Here is some information that people need to get straight about the difference between ADDICTION and NEED when it comes to prescriptions /medications.
To be addicted means you are taking a medication for other purposes for which it was prescribed and you think you need them especially if you are no longer suffering from the condition that you were prescribed these medications in the first place. If you are addicted to pain killers it is NOT because you are taking them for pain!
People like me who take prescription pain killers take them because if we did not take them ,our quality of life would be very low. My pain levels without medications would consistently be above 8 on my pain scale, while on pain medications it ranges from 5 to 7 unless I am in the midst of a flare, then nothing seems to help. This nasty stigma that is placed on Chronic pain sufferers has got to stop!!! I take multiple medications for various reasons not because I want to but if I did not I would be very sick and may stroke out. Medications for thyroid, high blood pressure, for diabetes , for stomach issues ,usually stemming from the medications. I am NOT ADDICTED to these medications but need them for health reason , for a better quality of life, I am not taking them for a thrill ride. The same goes for pain medications, I for the life of me can not understand why anyone would choose to take them for any other reasons but for pain. I really don't get it. I don't like how they make me feel head wise but for pain yes I will take them, it is a compromise on my part. But to tell someone they are an addict because they have to take pain medications for a relatively decent quality of life is SHAMEFUL , HARMFUL and people this has got to stop!
Yes there is a major problem with over prescribing of pain medications and especially the Opiates when other lesser pain medications would probably do the trick. That is the fault of Doctors and apparently they need to be educated to the proper use of pain medications and for the proper prescribing of them to the proper medical conditions.
I am not talking about short term prescribing of Opiates after a severe injury or trauma or for treatment after major surgery, those prescriptions should be limited to possibly a weeks worth at the most. But for people with long term Chronic conditions that will remain with the individual the rest of their lives , to prescribe the proper pain medications for these individual so that they can have some semblance of a quality of life, that my friend is NOT ADDICTION. Chronic pain is pain that has outlived it's usefulness. Acute pain is an adaptive beneficial response necessary for preservation of tissue integrity.
Chronic pain and addiction here
Addiction is a primary chronic neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. It's characterized by 1 or more of the following behaviors: impaired control over drug use, compulsive use, continued use despite harm -- and I emphasize harm -- and cravings.
Physical dependence is not addiction. Physical dependence is a state of adaptation that is manifested by a drug-class-specific withdrawal syndrome that can be produced by abrupt cessation of the drug, decreasing dose of the drug, decreasing blood level of the drug, or the administration of an antagonist that blocks the action of the drug.
Physical dependence and addiction can coincide, but physical dependence does not equal addiction in all cases. Physical dependence is a neuropharmacologic phenomenon, a natural physiologic event, while addiction is both a neuropharmacologic phenomenon and a behavioral phenomenon.
Tolerance is not addiction. Tolerance is a state of adaptation in which exposure to the drug induces changes that result in diminution of 1 or more of the drug effects over time. Now key to this definition is all other conditions remaining constant. The bad side of this for your patient is that the disease, the cancer, or the syndrome has progressed; the pain has increased. That is disease progression, and therefore, it is appropriate to titrate the opioids up and the adjunctive medications to a higher dose to meet the increased pain. That is dealing specifically with the disease, the cancer, or the syndrome and applying your rational pharmacotherapy appropriately.
Let me ask, would you make your patients beg for beta blockers, digitalis, or insulin, because you would be afraid that you would make them insulin-addicted diabetics or something similar? No, you wouldn't do that. You would treat the patient with mutual trust and respect and properly prescribe the medicine. The key with pseudoaddiction is that with proper pain management, retrospectively, the patient's behavior normalizes. However, with the disease of addiction, in the genetically sensitive individual, behavior deteriorates with pain management. Again, you're looking to improve their quality of life.
Chronic Pain vs Addiction
Now what is the difference between somebody who is a pain patient and somebody with the disease of addiction? A pain patient is not out of control with their medications. Somebody with the disease of addiction by definition is out of control. In a pain patient, the medications improve quality of life. In somebody with a disease of addiction, the quality of life is obviously decreased. The pain patient will want to decrease the medications if side effects are present, while the patient with the disease of addiction is oblivious to side effects and wants the medicines to continue despite any side effects.
The pain patient is concerned about physical problems; the patient with the disease of addiction is in denial. The pain patient follows the agreement for the use of opioids that you set up before writing the first prescription; the patient with a disease of addition by definition is out of control, cannot follow or does not follow the agreement for the use of opioids. The pain patient frequently has medicines left over. The point that I'm making is that the relationship between doctor and patient is one of mutual trust and honesty; you have a responsibility, but the patient also has a responsibility.
For what it is worth,
PATC
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