Drug Dependence vs Addiction

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Hope Quilt Information"><U><B>PROJECT</B></U></A></div> </td> <td valign="top" BGCOLOR="#000000" TEXT="#F7F7FF"> <bR> <div> <B><U>Drug Dependence vs Addiction</U></B></div> <bR> <div> <B>National Institute on Drug AbuseAddiction vs. Dependence</B></div> <bR> <div> <B> This is what distinguishes the pain patient who is tolerant to and</B></div> <div> <B> physically dependent on morphine, from the addict who is also tolerant</B></div> <div> <B> to</B></div> <div> <B> and physically dependent on heroin. Both are self-administering an</B></div> <div> <B> addictive drug several times a day.</B></div> <bR> <div> <B> But while the addict takes his drug to</B></div> <div> <B> get high, "mellow out," and largely avoid life, the pain patient takes</B></div> <div> <B> his</B></div> <div> <B> drug to get on with life. This apparently subtle distinction between the</B></div> <bR> <div> <B>contingencies surrounding drug use lead to a remarkably different</B></div> <div> <B>outcome</B></div> <div> <B> for these two different kinds of users.</B></div> <bR> <div> <B> Heroin addicts are lost to themselves, to their families, and to</B></div> <div> <B> society.</B></div> <div> <B> Not only can't they work,but they are almost certainly engaged in</B></div> <div> <B> criminal</B></div> <div> <B> activity, and they are at high risk of a variety of infectious diseases,</B></div> <div> <B> including</B></div> <div> <B> hepatitis and AIDS. Indeed, intravenous drug users have become the major</B></div> <bR> <div> <B> vector for the spread of AIDS into the heterosexual community in this</B></div> <div> <B> country.</B></div> <div> <B> Current estimates are that more than 55% of addicts in New York City are</B></div> <div> <B> HIV</B></div> <div> <B> positive. (16)Pain patients, by contrast, couldn't be more different.</B></div> <div> <B> Being on an opioid allows them to interact with their families, to get</B></div> <div> <B> out</B></div> <div> <B> of hospitals, and to go back to work. Indeed, their efforts to maintain</B></div> <div> <B> their health are in marked contradiction to the utter disregard addicts</B></div> <div> <B> show for their health. If we wish to equate addicts with pain patients,</B></div> <div> <B> the more appropriate comparison is with the under treated pain patient.</B></div> <div> <B> He is in the hospital or inactive at home, he is a major drain on his</B></div> <div> <B> family's emotional and financial resources, and he does not contribute</B></div> <div> <B> productively to society.</B></div> <bR> <div> <B>Another difference between addicts and pain patients comes when it is time to get off the drug on which they are</B></div> <div> <B>physically dependent. For addicts, this is a major hurdle. For the pain</B></div> <div> <B>patient, it is typically an uncomplicated   process. ... Drugs have a completely different meaning to pain patients, however....Because of the</B></div> <bR> <div> <B>meaning of drugs in an addict's life, drug addiction is a chronic,</B></div> <div> <B>relapsing condition. Because of the very different meaning of drugs in a</B></div> <bR> <div> <B>pain patient's life, drug addiction rarely, if ever, occurs after opioid</B></div> <bR> <div> <B> use has stopped. (10-12) This is a crucial point.</B></div> <bR> <div> <B> The data most often cited to link addiction to medically administered</B></div> <div> <B> opioids were derived from studies with addicts. (17-18) In the first</B></div> <div> <B> place,</B></div> <div> <B> this group is highly unrepresentative of the general population. In the</B></div> <div> <B> second, it is</B></div> <div> <B> made up of highly unreliable people. Self-reporting about drug use by</B></div> <div> <B> addicts is not the method of choice in studying drug use. (9) The more</B></div> <div> <B> appropriate data to address this issue have been derived from</B></div> <div> <B> retrospective reviews of large numbers of patients who received opioids</B></div> <div> <B> to</B></div> <div> <B> determine how many became addicts.</B></div> <bR> <div> <B>Of 24,000 patients studied, only 7 could be identified who got into trouble  with drugs as a result of medical administration. The conclusions of</B></div> <div> <B>this</B></div> <div> <B>discussion are clear:</B></div> <div> <B> (a) dependence and addiction are not equivalent to each other;</B></div> <div> <B> (b) patients who become dependent on opioids during the course of</B></div> <div> <B> medical therapy</B></div> <div> <B> rarely become addicted to those drugs; and</B></div> <div> <B> (c) in managing pain withopioids, there is little need to fear</B></div> <div> <B> addiction. Tolerance to opioids is</B></div> <div> <B> rarely a problem because it is possible to continuously increase the</B></div> <div> <B> dose.</B></div> <bR> <div> <B>Dependence is only a concern when prescribing drugs with antagonist</B></div> <div> <B>properties and in managing withdrawal. If addiction is not a reason to</B></div> <div> <B>avoid using opioids, many of the other reasons that have led to</B></div> <div> <B> widespread  under prescribing can be addressed more directly. Most important among</B></div> <div> <B> these are the legal barriers we have erected to limit the use of opioids</B></div> <bR> <div> <B> and the lack of knowledge among health care professionals about the</B></div> <div> <B> proper</B></div> <div> <B> use of these agents.</B></div> <div> <B>This appears on the Action on Pain website where they rally against poor pain managment by DR's and health care workers.</B></div> <div> <B>The website address is</B></div> <div> <B>http://www.asappain.com/placementreps.htm</B></div> <div> <B>The site is owned and operated by Skip Baker </B></div> <DIV ALIGN="LEFT"></DIV> <div> <B>                                       <IMG SRC="3099fc80.gif" border=0 width="159" height="200" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </td> </tr></table></body>