WHAT IS THE DIFFERENCE BETWEEN ADDICTION, DEPENDENCE, AND TOLERANCE?
HOW DO THEY RELATE TO THE RSD/CRPS PATIENT?
By Keith Orsini – American RSDHope 2008
DO CHRONIC PAIN PATIENTS TYPICALLY BECOME ADDICTED TO OPIOD MEDICATIONS
PAIN MANAGEMENT: DRUG TOLERANCE AND ADDICTION
In an article written by WebMD in collaboration with the Cleveland Clinic states, “Some medications used to treat pain can be addictive. Addiction is different from physical dependence or tolerance, however. In cases of physical dependence, withdrawal symptoms occur when a substance suddenly is stopped. Tolerance occurs when the initial dose of a substance loses its effectiveness over time. Addiction and physical dependence often occur together.” People who take a class of drugs called opioids for a long period of time may develop tolerance and even physical dependence. This does not mean, however, that a person is addicted. In general, the chance of addiction is very small when narcotics are used under proper medical supervision.” The article goes on to say, “Most people who take their pain medicine as directed by their doctor do not become addicted, even if they take the medicine for a long time.” You can read the original article in its’ entirety.
Another article, written by Leanna Skarnulis, states, “Chronic pain patients often confuse tolerance with addiction. They become fearful when the dosage of a narcotic has to be increased, but it’s normal for the body to build up tolerance over time, says Simmonds, spokeswoman for the American Cancer Society. “Patients don’t get a high, and they don’t get addicted.” Simmonds, who is in private practice in Harrisburg, Pa., tells WebMD, “The tragedy is that any day of the week a patient will be in my office in real pain, and a family member will say, ‘Don’t take morphine.’ Patients will suffer needlessly because they think they’ll get addicted. We have to take time to educate them.” Kathryn Serkes, director of policy and public affairs for the Association of American Physicians & Surgeons (AAPS) in Tucson, Ariz., agrees. She says the standard of pain management care is more aggressive today than what it was just five years ago. She disagrees with some critics who would use OxyContin only as a last resort. “The phrase ‘addicted to painkillers’ is used fast and loose.”
So if the evidence is clear to the medical community why is there such hesitation in prescribing pain medication for the patients who need it?
The answer may surprise you. Again, quoting from the same article The Backlash of OxyContin Abuse, “In certain parts of the country, the crackdown on illegal use of OxyContin has made it hard for pain patients to get legitimate prescriptions. OxyContin was the first prescription medication listed as a drug of concern by the federal Drug Enforcement Agency, which made it a target,” says Ronald T. Libby, PhD. The drug, Libby says, is “monitored by pharmacies and [Perdue] Pharma, the maker of OxyContin. Some physicians, knowing the DEA or sheriff is looking at these scripts, refuse to write prescriptions for fear of prosecution. Doctors can be scammed, and if a patient takes some pills and sells some, the doctor can be guilty of diversion.” Libby is the author of a Cato Institute policy report titled “Treating Doctors As Drug Dealers: The DEA’s War on Prescription Painkillers” and professor of political science and public administration at the University of North Florida in Jacksonville. “The war on drugs has become a war on legal drugs, on patients who take them, and on doctors who prescribe them,” Serkes tells WebMD.
(since this article was first written the makers of Oxycontin reformulated the ER version in an attempt to curb its’ abuse. The maker of Opana soon followed suit. Read the article here. )
Is it possible to find a middle ground? “The Pain & Policies Study Group at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center issues annual progress report cards evaluating states’ policies regarding the use of opioid analgesics in pain management. The concern is that cancer pain is often undertreated, and opioids like OxyContin are essential. Evaluation scores reflect a balanced approach in which law enforcement practices to prevent diversion and abuse do not interfere with the medical use of opioid analgesics in treating pain. In the group’s 2006 report, it was noted that policies adopted in the last decade by 39 state legislatures and medical boards addressed doctors’ concerns about being investigated for prescribing opioid pain medications. The report concludes: “Despite a growing effort by policymakers and regulators, the fear of regulatory scrutiny remains a significant impediment to pain relief and will take years of further policy development, communication, and education to overcome.”Link to original article
So what is the TRUTH ABOUT PAINKILLERS? MSN HEALTH AND FITNESS did a story recently about the Myths regarding painkillers. Here are a couple of the biggest;
- Myth No. 5: Most people who get addicted to painkillers are “accidental” addicts who sought pain treatment and had no prior history of drug problems. “More than three-fourths of the patients who had misused OxyContin in this national sample of addicts in treatment had never received a prescription for it. Even having chronic medical problems—which includes chronic pain—did not increase risk for OxyContin addiction. If you do not have a personal or family history of addiction—especially if you have never suffered psychiatric problems like depression, schizophrenia or bipolar disorder, and especially if you are middle-aged or older—your risk for developing addiction during pain treatment is “vanishingly low,” says Portenoy.
- Myth No. 6: Addiction is inevitable if opioids are taken long-term or in high doses—and the risk of addiction is very high for short term use. “This myth stems from confusion about the nature of addiction. Many people believe that addiction is simply needing a substance to function—but if this were the case, everyone would have to be considered addicted to food, air and water. “The reality is that addiction appears to be distinctly uncommon in patients without a prior history of addiction or a family history of addiction,” Portenoy says. In his own research on more than 200 patients treated with OxyContin for chronic pain over three years, no new cases of addiction were reported. “Over 30 years, I’ve seen a few thousand patients with cancer and sickle cell [disease] and other [conditions], and less than five that I’m aware of became addicted,” Payne says.”
In “OXYCONTIN – PAIN RELIEF VS ABUSE” one of the articles discussed above, you can read the following; “OxyContin contains between 10 and 80 milligrams of oxycodone in a timed-release formula that allows up to 12 hours of relief from chronic pain. What distinguished OxyContin from other analgesics was its long-acting formula, a blessing for patients who typically need round-the-clock relief. If you have pain that’s there all the time, four hours goes by very quickly,” says cancer specialist Mary A. Simmonds, MD. “If you’re not watching the clock, the pain comes back. People tend not to take their pills on time. The pain builds back up, so you’re starting over. It’s not very good management of pain.” Simmonds gave testimony on the value of OxyContin for alleviating cancer pain at a 2002 Congressional hearing. “For moderate to severe pain, aspirin and Tylenol aren’t effective. We do need opioids.”
Chronic pain Doctors and those in the medical profession who do not treat chronic pain often confuse tolerance with addiction; sometimes even some patients do as well because of what their Doctors tell them. As we read above; “They become fearful when the dosage of a narcotic has to be increased, but it’s normal for the body to build up tolerance over time, says Simmonds, spokeswoman for the American Cancer Society. “Patients don’t get a high, and they don’t get addicted.” Simmonds, who is in private practice in Harrisburg, Pa., tells WebMD.
Of course there are always the exceptions. There will be some patients who become addicted to narcotics but these are typically patients who have come into the disease with addictive personalities; typically already exhibiting addictive behavior with another product be it alcohol, medication, cigarettes, or any number of products out there. One of the ways physicians protect themselves and their patients is by requiring drug screenings/urine tests when patients first begin using narcotics. Eventually the physician and patient develop a strong enough relationship/partnership where trust is built up. Physicians will also tell you they have developed a sixth sense over time as to who is more likely to abuse/not abuse medications and they also rely on recommendations from the patients past physicians.
What cannot happen is penalizing the majority of CP patients because of behavior exhibited by the minority of patients and/or criminals who abuse, sell, distribute these types of medications. Most of these patients depend on these medications to resume as close to a normal life as they can after CP invades their family.
Please share this information with your Physicians and other health professionals. There are also additional articles on this topic in our Medical articles section, in the Medication section; MEDICATION ARTICLES
Compiled by Keith Orsini, American RSDHope, March 2008