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Friday, November 20, 2009

Addiction vs. Dependence

When you talk about opiod pain medication more and more people have the instant reaction of "anyone who takes thsoe medications is a drug addict". There is no compassion. There is no understanding. There is no leeway for medical conditions that might require long term use of opiods. As I have said before the US War On Drugs has become a very bad thing. It focuses more and more on doctors and chronic pain patients. More and more people in our society believe that anyone who takes opiods is a drug addict, regardless of the reason for the medications.

A few years back (while in high school) my daughter came home from school one day extremely upset and crying. Her science teacher was covering illegal drugs, alcoholism, and addictions in class that day. The teacher told the class that anyone who takes prescription painkillers on a regular basis is a drug addict, no exceptions. Further she stated to the students that there are no medical conditions that require taking such drugs on a regular basis, not even end stage terminal cancer or AIDS. My daughter told me that she had to leave the classroom because she was crying and so very angry. The next day she went to school with my cat-scan and x-ray films (with my permission) and asked the teacher if she could address the class about the issues of chronic pain and narcotic drug use. The teacher allowed her to do so but wasn't too enthusiastic about it.

To make the story a bit shorter (yeah I know..I'm long winded LOL) she showed the class the x-rays (which show the plate and 6 inch screw very clearly). She told them what my diagnoses were and then asked them what they would expect the symptoms or long term effects to be. Of course pain was one of the things the students mentioned. She then asked them if they were having to deal with a broken pelvis on a daily basis, did they really think they could do it without any pain medication at all. End result, the teacher apologized and told the class that she was wrong and that there were people out there who obviously did need such medications. My daughter then went on to teach the class the difference between addiction and dependence.

I am still very proud of my daughter for standing up to her teacher and classmates on this issue, specially since their belief that chronic pain patients are all drug addicts was so intensely, blatantly, and vocally stated. She told me that a few of the other kids still believed the addict line, but most of the class seemed more open minded to the idea that not everyone who takes pain medicine is a drug addict.

In 2007, my son brought home his science text book (6th grade) for a homework assignment. The chapter was about addictive substances such as caffeine, nicotine, and of course drugs. The textbook itself stated that anyone who takes opiod based pain medication on a regular basis is a drug addict. I was utterly flabbergasted to find such a skewed (and obviously wrong) statement in a middle school science text book! I was also very hurt when my son (who is a very literal person) proceeded to try and convince me that I was a drug addict because I take pain medication every day.

I showed him my x-rays and we talked about broken bones, nerve damage and opiod medications. Thankfully he understood that the text book was wrong but it still hurt like hell to have my son think I was an addict because of some stupid politically correct crap in a text book!

Many chronic pain patients like to blame media hype and the government for the widespread incorrect belief that all such patients are drug addicts. I agree but I've also seen that it goes further than that. Our schools, under the guise of trying to teach our children not to take drugs, are teaching this same misinformation. Many churches also teach their followers the same thing. Instead of true understanding, this lie is becoming more entrenched in society every day.

They teach this lie but they don't teach the difference between addiction and dependence; there IS a difference.

Addiction includes a psychological need that drives the person's behavior to acquire the substance they are addicted to in any way possible. This includes alcoholics, street drugs and prescribed medications. Addiction includes a psychological aspect that dependence does not. For one's need to be classed as an addiction there has to be both the psychological and physical aspects. The psychological aspects includes the firm belief that one must have the substance to survive. It is also accompanied by compulsive behavior to attain the substance and to maintain supply of the substance. If the substance is taken away the addict has not only physical withdrawl but mental withdrawl as well. An addict can not control their need for that substance, they absolutely have to have it even though they know there is no medical reason for taking the medication. An addict has the physical dependence on the drug, but in addition to that they also have a deep psychological need for the drug.

Dependence is NOT addiction. Dependence is solely when the body gets used to having a substance in it and goes into withdrawl without it, such as the nicotine in cigarettes. Narcotic medications are not the only medications that people can become physically dependent to. Anti-seizure medications, sleeping medications, anti-anxiety medications, even some anti-depressents can have dependency issues. (many other meds as well) Many chronic pain patients become physically dependent upon their medications without becoming psychologically addicted. If their physical condition were resolved they would no longer need the medication and would willingly stop taking it. Heck I would GLADLY stop taking opiods if I could! Someone who is only physically dependent on a drug *can* stop taking it if they have to, or their condition improves to a point where it ins't needed anymore.

Addicts WANT to take those drugs. People who are dependent but not addicted, don't want to take those drugs and would prefer not to take them. Their medical conditions make the drugs necessary, not some irrational psychological compulsion.

Is it possible for a chronic pain patient to become an addict? yes I believe it is. But having experienced first hand the failure of our medical system to treat chronic pain I firmly believe that for many chronic pain patients who become addicted, the medical system is partly responsible. A person who is in pain all the time, yet can't get adequate treatment for that pain (and is often ridiculed, judged, sneered at, insulted, humiliated etc), will eventually become desperate for relief. That desperation would make the person do things to get the medications that they wouldn't normally do and thus help create a psychological addiction.

However for those who develop an addiction in this way, the addiction can be treated by providing the patient with consistent and adequate pain control. Once their pain is better managed on a consistent basis, that fear driven desperation based addiction will fade. This would of course take time and consistency, something our medical community (and society as a whole) is not willing to do. We want quick results, instant gratification and medical things as well as psychiatric illnesses are not resolved instantly.

I think if more people were educated about the differences between addiction and dependence we would see a more humane response to chronic pain patients. I also believe that if more chronic pain sufferers were treated properly from the start (rather than needing to see many different doctors, suffer misdiagnosis etc for years before finally being treated) we would see fewer addicts within the chronic pain population.

I have felt that desperation for relief in the past. It caused me to consider smoking marijuana or buying painkillers on the street if I could find a seller. I didn't do either one out of fear of being arrested, but feeling that desperation to a point that I was even thinking about turning to street drug dealers, made me understand that some people (who doctor shop or get prescriptions from more than one doctor) do it because they have no other option available, not because they want to get high. Thus the resulting addiction is just as much the fault of the medical community as it is (possibly, I think it may be more the medical community) the possibly addictive nature of the drugs.

That this occurs is extremely sad and shows quite clearly how the medical community continues to fail patients on a regular (and ever widening) basis.


  1. Hi Missy a great post. people can be completely narrow minded.

    Diabetics will die without insulin, asthmatics will die without ventolin. These are all drugs, that science teacher was a complete womble.

    Many chronic conditions from heart disease to c.o.p.d require life time meds.

    In my case I have to have an opioid based medication to be able to maintain my weight, slow down my bowels and stop having diarrhoea up to 12 times a day, it helps with the pain also both bowel and kidney. If I don't take my medication I end up dehydrated and have massive weight loss.

    Without my medication I couldn't look after my kids and work.

    I found if I took the two tablets per Drs orders the side effects can be horrendous and last for up to ten hours once pain has resolved. When I asked for the quicker release lower dose tablets (instead of taking two of the others)
    eyebrows were raised.

    They couldn't comprehend why I would ask for a lower dosed tablet.
    Also the name of the lower dose confused people.
    What they didn't know was both medicines were the same, except one(the slow release) was four times stronger than the one I asked for being the lower dose.

    Yes I could stop these meds, which in reality is the only medicine I have to take x2 daily.

    But I would probably be dead in about two months through wasting away, no nutrients, dehydration etc.
    I started taking them when I went from 57kg (125 pounds) down to 45kg(99 pounds) in a couple of weeks and was hospitalised due to diarrhea.

    Some people are idiots and when they have pain one day through accident/cancer or something then they will eat their words.

  2. WORD! This post explains so well the difference between being dependant on a drug and being physically and mentally addicted to a drug. I thank you for writing it so clearly and putting it out there!


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