Pain expert Dr. Scott Fishman answers questions about pain medication:
Q: What is the difference between being addicted and being dependent?
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A: Fear of addiction has prevented many physicians from prescribing needed pain relief and many patients from controlling their pain and reclaiming their lives.
Pain doctors have known for years that taking opioids over long periods of time for medical reasons does not have to lead to addiction. More than a decade ago, neurologist Russell Portenoy, who was most recently President of the American Pain Society, reviewed studies of almost 25,000 cancer patients. Most of those patients had been on opioid therapy for many years. Of the whole group, very few showed any signs of drug abuse, drug craving, or drug-seeking behavior.
Every one of these cancer patients was dependent on their medication. However, their physical needs were worlds away from addiction. Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and to keep satisfying it, no matter what.
It is a compulsive behavior that demands more and more drugs, regardless of the consequences that lead to dysfunction. A person who is addicted to opioids has a disease that undermines optimal function and drives one to compulsively use a drug, despite the negative consequences.
The pain patient who is effectively treated with opioids finds life restored-even if he is dependent on them. With the pain muted by stable and steady controlled use of long-acting opioids, a patient can reclaim his life, go back to work, return to family life, and pursue favorite pastimes. Dependence is a physical state that occurs when the lack of a drug causes the body to have a reaction. Physical dependence is solely a physical state indicating that the body has grown so adapted to having the drug present that sudden removal of it will lead to negative consequences such as a withdrawal reaction. This can occur with almost any kind of drug.
A good example of dependence is a heavy coffee drinker's use of caffeine. If you are used to drinking several cups of coffee each day, you soon learn about physical dependence when you miss a day or two. This does not mean you are addicted to the caffeine; it only means your body is surprised not to see what it has come to expect.
In the case of opioids, a certain amount taken every day fills the glass, and no more may be needed or desired. If the medication is removed, the consequences are physical (sweating, running nose, diarrhea, racing heart, or nausea), not psychological.
As any diabetic will testify about insulin, or any heart patient will testify about blood pressure medication, dependence is not necessarily indicative of addiction or drug abuse. In fact, regular use of these medications may be essential for good health.
The difference between a patient with opioid addiction and a patient who is dependent on opioids for chronic pain is simple. The opioid-dependent patient with chronic pain has improved function with his use of the drugs and the patient with opioid addiction does not.
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