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Pain Medications - Tolerance, Dependence, Addiction
Caprice_WebMD_Staff posted:
We've often talked about this here. Both patients and their doctors fearing the specter of addiction. So what really are the differences between tolerance, dependence and addiction?

Pain Medications: Are You Addicted?

What do you think of the article? Do you think it gets it right?
We must let go of the life we have planned, so as to accept the one that is waiting for us.
~Joseph Campbell
bren_bren responded:
I thought the article was spot-on. I wish all physicians, like Reisfeld, took the time to explain the potential for addiction w/ opioid medications; especially those with a family history, personal history, mental disorders, etc. instead, I have answered countless questionnaires to this effect and always wondered why. It was a screening process. The possibility of addiction was never explained to me, and certainly the early warning signs were lacking. It's unfortunate that we have to educate ourselves because our first instinct is to trust our doctors, not seek out studies, or other educational tools elsewhere.

I'm glad you shared this, Caprice, and really glad that WebMd produced an article on the subject...I learned quite a bit.

PS. I found an interesting article about the role genetics may play in addiction. I was surprised to learn that those with a history of sexual abuse are "300% more likely" to succumb to addiction. Hope the link works, for those interested:
Caprice_WebMD_Staff replied to bren_bren's response:
Thanks for the link, Bren. And for your feedback.
We must let go of the life we have planned, so as to accept the one that is waiting for us.
~Joseph Campbell
annette030 responded:
I only read part of the article, but he got the definitions of tolerance, dependence, and addiction right so I bet the rest of the article was right on also.

Take care, Annette
annette030 replied to bren_bren's response:
Please remember that with a base of 1-2% of folks using opiates becoming addicted, even a 300% increase is not very much. That would come out to 3-6% of those folks that used opiates becoming addicted. It would be interesting to know how many subjects were in that study and how it was done.

Same with the study that showed 100% of women who were addicts reported physical or emotional abuse, that is not even statistically worth reading if the study only includes 15 women, but would be a lot more impressive to me if it were hundreds of women.

Thanks for the link, Bren-Bren.

Take care, Annette
trs1960 responded:
I too agree that the article is very accurate with everything I've read and all of the empiracle data I've lived through.

2%-3% is always the number I've heard of people getting addicted when using opiads for true pain under a doctor's care.

trs1960 replied to trs1960's response:
There's a very good book by a Doctor Adams. I don't have it anymore as it was a loaner from a PHD I was seeing.
Dr. Adams was a firm eleiver that morphine was far safer than NSAIDS for chronic pain sufferers. He prcticed medicine in Canada and Texas and was very well known for his beleifs. Not all doctors practice the assued status quoe. I'll see if I can find a link to the book. It's worth reading and corroborates the 2%-3% addiction rate of true pain sufferers.

annette030 replied to trs1960's response:
The nursing journal "Nursing 2010" gave me a number of less than 1% of people getting opiates from doctors become addicted to them. I have also read the 2-3% numbers in other settings. I have found that the numbers given periodically go down further and further. They were reported in the same journal at 5% just a few years ago.

Even using 5%, that is a small number of users.

Take care, Annette
TDXSP08 responded:
IMHO Caprice it boils down tone word "intent" no one takes Medications and and says i'm going to develop tolerance or dependance on my Medications because i have needed them for the last 10,12, 15 some odd years to help control my pain and give me a quality of life i was missing.

An addict takes the same Medications at unsafe unprescribed dosages in an attempt to achieve an altered physical or mental effect that the physician is not aware of or in agreement of - generally the addict will also steal anything of value from anyone any time to sell or trade for more of the drug/intoxicant they "need" and they intentionally do this month after month until they have burned all the bridges to their support network and end up with nothing but a shadow of what they used to be and end up where sooner or later they all end up dead or in treatment.
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
annette030 replied to TDXSP08's response:
Addiction is much sneakier than that unfortunately. A person may take their prescribed drug at the prescribed dosage and may notice that it is easier to get through the day at a job they hate, or they just might "feel better" emotionally. Soon they are taking the drug for different reasons than the doctor originally intended, not for the physical pain it was originally prescribed for.

Some addicts do not ever become the thieving, nasty people you mention. Some do, as they run from withdrawal symptoms. Some simply run from one RX to another, perhaps from one doctor to another.

We must all be very careful to ask ourselves why we take each and every dose of pain medicine we take, and be certain we are taking it for the physical pain for which it was prescribed. The rate of addiction may be less than 1%, but that includes all of us.

Take care, Annette
trs1960 replied to annette030's response:
If your doctor writes a script to increase your quality of life and it lessons your pain and also makes you feel better does that mean your abusing the drug because you also like the fact that it augments your quality of life by making you feel better? Is not the abscence of pain one way to define feeling better? Or is the drug acting with great efficacy and working in a complimentary fashion?

I know we're not looking for drugs to get high and say that that in itself is augmenting quality of life, but it is interesting.

I've had a few drugs actually give me a little euphoria...and I liked it. Does that mean I'm an addict or I used the wrong drug? I've had some drugs give me nuasea and constipation and I was told to be patient and take a stool softener...why shouldn't I just let the euphoria pass too?

Annette, you're absolutely right. Its a complex issue and one that becomes more difficult to understand as we need opiads to manage chronic pain that torments us for decades.

My doctor has told me more than once "I'll write you a script for almost anything you want, because I know you are more concerened about getting addicted than I am of it happening to you." He's also told me that I have objective criteria that more than proves that I suffer from severe back problems and I will likely be fighting this battle for the rest of my life.

We are in a niche group of people that use drugs that would normally be reserved for illicit use only. The fact that we have a doctor's approval makes it legal, The fact that our nueorological system even metabalises the drugs differently becuase of our chronic pain may make it less likely that we become addicts, but I still can't help but think I'm playing with fire. However living with no pain meds is like man living without is one of mankinds greatest discoveries right?

I think that those of us that worry about addiction and read these studies about maladaptive side effects are probably less likely to become an addict in the text book sense, but there is so much grey area in our grey matter.

One thing you said Annette that I think is really important is that drugs are sneaky. I can not agree with more! As your tolerence builds the effects change and your body starts to metabalize things differently. The right (or wrong) drug can sneak up on any of us regardless of our intentions or care and diligence.

Take care all.

juvewarden responded:
I have had 2 back surgeries in the past year. Microdiscectomy of L5 S1 and then a fusion of those a year later. I am 4 months post op now and doing great. However , in between the 2 surgeries I was taking high doses of percocet, norco and also muscle relaxants and Lyrica....neurontin.....and so on....

I have been so scared that I was going to become addicted and it was never explained to me the difference between dependence...which I was..and addiction.

Great article for all pain management patients.
JohnFS responded:
The article is very good. It is unfortunate that neither the everyday press nor politicians understand these points at all. As a result, much of the population is also misinformed. This is to the detriment of many legitimate chronic pain sufferers.
cweinbl responded:
Addiction is a psychological disorder, characterized in this context by using too much medication, running out too soon, obtaining an opioid Rx from multiple physicians concurrently, stealing medication, purchasing it illegally and using it to obtain a state of euphoria rather than for pain.

Tolerance and withdrawal are physiological conditions related to use of opioids. Both conditions can be ameliorated under the care of a physician.

The bottom line is that if you have no prior history of addiction disorder, your chance of becoming addicted is less than 1%. This data comes from two newer studies than the one mentioned in the article above. One study ( ) posted the addiction rate below 0.8%. In total, among the 1,160 patients studied and closely monitored for 18 months, there were only a total of 10 cases of substance abuse or addiction reported (0.8%), which is consistent with low numbers found in other studies.

The other study ( ) searched 10 bibliographic databases up to May 2009. It posted signs of addiction in less than 1% (0.27%) of participants. It used random-effects meta-analysis' to summarize data where appropriate, used the I(2) statistic to quantify heterogeneity, and, where appropriate, explored heterogeneity using meta-regression. Several sensitivity analyses were performed to test the robustness of the results. These are government funded studies with a statistically large number of participants, using the latest algorithmic data mining techniques.

If you have no history of addiction disorder, you can use opioid medications for decades without fear of becoming addicted. Tolerance is overcome by increasing dosage. When tolerance is reached at the highest safe dosage, rotating to a chemically different opioid resolves the issue. Dependence is not an issue until the patient no longer requires the opioid. Then, under the care of a physician (and often with opiate antagonists) patients can gradually diminish the medication safely and effectively.

This should put to rest the clamoring of media and the irrational fears of patients who believe that long-term use of opioids leads to addiction. It clearly does not; and even when such patients use opioids for decades, they are at no more risk of addiction that someone using the drugs for a few weeks.
charl1942 replied to bren_bren's response:
Frightening huh Bren?

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