Nov 22, 2009
Almost weekly on the PM Forum I hear about the fear of addiction. The questions, concerns and accusations come from Chronic Pain (CP) patients and their loved ones. I read posts that proclaim their family, friends or themselves as being addicted to opiates (narcotics) based solely on the fact that they are dependent upon them to control their chronic, irretractable pain. There is a huge difference between addiction and dependency. Don't confuse one with the other even though in some cases it may appear to be a fine line.
With that in mind I have done some Internet searching and reading in an attempt to gather accurate information for our members regarding this issue. What follows is taken in part from various articles and information obtained as I searched along with my own opinions and knowledge.
One of the toughest challenges what we as chronic pain patients encounter is our quest for adequate pain control. There is a huge misunderstanding of the difference between physical dependence on a drug and drug addiction. It is true that many CP suffers, friends, family and unfortunately even the some physicians are fearful that ppl requiring opiates on a long-term basis will become addicted or addicts. Statistically the number is very low, around 4%. The rare few who do develop a problem with an addiction are often those that have a genetic predisposition to addiction. But as a result of this unfounded fear and "opioid-phobia," CP patients are often labeled as “drug seekers” and stigmatized for their use of opiate medications. Worst of all, our pain frequently remains under-treated or even untreated.
Addiction is a neurobiological disease that has genetic, psychosocial, and environmental factors. It is often characterized by one or more of the following behaviors:
Little or no control over the drug use
Compulsive opiate use
Continued use of the opiate (narcotic) regardless of physical, mental and/or social harm
Taking opiates more frequently or a higher dose than prescribed
Ingesting drugs in ways other than directed
Frequent reports of prescriptions being lost or stolen.
A deep craving for the drug
Using multiple pharmacies to fill narcotic prescriptions
People that are dependent on narcotic/opiate to control their chronic pain will not exhibit the above behaviors. However don't confuse true addiction with pseudo-addiction. Pseudo-addiction may occur when CP is not being treated adequately. At those times a CP patient's behavior can border those of an addict. When one is desperate for pain relief we may become clock watchers, waiting for the time we can take that next dose. We may panic at the thought that when our prescription requires it's regular refill the physician is out of town or unavailable. These may appear like drug seeking behaviors when in all actuality they are not. The difference between pseudo-addiction and true addiction is in part that these behaviors stop when pain is effectively treated.
Physical Dependence is our systems adaptation to a opiate. Our body becomes accustomed to regular doses of a certain opiate. If the opiate is abruptly discontinued we experience withdrawal symptoms. This occurs with those that are true addicts as well as those that are dependent on opiates for pain control. Our body can make no distinction and we experience withdrawal. There are medications that are not opiates that the withdrawal process will also occur if they are abruptly discontinued. They include steroids, antidepressants and beta blockers.
People who become addicted to narcotics usually obtain a feeling of euphoria or being “high.” They seek that high for the sake of the feeling rather than to control their pain. However they soon require more and more of the narcotic to reach that "high." They become desperate in their search for more of the opiates (narcotics) through any means, legal or illegal.
CP Sufferers are dependent upon opiates to function and obtain some sort of normalcy in our lives. We take our pain medications when and as it is prescribed. We obtain our prescriptions from one physician and under normal circumstances one pharmacy. When we obtain adequate pain relief we more often than not have positive family units. We interact positively with society and continue to make meaningful contributions. If at all possible we maintain employment. Our goal is not to achieve a high but to function with as little pain as possible.
Addiction is a downward spiral. Addicts are often unable to function and interact socially or maintain employment. Their main goal is to obtain the "high" they so desperately seek, often at any and all costs and to avoid reality.
Chronic pain is a disease. So please my fellow chronic pain sufferers don't be so hard on yourselves. If you require opiates to control your pain, you are not an addict. If you take your pain medications as prescribed for your CP, you are not an addict. We are dependent. There is no shame in dependency.