Use and Abuse Of Narcotic Pain Medications

By Julio C. Gonzalez, MD

What Is Drug Addiction?

According to The American Academy of Pain Medicine, The American Pain Society and The American Society for Addiction Medicine, drug addiction is a primary and chronic neurological disease that has genetic, psychological and environmental factors. It is also a state of adaptation that is manifested by a specified drug class, and can cause withdrawal symptoms after

Abrupt cessation
Rapid reduction
Decreased drug content in blood
Administration of certain antagonists like naloxone

Drug addiction is a disease in itself. The drugs do not cause it; it is triggered by the abuse of drugs in susceptible persons.

Addiction is recognized by the four C’s

Control over drug use impairment
Compulsive use
Continuation of use, despite harm
Craving

What Is Pseudoaddiction?

Pseudoaddiction is a false addiction. It describes patient’s behavior that may occur when pain is undertreated, mistreated, or misinterpreted. Pseudoaddiction can be distinguished from addiction in that the behavior resolves when pain is effectively treated.

The patient with unrelieved pain may become focused on obtaining medications by “clock watching,” or drug seeking. They may display some behaviors such as doctor shopping or deceiving physicians to obtain relief.

What Is Physical Dependency?

Physical dependency is a known effect resulting from the use of narcotic pain medications, likely to produce “withdrawal symptoms” when the individual ceases or reduces the intake of narcotics. Some of the “withdrawal” symptoms likely to occur may include sweating, rebound pain intensity, chills, restlessness, small pupils, salivation, running nose, anxiety, sweating, irritability, nausea, vomiting, etc.

It is important to understand the difference between addiction, pseudoaddiction, and physical dependency. Because withdrawal symptoms are frequently seen in all of these states, it is easy to think that withdrawal is equal to addiction. This is not the case. It is the behavior toward the drug that determines if an addiction is present.

If you or someone you know is struggling with pain or drug management, contact your pain management specialist or prescribing physician.