Healthcare Professionals' Perspective
Fear of Addiction

Ultimately, clinicians want to relieve 100% of their patients’ pain; however, false notions of addiction blind them to the fact that opioids are safe, effective analgesics that relieve pain almost completely.¹ To understand how opioids are effective for intractable pain without threat of addiction, it is necessary to understand what addiction is.

Addiction Defined

Addiction is defined by the American Society of Addiction Medicine as the abuse of any psychoactive substance with compulsion and loss of control despite adverse consequences.¹¹ The American Medical Association Task Force defines addiction as a chronic disorder characterized by the compulsive use of a substance resulting in physical, psychological, or social harm to the user and continued use despite the harm.¹¹ In other words, addiction involves a dependence upon a drug to experience euphoria despite harm to oneself or others.

Opioid use for intractable pain is not associated with dependency upon a drug despite harm to oneself.³ In fact, opioids increase intractable pain patients’ quality of life.

Patients do become physically dependent upon opioids³ because, without appropriate opioid therapy, they would continue to feel pain. Also, according to Aaron Gilson, Researcher at the Pain and Policy Studies Group at the University of Wisconsin, initial tolerance to opioids may result and, if abruptly taken off opioid treatment, withdrawal symptoms may arise. However, as Gilson goes on to explain, tolerance and withdrawal symptoms resulting from opioid treatment for intractable pain do not indicate addiction. These are simply physiological reactions to opioids. Studies have shown that less than 1% of those taking appropriate levels of opioids for pain management become addicted.^1,4

Difference between pain patients and addicts

The difference between pain patients and addicts seeking euphoria is that patients can take increasing doses of opioids, as pain persists, without severe side effects while addicts cannot.⁴ As intractable pain continues to persist, usually a sign of disease progression, pain patients may require higher increments of opioids to relieve pain. Fortunately, opioids taken for intractable pain do not have a ceiling dosage—a dosage where the drug can no longer treat a higher level of pain.¹² In fact, according to Dr. William Hurwitz, pain patients who would otherwise be incapacitated by pain can increase their quality of life by taking dosage levels of opioids that would kill the average person.⁴

Although not proven, researchers believe that pain patients and addicts respond to opioids differently because the nervous pathway that transports intractable pain develops little to no tolerance to opioids. The nervous pathways that transport acute pain and pleasure do develop significant tolerance to opioids.⁷