The media, our friends, our family, even our doctors tell us that long term use of opioid pain killers causes addiction. I bet there isn’t a single person with chronic pain who hasn’t been treated like some twitchy drug-seeking addict by their doctors, friends and family. Well I’m here to tell you–they are wrong! This is actually a widespread misunderstanding of the difference between physical dependence and addiction. This difference is vital. Here are the definitions.
Addiction is a neurobiological disease. Your genetics, your environment, and how you interact with it are all factors in addiction. People who are addicted tend to have poor control over the drug use. They crave the drug for the high not the pain relief. And the real telltale is when your drug use continues even when it starts to hurt you physically, mentally, and socially
Now poor control over drug use does not refer to the fact that as time goes by you need more medication in order to get the same pain relief. That is caused by your body building up a tolerance, which is a completely natural reaction to taking many medications long term not just pain meds. Also these meds do interfere with you physically, mentally, and socially by causing fatigue, loss of concentration, and lethargy. These are side effects. Addiction, on the other hand, means you are putting getting the drugs and being high above other normal priorities such as your health, your mental state, and your relationships.
Physical dependence is where the body adapts to the medication and builds a tolerance so when the medication is stopped cold or reduced too quickly you will experience withdrawal symptoms. Physical dependence doesn’t just occur with opioids either, many other medications build a physical dependence including antidepressants, beta blockers, corticosteroids, anti-seizure medications etc.
While most chronic pain patients who take opioids long term do become physically dependent, very few will ever become addicted. The small handful that do develop a problem most often are genetically predisposed to addiction. In a review of 24,000 patients who were medically prescribed opioids, only seven could be found who were addicted. The long and short of all this is that addiction is the exception rather than the rule.
What does all this mean? It means that all the hype isn’t true. If your pain were to disappear tomorrow you may have to reduce you dosage slowly, but you won’t have any trouble giving them up. You just have to give your body time to adjust to the new reality. So the next time someone lectures you about the dangers of addiction to pain medication you have the option of setting them straight or silently knowing that they are wrong and you are fine. Now you can let go of any guilt or anxiety about your “addiction” to pain killers because it probably doesn’t even exist. I know I was relieved when I realized that while my body was dependent I was not addicted. There would be no rehab in my future and I could stop worrying about my future status as the drug addicted disaster everyone told me I was bound to become. So can you.