Pain Medication Tolerance vs. Addiction

drug tolerancePain medications such as opioids and narcotics can be very helpful at relieving and managing pain. However, if these pain drugs are used in excess they can lead to tolerance and addiction. This article will investigate the similarities and differences of drug tolerance and addiction. Are they the same? Does one lead to the other? Read on to learn more.

Pain Medication Tolerance

Drug tolerance is a state that occurs when a medication dose ceases to be effective for a person who previously found the same dose to have a therapeutic effect.  A higher dose is then required to achieve the same previous effect.  Tolerance is a common phenomenon with many medications, especially opioids and narcotics.

Enzymes that metabolize a drug become more active over time as the presence of a drug becomes routine. These enzymes clear the drug out of the body faster and, as a result, it takes more of the drug to achieve the same previous therapeutic level.

Addiction to Pain Meds

Addiction to a drug is a physical and psychological state in which a person has a loss of control in their behavior and is unable to limit the intake of a drug despite negative consequences.  In addiction, the drug provides a positive, pleasurable reward to the brain.  An addict will seek out the drug even if it is ruining their health or involves illegal activity.

Addiction is a disease of the brain. It occurs with many drugs that stimulate the dopamine reward centers and is also seen with opioid medications and alcohol.

Dependence is usually coupled with addiction. When a person is dependent on a drug, they can function normally with the medication in their system, but experience a physical disturbance when the drug is removed. Opioid withdrawal can cause:

  • Nausea
  • Vomiting
  • Diarrhea

Dependence occurs with many medications, which is why many drugs have warnings not to suddenly stop taking the medication.

The Difference Between Tolerance & Addiction

The difference between tolerance and addiction is the psychological desire for the medication that occurs with addiction.  Many drugs can develop tolerance effects.  Sometimes changing the medication to a slightly different drug that is similar or changing the dose can overcome this issue.

Addiction is an abnormal craving for the drug since it gives the person some sort of psychological pleasure, and that the person will do anything to get the drug despite the consequences.  Those who are tolerant (and not addicted) can be withdrawn from the drug and do not crave it once it is no longer available.

Tolerance to a medication does not equate to addiction.  However, a person who is tolerant to a medication can also have addiction problems to the same medication.  If you have questions, you should talk directly with your physician and be evaluated.

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Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).

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