RE:Medical use of opioids is generally not associated with addiction (less than

[Guest guest]

Physical Dependence on Opioids

With long-term use of opioids, patients will experience physical

symptoms (abdominal cramping, sweating, nausea, diarrhea,

irritability) if the medication is abruptly withdrawn or the dose is

markedly reduced. This type of physical dependence is not limited to

opioids but can occur with other drugs such as antihypertensives and

steroids. It is a medical condition and should not be taken as a

sign of psychological or spiritual weakness. Withdrawal symptoms are

easily avoided by using a tapering regimen when lowering the dose.

This can nearly always be done, without discomfort, in an outpatient

setting. When necessary, however, withdrawal symptoms can usually be

relieved by slowing the taper or using small doses of clonidine or a

benzodiazepine.

---------------------------------------------------------------------

-----------

Appropriate Use Versus Abuse

" Nothing is intrinsically good or evil, but its manner of usage may

make it so. " St. Aquinas

The fear of drug abuse and drug addiction is the major reason that

physicians are reluctant to prescribe opioid medications for

patients in severe pain. The inappropriate use of a medication for a

nonmedicinal problem is drug abuse. Using a pain medication to get

high or euphoric is clearly inappropriate, as is using drugs to

escape family or other problems that should be dealt with by other

means. If a patient's physical pain has prevented him or her from

living life fully, using a medication that allows a return to normal

activities cannot be called drug abuse.

The appropriate role of medicine is to prolong and maintain life,

promote function, and provide comfort from symptoms of disease. It

is up to the physician to determine whether the prescribed

medications are being used to participate in life or to escape from

it. The patient's mood and activities, and the reports of family

members, can be helpful indicators. Health care facilities are

beginning to use validated quality-of-life instruments that should

make the assessment of appropriate and inappropriate use easier.

Appropriate use of pain medications can significantly increase the

quality of life, inappropriate use invariably decreases it.

Addiction and Pseudoaddiction

Taken to the extreme, drug abuse can become drug addiction, a

driving force that leads to compulsive, socially inappropriate, or

even dangerous behaviors. The overwhelming majority of drug addicts

report that their addiction began with recreational drug use.

Medical use of opioids is generally not associated with addiction

(less than 1%).