Opioids – Understanding Dependence Vs. Addiction

addiction dependenceAnother misleading article appeared in the paper again last week, this time it is again about the opioid crisis. The headline gets the story wrong, and is truly misleading. It says in the headline “Third of long-term opioid users addicted”. The story is from the Washington Post-Kaiser Family Foundation survey of 622 users of opioids for over two months. In the article it states one third of users are either addicted or dependent on these powerful painkillers. The critical information is in one word that was left out headline and it was the word “or”. Addiction and dependence are two very different things, and two-thirds of the people had neither of the problems. Deaths from opioids are indeed a crisis, as the yearly total of opioid deaths are in the region of 30,000 in the United States – about the same as the number killed by either auto accidents or gun violence.

Chronic Pain

Chronic pain is an extremely difficult medical problem. Pain is caused by hundreds of issues and there is no simple solution to many of the problems related to pain. It is not a glamorous condition, and despite the deaths related to opioids, not much is being done to find better treatments for pain. There has been little government support for finding treatments to pain while billions are being spent to treat addicts. There are no moonshots or big government programs to fund research into better treatments for pain. With a third of the population in the world dealing with pain, it is a wonder why so little is spent on finding solutions.

Addiction Vs. Dependence

To understand the article noted above, knowing addiction and dependence are two different things is incredibly important. Dependence is a condition where the body becomes adapted to a chemical, and if the compound is stopped, then the body goes through withdrawals from that compound. There are a number of compounds like this that are medicines including anxiety drugs and many others. Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. In addiction there is an inability to abstain from behaviors that are detrimental to one’s physical and emotional health.

People who have chronic pain may use opioids to control symptoms and allow for increased daily functions. If they have been on the medications for a long time, then they may or may not be dependent on them physically. If they are suddenly stopped, and you are dependent, the body would go through withdrawals. Understanding pain and dependence is a medical problem and treated best by experts in Physiatry and Pain Medicine.

Addicts use a medicine like opioids for pain relief, but mostly they are used for the pleasure it creates in the brain. They crave the reward it gives and will do whatever it takes to obtain pleasure even if it is causing physical, legal, behavioral, or emotional destruction. Addicts are unable to control their cravings and will continue the activity despite the harm it is causing. The number of pain patients that are truly addicts alone range from estimates at about 5-7% to about 17%. The addicts are usually those who are using pain medicines illegally and are dying. Understanding addicts and treatment is a Psychiatry and Addiction Medicine problem.

Finding a Solution to the Pain

Chronic pain affects a third of the world population. There are not enough good treatments available and the research in this field is poorly funded. Opioids can be a very effective treatment for some people, but they have many drawbacks. Most people can use these medications safely if needed. Addiction is a separate disease, and opioids have now become a tempting drug for many to satisfy their needs. Possibly the best solution to the opioid crisis is finding a solution to pain versus treating another cause of addiction.

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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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