Addiction, physical dependence and tolerance to painkillers

There are differences between addiction, physical dependence, and tolerance to painkillers. Each of us must understand the difference.

Many people with chronic pain disorders, including certain types of arthritis, take painkillers. Their medical condition determines the need for such drugs-which is why they are included as part of the treatment plan. However, if you pay attention to the news, those who legally take pain medications will be classified as abusers. We can easily understand how it developed. After all, there is an epidemic of opioid abuse in the United States, and these drugs are said to be over-prescribed. Coupled with a celebrity who died of drug overdose, the anti-drug campaign reached its climax.

Each of the above questions is a reasonable question. However, the same is true for people who legally need painkillers to work and have a certain quality of life (such as chronic pain patients). While dealing with other urgent matters, their plight cannot be minimized. Because too many people do not understand the difference between addiction, physical dependence and tolerance, this understanding has largely disappeared. We cannot blur the boundaries between these three factors and look forward to solving problems related to drug abuse and abuse. This is the first step that all of us must take-understanding the terminology.

What is addiction?

The American Society of Addiction Medicine (ASAM), American Academy of Pain Medicine (AAPM), and American Pain Society (APS) endorse the following definition of addiction because it is related to the use of opioids to treat pain:

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Addiction is a primary, chronic, neurobiological disease, and its development and performance are affected by genetic, social, psychological and environmental factors.

The characteristics of addiction include one or more of the following behaviors: impaired control of drug use, compulsive use, continued use despite injury, and craving.

What is physical dependence?

The American Society of Addiction Medicine (ASAM), American Society of Pain Medicine (AAPM), and American Society of Pain (APS) recognize the following definitions of physical dependence:

Physical dependence is an adaptive state, manifested as a drug type specific withdrawal syndrome, which can be caused by abrupt withdrawal of the drug, rapid dose reduction, lowering of the blood level of the drug, and/or administration of an antagonist.

What is tolerance?

The American Society of Addiction Medicine (ASAM), American Academy of Pain Medicine (AAPM), and American Pain Society (APS) recognize the following definitions of tolerance:

Tolerance is a state of adaptation, in which exposure to drugs will cause changes, causing one or more drugs to weaken (ie weaken or lessen) over time.

In other words, most painkillers and addiction experts agree that chronic pain patients who have been treated with opioids for a long time often develop physical dependence. Some patients develop tolerance. However, usually, this group of patients is not addicted. The actual risk of addiction is considered unknown and unpredictable, but it may be related to several factors, including genetic predisposition.

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Addiction itself is a primary chronic disease. Exposure to drugs is only one factor in its development. In fact, in most cases, exposure to drugs that stimulate the brain’s reward center does not produce addiction.

Characteristics and behavior

Impaired control of drugs, craving and compulsive use, and continued drug use despite negative physical, mental, or social consequences are all considered characteristics of addiction. However, it may be more complicated than simply identifying the presence of these features. The same characteristics may be related to insufficient pain relief. Doctors must be able to use their judgment and distinguish between addiction and other causes.

There are certain behaviors that indicate the possibility of addiction. These actions include:

  • Failure to comply with the prescribed medication schedule
  • Take more than one dose at a time
  • Multiple reports of stolen or lost drugs
  • Doctor shopping (obtain medicine from more than one doctor)
  • Isolation (want to be alone)
  • Also use over-the-counter psychotropic drugs
  • Use painkillers to calm, intoxicate, boost energy, or reduce anxiety
  • Request for certain formulations or routes of administration of drugs
  • Avoid or are not interested in non-opioid treatment options

Addiction is clearly related to potentially serious and even fatal consequences. On the other hand, physical dependence is considered to be the body’s normal response to long-term or continuous use of certain drugs-not just opioid painkillers. For example, corticosteroids, antidepressants, beta-blockers, and other drugs that are not considered addictive may cause physical dependence. If you want to stop medications that may be related to physical dependence, you should gradually reduce the medication to avoid withdrawal symptoms (for example, prednisone taper).

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Tolerance is even a little hard to understand. There may be tolerance for the expected effects of the drug, but also tolerance for undesirable effects. Tolerance is also variable, occurring at different rates for different effects. In the case of opioids, tolerance to analgesia occurs more slowly than respiratory depression.

Bottom line

Addiction is primarily a behavioral disorder, although it may overlap with physical dependence. In general, addiction includes the use of drugs regardless of negative consequences, craving for drugs even when there is no physical pain, and use of drugs for reasons other than prescribed indications. Physical dependence becomes obvious when someone develops tolerance to the drug or has withdrawal symptoms after a sudden stop of the drug. When the same dose cannot achieve the same result, there is tolerance, so a higher dose is needed to achieve the desired result. On its own, physical dependence does not mean addiction, but addiction may be accompanied by addiction.