Opioid Addiction vs. Dependence
Understandable concern, especially in the light of the current “opioid crisis”. However, it is vital to be educated on what exactly it means to be “addicted”, as well as understand how we expect the body to react to opioids when used properly to control pain – especially in the palliative care setting.
First, let’s review the definitions:
• Physical dependence: a state of adaptation that is manifested by drug class-specific signs and symptoms that can be produced by abrupt cessation, and/or administration of an antagonist
• Addiction: a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations; characterized by behaviors such as impaired control over drug use, craving, compulsive use, and continued use despite harm
• Tolerance: a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce a specific effect, or a reduced effect is observed with a constant dose over time (Fishman, Dr. S. (2007). Responsible Opioid Prescribing: A Physician’s Guide. Washington, D.C.: Waterford Life Sciences.)
Ok, so now what does this actually mean…
It means that dependence is natural, and is the expected response of the body! However, when the medications are being taken other than prescribed, or are changing your lifestyle, affecting the relationships around you, or driving you to do things you wouldn’t normally do (stealing, breaking into neighbor’s house for cash/pills, avoiding friends and family members) – that’s considered addiction and is a problem!
This is the reason why opioids are absolutely okay when prescribed appropriately and taken as prescribed. Morphine is considered the “gold standard” for pain controlling opioids. All other opioids are based off of morphine and dosed accordingly.
Now, let’s say you’ve been taking the opioids for a while and notice that you hurt more if you skip/miss a dose or the current dosage is not easing the pain as it used to…
This, again is a normal physiologic response – called tolerance. This results from regular use of a drug in which an increased dosage is needed to produce a specific effect.
Let’s educate ourselves, as well as our patients and their families so that they are no longer scared, but educated and aware.
Don’t be scared. Be educated.
Written by: Jaymie Wilson, APRN-CNP, ACHPN
(The Institute on Drug Addiction. (2007, January). The neurobiology of drug addiction. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/9-brain-regions-mediating-develo