There is a difference between addiction, physical dependence, and tolerance to pain medication. It is imperative that each of us understands the difference.
Many people with chronic pain situations, including certain types of arthritis, are prescribed pain medication. Their medical situation dictates the need for such drugs—that’s why it was prescribed as part of their treatment plan. Yet, if you pay attention to the news, people who are legitimately prescribed pain medication are being lumped in with the abusers.
Each of the aforementioned problems is a legitimate concern. But, so is the disregard for people (e.g., chronic pain patients) who legitimately require pain medication to function and have some quality of life. Their plight cannot be minimized while the urgency of other matters is dealt with. This realization has largely been lost because too many people do not understand the difference between addiction, physical dependence, and tolerance. We cannot blur the lines between these three factors and expect to solve problems connected to drug use and abuse. It is the first step we all must take—understanding the terminology.
Addiction is a compound situation, a brain disease that is manifested by compulsive substance use despite unsafe consequences. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will reason problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution (i.e., diminishing or lessening) of one or more of the drug’s effects over time.
That said, most pain medicine and addiction specialists concur that chronic pain patients treated longterm with opioid drugs generally do develop physical dependence.
What Is Physical Dependence?
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing the blood level of the drug, and/or administration of an antagonist.
Impaired control, craving, and compulsive use of the drug, as well as continued use of the drug despite negative physical, mental, or social consequences, are considered characteristic features of addiction.
There are specific behaviors that point to the possibility of addiction. Those behaviors include:
- not adhering to the prescribed schedule for the drug
- taking more than one dose at a time
- repeated reports of stolen or lost drugs
- doctor shopping isolation
- additionally using non-prescribed psychoactive drugs
- using pain medications for sedation, intoxication, to boost energy, or to lower anxiety levels
Addiction clearly is associated with potentially serious, even fatal, consequences. On the other hand, physical dependence is considered a usual response by the body to the chronic or continued use of certain medications—and not only opioid pain medications. For example, a physical dependence can happen with corticosteroids, antidepressants, beta-blockers, as well as other medications not considered addictive.