses together, frequent reports of lost or stolen prescriptions, doctor shopping, isolation from family and friends and/or use of non-prescribed psychoactive drugs in addition to prescribed medications. Other behaviors which may raise concern are the use of analgesic medications for other than analgesic effects, such as sedation, an increase in energy, a decrease in anxiety, or intoxication; non-compliance with recommended non-opioid treatments or evaluations; insistence on rapid-onset formulations/routes of administration; or reports of no relief whatsoever by any non-opioid treatments.

    Adverse consequences of addictive use of medications may include persistent sedation or intoxication due to overuse; increasing functional impairment and other medical complications; psychological manifestations such as irritability, apathy, anxiety or depression; or adverse legal, economic or social consequences. Common and expected side effects of the medications, such as constipation or sedation due to use of prescribed doses, are not viewed as adverse consequences in this context. It should be emphasized that no single event is diagnostic of addictive disorder. Rather, the diagnosis is made in response to a pattern of behavior that usually becomes obvious over time.

    Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may "clock watch," and may otherwise seem inappropriately "drug seeking." Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated.

    Physical dependence on and tolerance to prescribed drugs do not constitute sufficient evidence of psychoactive substance use disorder or addiction. They are normal responses that often occur with the persistent use of certain medications. Physical dependence may develop with chronic use of many classes of medications. These include beta blockers, alpha-2 adrenergic agents, corticosteroids, antidepressants and other medications that are not associated with addictive disorders.

    When drugs that induce physical dependence are no longer needed, they should be carefully tapered while monitoring clinical symptoms to avoid withdrawal phenomena and such effects as rebound hyperalgesia. Such tapering, or withdrawal, of medication should not be termed detoxification. At times, anxiety and sweating can be seen in patients who are dependent on sedative drugs, such as alcohol or benzodiazepines, and who continue taking these drugs. This is usually an indication of development of tolerance, though the symptoms may be due to a return of the symptoms of an underlying anxiety disorder, due to the development of a new anxiety disorder related to drug use, or due to true withdrawal symptoms.

    A patient who is physically dependent on opioids may sometimes continue to use these despite resolution of pain only to avoid withdrawal. Such use does not necessarily reflect addiction.

    Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects. For example, in the case of opioids, tolerance usually develops more slowly to analgesia than to respiratory depression, and tolerance to the constipating effects may not occur at all. Tolerance to the analgesic effects of opioids is variable in occurrence but is never absolute; thus, no upper limit to dosage of pure opioid agonists can be established.

    Universal agreement on definitions of addiction, physical dependence and tolerance is critical to the optimization of pain treatment and the management of addictive disorders. While the definitions offered here do not constitute formal diagnostic criteria, it is hoped that they may serve as a basis for the future development of more specific, universally accepted diagnostic guidelines. The definitions and concepts that are offered here have been developed through a consensus process of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.
  2. caffey

    caffey New Member

    When I was in hospital 2 years ago. The doctor walked in and said your body is dependent on the drugs but you are not an addict and you need to know that. He kept repeating himself several times. He then went on to say. Addiction is when you use the drugs more often than what is prescribed and in ways other than prescribed i.e. shooting, snorting etc. Dependency is a physical thing and if you discontinue the drugs suddenly you will go into withdrawal but it is not addiction. It so changed my life. I have just started going to a pain clinic and he told me the exact same thing. Also I don't know about your laws in the US but in Canada it is illegal to get narcotics from more than one doctor within 30 days. I was also told one doc, one pharmacy and you won't get yourself into trouble. It is time for those who are on narcotics to quit feeling guilty about taking them or allow others to make them feel guilty. If you need them you need them just take them as prescribed. NUF said.
    Cath
  3. Mikie

    Mikie Moderator

    Those who have known me here for a while know that this is one of my passions--to stop the judgement which comes from ignorance of the difference between dependence/withdrawal and psychological addiction.

    Before the Guai treatment made taking narcotics unnecessary for me, I was on Morphine and later on Vicodin. Before I got sick, I was one of those people who was scared to death of narcotics. If anyone had ever told me I would need them on a regular basis, I would have thought them crazy.

    Docs prescribe medications which, in my opinion, are far more dangerous than narcotics. They will write prescriptions without warning their patients of the side effects and don't even follow up with their patients. Yet, these same docs are woefully ignorant when it comes to opiods. I call it the "Reefer Madness Mentality."

    The best thing we can do for ourselves is to learn everything we can about any med or treatment before we are willing to take it. We need to carefully weigh the potential risks versus the potential benefits and decide. I take Klonopin which I consider to be a heavy-hitter med. It cannot be withdrawn suddenly without serious withdrawal symptoms, including the possibility of seizures. This drug has been a God send to me, allowing me to sleep, stopping the horrible sensory overload which kept me from being able to shop or eat out, and putting an end to my anxiety and panic attacks. It also helps with muscle spasms, tinnitus, and pain. All things considered, I decided that it was worth the risks. I'm not addicted to it but I am certainly physically dependent on it.

    Very, very few people who take opiods for chronic pain become psychologically addicted to them. For the rest of us, they are a lifesaver. No one should have to suffer horrible chronic pain. It destroys the body and the spirit. We need not justify our decisions to others nor be diminished by their judgemental reaction. This includes our families who think they have our best interest at heart. They probably do but this is our decision to be made with our docs.

    Love, Mikie
  4. julieisfree05

    julieisfree05 New Member

    My WONDERFUL Neurologist has stated more than once that:

    "Withholding pain relief from a pain patient is just as unethical as withholding insulin from a diabetic."

    Again, NUFF SAID!

    - julie (is free!)
  5. krchamp

    krchamp New Member

    Julie. I had never thought of it that way. My doc is really good about treating my pain.

    My dad gives me that look anytime I take something. I think next time I will just tell him what your doc said.

    Thanks!
    Kristi
  6. julieisfree05

    julieisfree05 New Member

    I got that kind of thing from friends and family, but they finally understood that without the pain medication, I would have had NO life at all.

    The other way my doctor describes the difference between addiction and pain relief is that proper pain control IMPROVES quality of life, while addiction DECREASES quality of life.

    If you are able to function better with pain medication, addiction is probably not an issue.

    Addicts will lie, cheat, steal, or do whatever they have to in order to feed their habit. Their quality of life and ability to function overwhelmingly decreases.

    - julie (is free!)
  7. Mikie

    Mikie Moderator

  8. Mikie

    Mikie Moderator

    This is an important message.

    Love, Mikie
  9. naturebaby

    naturebaby New Member

    Another bump...this topic is SO important!!!
  10. lin21

    lin21 New Member

    For those of you have read my posts, you know that my DH had an addiction to his meds and went to a rehab this couldn't have been posted at a better time.
    I am living this every day.
    Although we were walking on egg shells for a few weeks , he "seemed" to be more himself, now he is driving me crazy.
    He doesn't see a problem with him going to meetings in our town and he is wearing this like a badge of honor. on the other hand I see the problem with this and it has torn us apart.
    He now calls me the only drug addict in the house. I was on over 20 meds before i was prescribed oxycontin and it was the only med my body responded to. For anyone that doesn't know, you don't get high when you take it as prescribed. His family blames me for his addiction even though he conned his doctor into prescribing them for him and didn't take them as prescribed. I am not changing my meds or going off them because of his problem.
    He is tearing our family apart but so be it, it was his choice.
  11. Mikie

    Mikie Moderator

    Rehab includes taking responsibility for one's own actions. If he has an addiction problem; it's his problem and his responsibility.

    It is not unusal for a reformed addict to act like this but it's clear that he needs therapy to deal with this. He's new to this and it seems like some reformed addicts have to almost wear it on their sleeves to convince themselves that they are now different. It's kind of a form of fear of falling off the wagon using false bravado as a facade.

    Encourage him to get a sponsor, if he doesn't already have one, and attend meetings. Good luck.

    Love, Mikie
  12. BethM

    BethM New Member

    Thank you for posting this article. This is such a vital topic for those of us who deal with chronic pain. The article is written clearly and well.

    I will be seeing my new primary care doc the first week in January to discuss meds and fibro, and I will need a new script for Darvocet. I've seen this doc once, and she looked at me sideways when I told her I take Darvocet daily. So, it will be an interesting appointment. I may print out this article, or email it to her.

    I am not a good candidate for drug addiction. I have a very low tolerance to anything that is sedating. Don't think I could take enough to become truly addicted. (I cut the Darvocet in half, as a whole one puts me to sleep very quickly and leaves me groggy most of the next day. Half a
    Darvocet is a perfect dose.) Despite taking it for several years I have not developed much tolerance to the Darvocet, for which I am grateful.

    However, physical dependence is a totally different issue. I do have occasional days when I realize in the evening that I haven't needed to take any pain meds, and that is simply a miracle in my mind, something to celebrate. I hope my doctor can understand this.

    Chronic pain is misunderstood by most people in our society. I certainly hope that more doctors will educate themselves and keep their personal biases tucked far away, when they treat their patients.

    Peace,
    Beth.
  13. Lendy5

    Lendy5 New Member

    Bumping for others to read. Excellent article.

    Love & Hugs,
    Carolin
  14. suzetal

    suzetal New Member

    And who bumped it.........Christmas Eve at my best friends house............Her sister in-law asked what kind of medication you on now????? I told her and she had the nerve to ask me what kind of high do you get from it....

    I started to say High............When my husband interrupted me and informed her that I do not get a high from my pain medication cause I need it.............I am not just using I need .........So I do not get a high....

    Than she directed her ??? to me again and I told her I felt my husband had answered it.......SHE SAID YEH BUT HES NOT THE ONE TAKING THE METHADONE you are.I again told her that I do not get high.

    She still did not believe me and asked me for a few so she could try it for herself.I said that if she needed pain meds. she should see her doctor.........Than I asked what she had .....She said her doctor thought she might have Lupus or RA but her doctor was not sure so he would not give he anything for pain...

    I told her well I'm not sure either so I am not going to give you any of mine either......She said I miss understood she just wanted to see if I got a HIGH from them...........

    I told her my husband and I both said no I don't and you need to get them from your Doctor not me ........That was it I did not give her any......Than she had the nerve to ask my friends husband if I had given him any ( He just had major back surgery and he told her he was out of his Oxcycoten) so she assumed I gave him a few ....She assumed wrong I do not share my medication.....

    He was not out but he knew she was an addict but never had time to tell me.I could tell she was by her questions.

    I still never share...And I do not get that high they all talk about......I need my medication for pain nothing else....//////////////........Pain is not fun neither is having to take medication all the time......NOT FUN.

    Sorry about my long answer but I needed to get this off my chest.

    Sue
  15. Mikie

    Mikie Moderator

    What an uncomfortable experience for you. Kudos to hubby for standing up for you. He sounds like a keeper.

    There is so much ignorance out there regarding pain and opiods. It doesn't help when people like this woman engages in drug-seeking behavior.

    Love, Mikie