Opioids: Addiction vs. Dependence

Discussion in 'Fibromyalgia Main Forum' started by gapsych, Jun 18, 2010.

  1. gapsych

    gapsych New Member

    I try not to post long articles but dependency vs. addiction is an important disctinction. If you are like me sometimes copying and pasting URLs can be difficult. This is an article people might want to print out and keep.

    Didn't we used to be able to post urls where you only had to click to get to the site? Am I misremembering? Won't be the first time.

    Sources are at the end of this article.

    Opioids: Addiction vs. Dependence
    by Karen Lee Richards, ChronicPainConnection Expert

    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 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: http://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: http://www.cpmission.com/main/addiction.html
  2. heapsreal

    heapsreal New Member

    If you need drugs for a medical condition to improve quality of life, go for it.
    if u take drugs to get high and cant stop, then your addicted, maybe self medicating for depression/anxiety, maybe??

    Just a thought
  3. gapsych

    gapsych New Member



    ETA Missed your last couple of sentences. Alcohol may also be self medicating for depression, anxiety, you name it. Good point.[This Message was Edited on 06/18/2010]
  4. Doober

    Doober New Member

    When it is found that someone is on pain medication for a long period of time because they need it in order to function. They are automatically termed an addict.

    You and I know the difference between someone who has an addiction or who has a dependancy. But the majority of folks out there really do not know the difference.

    We can definately thank those who were seeking these types of drugs for the "high" like those who were robbing drug-stores, which forced many of them to stop stocking certain kinds of meds.

    I mean, I CANNOT imagine what someone who has a dependacy on the mads to control real pains must go through when they are FORCED into rehab to get them off the meds because family members think they know better.

    Not only the withrawals of the meds , but the return of the pains for which they were taking the meds for.

    There is definately different types of treatment of different people. Someone has surgery, given pain meds and are told, "hey take the meds so you can recover without pain. But when a chronic sufferer is given the same meds, after a while, views of that person changes.

    These types of articles are great for us to read, but the even better thing to do is print them out and just leave them in open areas around your home.

    We often say that we want to print these things out and hand them to friends and family, never works, though. But when you print them out and leave them just laying around, there is something very different to a person's interest when they are "snooping" around the house just reading other people's things.
  5. gapsych

    gapsych New Member

    Good point. I think this can indeed happen. However, some people end up having to up their medication to control the pain. This is a bit different than taking it to get high.

    I know your have also reported that you think there was a strong genetic component with your daughter's situation.

    Not everyone who starts out on pain medication for legitimate pain end up getting addicted. But some people who are predisposed may end up becoming addicted just like others who start out self medicating without any physical but mental pain.

    If you are taking the correct amount of pain meds. it should not make you "high" but take away any debilitating pain.

    When there are legitimate reasons to take these medications, there should be no stigma attached. Hopefully, people are getting more educated about this topic.
  6. gapsych

    gapsych New Member

    Rebound pain is very real. This is why it is so important to be monitored by a doctor with lots of experience in this area. I know that some doctors may have you rotate several meds instead of taking the same one continuously. I know my daughter did experience rebound when she had migraines but she had a pain specialist at the "headache clinic" who was very knowledgeable. She is now on one of the newer medications so does not have to take these anymore.

    I rarely have headaches, today being an exception and I would not wish that kind of pain, well I guess any kind of pain on anyone.

    I had a friend who just had her knee replaced and it was very painful but it has really helped. I know there are no guarantees with these type of surgeries and not an easy decision to make.

  7. bigmama2

    bigmama2 New Member

    i once had a neck injury that was severely painful. the kind of pain that you feel searing into you and makes your eyes tear up and you want to pull your hair out. i couldnt take it!!!! i screamed/yelped at my dr to give me "the good stuff"- now!!! it was necessary!! so i took narcotic pain meds for a week or two or three - i forget- while i underwent physical therapy and traction. as injury improved, i weaned off the meds. yes i got bad constipation- but HELLO- what is worse... severe screaming pain, or not being able to take a normal crappe?

    pain meds are necessary sometimes. anyone who has ever had severe pain will understand that.

  8. Misfit101

    Misfit101 New Member

    THANK YOU for posting this. I never understood the getting high thing cos ive NEVER experienced it. And i dont need increasing amts of my meds either. Once we got the dosage to where it was adequate ive been on that same dose for 4 yrs. When i overdo things i have my breakthru meds. I can go days or weeks wo needing them. Just depends on what i get myself into. I would challenge anyone that would judge me to live a wk in my body sans meds. You couldnt do it...trust me. Im not so sure i ascribe to the disease concept of addiction...but im not in a position to argue about it. And i dont hide the fact that i have to take meds...i dont care what anyone thinks and they dont dare challenge me. If they could live with the constant pain from feeling like someone SLAMMED a hammer in their back...more power to em.
  9. hermitlady

    hermitlady Member

    I have had an interesting experience that I'd like to share, please no bashing, arguing etc. This just might help someone, and I lived to tell the story, so here goes.

    Due to FM pain, I started taking Vicodin a few yrs ago. Started w 5/500's once or twice a day as needed. It made me feel so much better, less pain, more energy, it was a lifesaver.

    Gradually, due to various reasons unknown to me (stress the main factor I believe), my pain levels gradually increased, and so did my daily dosing requirements. Over a year or so I went from 1 pill a day to 6...then I was bumped up to the next higher strength Vicodin. (7.5mg hydro I think)

    I can't remember exactly how long I took that strength, maybe 9 mos or so, but my pain levels continued to increase....and I needed more meds to feel functional. Now, you could have NEVER convinced me that my pain was increasing due to the meds, it felt like the same type of FM pain, just greater.

    I would wake up in the morning after not having taken a dose during the night (7 or 8 hrs) and I was in misery. My legs and feet were always screaming and throbbing until I took my first dose of the day...an hour or so later I was up and moving. I continued to take my doses every 4-6 hrs depending on how I was feeling that day.

    Probably after almost 2 yrs total, I was up to Norco 10/325 because I needed even more relief and I also wanted less aceto going into my system. I gradually ended up at my max dosage on these after 6-8 months. My body just built up a tolerance, simple as that. And, my pain was worse than ever when each dose wore off.

    I NEVER got high at all, just felt more human due to reduced pain levels, and therefore had a bit more energy and better mood.

    OK, so I was still convinced all of this horrible pain was due to the FM. Some days I would take a couple extra pills, some days fewer. It again gradually crept up on me and I consistently was taking my max dosage and worrying about running out of pills early each month. I had a giant monkey on my back!

    This is all hindsight, when I was in the midst of it all, it was all just about the pain and keeping it at bay. My mental state was also effected, poor memory, spaciness (but didn't think it was the meds, just brain fog), etc. My physical appearance also deteriorated, I was bloated and pale.

    Ok, so I had some input from my husband and sisters because they were concerned about my health....and I was secretly getting worried myself. Didn't really want to admit it, but I knew I was dependent on these meds.

    A couple of times I took several extra pills at a time just to numb myself down, not to attempt suicide, I was really suffering. Then I'd be wasted for a couple of days afterward, depressed, etc. I was starting to bottom out, and not letting anyone know I felt so trapped. I felt weak and stupid, but I was in terrible pain.

    From all of this happening over the final couple of months, I decided to try and detox to see how I'd feel w/o the Norco. I was basically terrified and didn't think I could function off the Norco.

    I went inpt and was given Suboxone, Flexeril for a wk to wean off the Norco. I was so sick, in horrible pain, extremely weak....took my final dose of Suboxone and was sent home the same day. After that, I went thru withdrawals from the Sub at home, really awful.

    I also must mention the group therapy that I participated in while in detox. It was disturbing to me because they wanted me to refer to myself as an Addict. I never felt I was an addict, just dependent on my pain meds. I never doctor hopped or any of the addictive behaviors commonly practiced. I was in there w heroin addicts, alcoholics, meth addicts, you name it.

    I was mainly terrified of the pain I would still have from the FM when the drugs were out of my system. They were supposed to provide pain mgmt strategies during that week, but they barely touched on the topic. I didn't want to think about living in pain, it was so scary.

    Long story short....the first 2 months clean, I was so miserable. Still had bad pain, and now it was constant. Only took Advil, and sometimes Flexeril and Celebrex. I no longer had a single pill of Norco in my possession, and I know I would have caved in and taken it if I had found some...definitely craved it to give me some relief.

    I went thru detox and came home the 4th of Feb 2010, so it's been 4.5 months. I'm feeling sooo much better now, my pain has decreased an incredible amount. I still have days where I feel bad, but it is NOTHING like I was feeling while on the narcs.

    If you had tried to tell me that I'd be improving like this over time, I wouldn't have bought it. My doc said to give it 6 mos to recover. I admit, I still have fatigue and weakness along w the pain, and I do suffer depression along the way. But the pain is tolerable now, and I only take Advil once or twice a day on average.

    I just want to share this if it could possibly give anyone here hope for less pain w less meds. I am a true example of this phenomenon, HONESTLY!

    Don't get me wrong, take the meds if you need them...I know we all need relief sometimes. Pain is torture, we deserve a better quality of life. If it comes to a point where I need narcs again, I would take them, but now I know how my body responds from their daily use. Live and learn!

    I did try several different narcs over time, but the hydro meds were the best for my body. Everyone is so different, my system is very sensitive and picky about it's med tolerance. Also, the last year or so I was given a low dose of Methadone along w the Norco since it was longer acting. This is another med that's hard to detox from.

    So, that's my story...and I still do not believe I was an addict!
    [This Message was Edited on 06/19/2010]
  10. hermitlady

    hermitlady Member

    I was told during detox that I should attend AA or NA mtgs and I did go to a couple of them while in the hospital. Everyone there told me it was absolutely necessary to have support of this kind in order to stay free of my addiction.

    I just could not relate to their program, and 95% of the people there were recreational drug addicts, not chronic pain sufferers. There's a huge difference in the mindset of these 2 groups of users. They got very defensive w me and almost ridiculed me for saying I was not an addict. It wasn't very supportive IMO.

    I knew I wasn't going to hit the streets looking for Norco...I had never done that before, why would I now?? In fact, when I spoke to my doctor about my concerns of taking narcs, he told me as long as I wasn't robbing liquor stores to pay for my habit, I was fine! LOL

    Also, I was never able to find any support for chronic pain related drug use/detox, just for the "addicts". Kind of an unfair situation if you ask me.....

    [This Message was Edited on 06/19/2010]
  11. siestasuze

    siestasuze New Member

    It is so nice to have information like this shared! I have fibromyalgia and have suffered from chronic pain before I was even diagnosed. Since being diagnosed, 10 years ago, the ONLY pain relief I've gotton is from Opiods.

    Actually, I am on same dose of opiods as when first diagnosed. Being able to avoid "tolerance" and not have to increase dosage needed for pain relief for last 10 years, is due to switching to different types of opiods, and back and forth. Only way my Dr. has allowed me to continue using these types of meds.

    I am one of those who has never felt euphoria or highs from any of the meds used. From Fentanyl patches, kadian (morphine), percocet, and oxycontin. Therefore, I have NEVER felt guilty for using these meds because they are controlled! Without them, I would be laying in bed suffering from unbearable pain, or worse-not being here in order to avoid living in pain. Dont misunderstand, I still have pain, but it is tolerable.

    Sorry to ramble, just wanted to speak up and say it is OK to use opiods for pain relief. As long as you avoid misusing, and take ONLY as prescribed. It's people who misuse these meds who make it harder for the people who really need them for pain relief to get them.

    Anyway, thanks again for the posting of this article!! It helps to have information like this to show close family members who are worried about the use of opiods, helps to validate the difference between using for relief of chronic pain and abusing.

    Apologies again for such a LONG post, I just hate when people get labeled as "druggies" just because they need to use opiods in order to fight chronic pain. :) suze
    [This Message was Edited on 06/19/2010]
  12. gapsych

    gapsych New Member

    What a horrible, horrible experience.

    Taking meds. to get high is very different. It seems like there should be a program for what you needed.

    Great that you are feeling better and that the liquor stores are safe.

    Take care.

  13. hermitlady

    hermitlady Member

    I saw a show last wk about addiction, and they showed an addict using Oxy in a way I had never heard of. I won't go into detail, but due to these reality shows, many folks are getting educated about things that they would have never known otherwise. And not good things....Gee, now I know another way to potentially get high from narcotics, thank you so much DirecTV!

    Suze.....You've been lucky to not have developed a tolerance, I did try switching meds around like you have, but could only tolerate the Vic and Norco...Hydrocodone was my friend.

    Gap.......Yes, the fellow at the neighborhood Stop N Shop is breathing a little easier these days!!![This Message was Edited on 06/19/2010]
  14. gapsych

    gapsych New Member

    People just do not realize how pain can effect you.

    Strangely enough, opiods do not help my pain and the tramadol seems to work. I know I am very very lucky and fear that someday it won't.

    I just think it is such an important distinction to make and could save a lot of grief that we sometimes get over this issue.

    Take care.


  15. hermitlady

    hermitlady Member

    And if you watch enough TV, you can indeed find new things to mess yourself up with. There should be more restrictions on some of these reality tv shows....

    Huh, TV can be addicting too. Hmmmm.

    Today I seem to be addicted to my laptop, I've posted more today than I have in the last month!
  16. gapsych

    gapsych New Member

    I can not stand reality TV. I have watched HGTV's design star.

    It almost matches the drama on this board.

  17. Misfit101

    Misfit101 New Member

    The addicts already know every way possible to abuse a drug. And what they dont know another addict will show them. They dont need to learn it from a tv show. Its the ppl who ARENT addicts that learn. And since theyre not using narcotics to get high with it doesnt matter. Those kinds of shows just might help someone else recognize addict behavior in someone they care about. Discovering that someone you love is an addict isnt the hardest part...getting THEM to see it and get help is.
  18. gapsych

    gapsych New Member