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Opiods: Addiction vs. Dependence (and Getting the Meds You Need)

Pain patients are highly unlikely to be addicted to painkillers (opiods). They are, however, likely to become dependent on a drug, which is very different than addiction.

If you stop taking an opiod, you may have withdrawal symptoms, including nausea, vomiting, diarrhea, sweating, muscle twitching and aches and pains, and increased pulse and blood pressure. Even though this list is reminiscent of the withdrawal scene from Trainspotting, it doesn’t mean you’re an addict. It means that you have a physical dependence on the drug.

You can develop a physical dependence and experience withdrawal symptoms with many different meds, including antidepressants, but you aren’t addicted to them. It works the same way with opiods. Docs make a schedule for to reduce the amount of a drug we take slowly to avoid these unpleasant symptoms, but they may be inevitable. Just as you might be nauseated and dizzy when you stop taking an antidepressant, you may have diarrhea and a racing pulse when you stop taking opiods. (For a personal tale of dependence and withdrawal, read Chapter 19 in All in My Head by Paula Kamen.)

Tolerance is another physical phenomenon that may cause fears that you’re addicted to opiods. Maybe a small amount of a drug relieved your pain initially, but over time you need higher and higher doses to maintain the same level of pain relief. Like dependence, tolerance is not a sign of addiction.

Patients who take opiods may exhibit addict-like behaviors (called pseudoaddiction) — like hoarding pills and being preoccupied with taking the next dose at the precise time it is OK to do so. Understandably, seeing a patient with these behaviors make a doctor very cautious. However, pain patients stop behaving like addicts when they get adequate pain relief.

That deserves repetition and it’s own paragraph: Pain patients stop behaving like addicts when they get adequate pain relief!

Pain specialist Scott Fishman sums up the difference between patients who are dependent and those who are addicted well: “The difference between a patient with opioid addiction and a patient who is dependent on opioids for chronic pain is simple. The opioid-dependent patient with chronic pain has improved function with his use of the drugs and the patient with opioid addiction does not.”

You may be reassured that you’re not an addict, but that doesn’t mean it will be any easier to get docs to prescribe opioids. Here are some thoughts for patients seeking pain relief with opioids:

  • It will probably take multiple visits to a pain specialist to get a response. He or she needs to get to know you and your case before prescribing opioids.
  • A specialist at a pain clinic rather than a pain specialist in a solo practice or one in a team of many different types of doctors may understand your pain better.
  • Pain specialists may not give you the time of day if you haven’t seen a neurologist or headache specialist first.
  • Patients who say they’ve tried everything to treat their headaches often haven’t. There are so many preventives and abortives available that there are probably many that you’ve never considered. This may be a sticking point with a pain specialist. (Although I know that many readers have tried just about everything.)

And some recommendations:

  • If your neurologist agrees that the next step for you is opiods, ask him or her to call or send a letter to a pain specialist to explain this.
  • Have your neurologist’s office send your medical records to the new doc before your appointment.
  • Look for a doctor who specialized in pain medicine during his or her residency (probably through a fellowship).
  • Seek out doctor who finished residency recently. He or she may be more afraid of legal repercussions, but may also have more current attitudes about pain management.

P.S. I’m afraid this reads like a tip sheet on feeding a prescription painkiller addict’s habit. Chronic pain management with opiods is absolutely necessary for so many people that I’m publishing it anyway. So there.

24 Responses to Opiods: Addiction vs. Dependence (and Getting the Meds You Need)

  1. Angel says:

    It drives me nuts that every doctor and hospital has that “pain scale” but many won’t actually do anything to adequately help reduce your pain.

  2. Diana says:

    Thank you. I’ve been taking fiorinal with codeine for more than 7 years (have had migraines >25 years). At first only as a backup plan to the triptans, which were working pretty well, and more frequently as the migraines became worse.

    I can’t help that they got worse, and I feel awful about having to rely on codeine the way I do. I once asked for a prescription of just fiorinal to see if I could get by on that, and had to realize then that it is the codeine I need to keep the pain at bay.

    I do function better with it – much better. Without it I’ll develop a hellish migraine, guaranteed, and with it I’m pretty much fine except for the occasional flareup.

    The guilt is so hard to deal with, that I try to see how long I can go without it some days, ignoring the nagging little pain that’s building up until it explodes, and then it’s too late. A regrettable mistake.

    I am extremely thankful my neurologist “gets it.” Without a way to manage the pain, at this point, it really truly is so unbearable I’d probably have to kill myself. My Dr. doesn’t even give me a bad time about it. I wish I could be easier on myself, this just isn’t the way I want to be.

    So thank you for this article. I needed someone to reaffirm what I already knew, but have a hard time accepting.

  3. nyyankee7 says:

    I am thankful that I finaly read something by someone who understands. I have a back problem, pinched disc (I guess)as so the MRI suggests. The doctor put me on Oxycontin (10mg), one pill a day. I am 6 feet tall and weigh about 240 lbs., 10mg’s didn’t do it so I took 15mg’s twice daily. This not only allowed me to be basically pain free but let me concentrate on my work and family life without interference. I am not advocating the use of drugs as opposed to therapy, but I have gone through that as well. Therapy only worked for me for the first 30 minutes after leaving the pain management center office.
    I eventually (due to increasing my dosage)would run out and ask for re-fills (the doctor was afraid of prescribing these meds), I would get some but he never would agree on the dosage, continuing saga. My body would become dependent on the Opiod but I in no way was using for the “high”, if so the case, I would have taken even higher doses, taken a variety of other opiod’s, etc.

    To make a long story short, the doctor changed and decreased my medication to the point of high anxiety, high blood pressure, (withdrawal)etc. I was looked upon as a drug addict at the hospitals (the hospitals do nothing but give small doses of clonidine)and after visiting four er’s in a 10 day period, finally was told to take buttenox on an in patient basis at the hospital that treats addictions and withdrawls associated with them.

    After the first shot (within 5 Minutes) I was like a new person, 3 days later was feeling great and had gone home. Within 3 days the same symptoms happened. I seeked the treatment of a phychiatrist whom dis agreed with the treatment, said all I needed was methadone and on an out patient basis. He prescribed the methadone (pill form)and I took it (40mg’s daily) along with anxiety meds, etc. Eventually went down to 2 1/2 mg’s daily (doc says cant hurt and dont know why I feel I need it)and that is fine, still taking all kinds of other meds for pain (non-narcartic)which does nothing but depresses me further.

    The strange thing is that I was only on the Oxycontin for 2 months, other people take it for years and the doctor even agrees that at any time you can ween off it, so why the catastraphy. We all know that the drugs are not the answer, but until we learn how to deal with the issues, why not.

    If anyone knows what I can take, something similar to an opiod, codine, something with the med included as an ingredient, please let me know. kids are using these things and I dont know how they do it, wish I did.

    nyyankee7@sprintpcs.com
    Feel free to e-mail me privately

  4. Mikey says:

    My wife has been suffering for a long time from several ilness, including migraines, scoliosis and arthritis. She has had several operations and tried many drugs with no lasting success. Sometimes she just lays in our bedroom crying. Previously, she had been a happy mother of 3 who exercises and eats right. I feel she is beyond her limit of what she can take. No matter how hard she tries, her doctor will not give her anything strong for her pain. She tried a new doctor (GP), who told her he would need to see her several times to even consider prescribing anything, and that she needs to see other specialists. He was not sympathetic at all. What I want to know is, how do you go about getting narcotic pain meds? Do we have to order on line? Or how do we find a sympathetic Dr – trial and error?

  5. Abbe says:

    Has anyone heard about migraine surgery? There’s a Doctor David Branch in Bangor, Maine who does it. I’m considering it, but my insurance won’t cover it. So I subsist on daily triptans and take fiorinal a few times a week if the triptans don’t do the trick.

    I’ve given up what I can to prevent the onset, but there’s always something. The most frustrating is getting migraines when I lift my head too quickly from a forward bend in yoga. Any suggestions on dealing with exercise-induced migraines apart from staying in bed, which I really do prefer?

    *********
    Although it makes the news a lot, I’m not convinced that this kind of surgery is a good idea. I suggest trying Botox before you make plans for surgery. It may help predict how effective the surgery would be for you.

    You could ask your yoga teacher for alternative poses that you can do while everyone else is doing forward bends. Maybe other types of exercise are less likely to induce a migraine for you.

    Kerrie

  6. DamionKutaeff says:

    Hello everybody, my name is Damion, and I’m glad to join your conmunity,
    and wish to assit as far as possible.

  7. Cols says:

    As a sufferer of migraines for 24 years I will share will with you a drug which changed my life. It is taken on a daily basis for prevention. It’s called Topamax. It works really well. One of the side effects is weight loss which as a woman is truly a bonus!!! I have to agree myself I am tired of Docs who are afraid of painkillers. I am truly not looking to get high everyday, I just want the piece of mind to know if massive migraine pain happens I have meds to help.

  8. My name is Dwayne. I also suffer from extreme
    migraines. I get two or three fiorinal/codeine
    prescriptions a year, so I now have to by painkillers illegally when I can. It takes up
    alot my money and it’s illegal, but until I
    run across the right doctor I’ll have to keep
    it up. I’ts got to the point to where the only
    thing I can do is hurt so bad it incapacitates me.
    It is tearing my life and livelyhood apart.
    The bad part is knowone understands. They just
    I’m a junkie.

  9. Brian says:

    I suffer from alot of what I’ve read here.There
    is a reason we can’t get the meds we need and it’s
    not the doctors fault. They don’t want us to be
    in pain constantly(or I would hope not). It’s
    the DEA scaring the shit out of them. I wouldn’t
    wan’t to jeopardize all I worked for either. We
    need to do something about these so called DEA
    agents harrassing our doctors. There are many
    people with the same problems. All we need to do
    is stand together and tell them enough is enough.

  10. Jim Benedict says:

    I am a state worker with a history of 2 back surheries, intractible hip pain and episodic migraine headaches. I have been presribed Lorct (10/650), Fentanyl patch (50 mg every 3 days) and Diazepam as needed up to 3 times a day. I have been on this regime for over four years and up until a few months ago, its allowed me to work, function on a professional level and enjoy life. Lately, I have been given extra responsibilities (more committees, more travel and a great deal more work) After a month, my hip pain has become increasing in severity, my back pain can make it nearly impossible to get out of bed, and the Valium doesn’t have any effect. I want to talk to my Doctor about either increasing the doasage or changing to something that will return my quality of life but am afraid he will assume the worst. What can I do? This medicine allows me to live!! does not give me any “euphoira” as they call it and with the stigma attached to the poor souls who are “addicts,” I am afraid he will think I am one. Please give me advice here…I cannot tolerate this much more, wouldn’t dare look to the street, or ever go against his instructions. I am terrified because without relief I could lose my job. Any suggestions? Please?

    God Bless You all…I can totally understand what you are going through.

    Jim

  11. syl c. says:

    I have had 3 surgeries one being a cervical surgery the other two back with one a failed back surgery. I take Oxy, Actiq for breakthrough pain. The Actiq is truly amazing as it acts very quickly and I am blessed to have a docor who understands that I am not an addict but a human being struggling with immense pain and depression. Without these drugs I could not do daily activities. I can’t even imagine not having them as I don’t know what I would do considering the pain I suffer. The DEA should not scare doctors into not helping people like us that really need them. You need to find a good doctor who is sympathetic and can sort out the “good” from the “bad” and that entails looking at MRI’s getting medical history to back up your needs for these powerful drugs and using them exactly as they are prescribed I would not be here today if it were not for my doctor cause I surely would have taken my life to erase the pain.

  12. Todd says:

    “Pain patients are highly unlikely to be addicted to painkillers (opiods).”

    Where do you get this information? I hate to say this but you are absolutely wrong. Pain patients are just as likely as anyone else to became addicted to pain pills. I would say more likely than most because they will be more likely to use pain meds.

    Do you write this to make yourself feel better? If this is to help people why no tbe honest so you can help. Don’t feel peoples heads with half truths adn nonsense.

    Opiod addiction is not rare it is an almost guarantee with prolonged use of opioates.

    You describe the physical dependence fairly accurately but leave out the fact that the worse part is the psychological cravings that go hand in hand with the physical.

    I don’t mean to come across as an instigator but this is blatantly misleading at best. People please do your research addiction is a horrible nightmare and opiod is the worst kind! Sorry

  13. reality says:

    In reality the dea is the ones at fault here, not the doc’s… i take lortab 10-500 1 tab 4 times daily for chronic shoulder pain, i am by no means an addict, just some one who needs pain medication to control the symptoms of a problem, no different then someone with hypertension would take a ACE inhibator, or BETA blocker,

    i have been on this medication and dose for over 7 years, and NO i have not grown a tail, or turned to robbery to suppply my “habit” why you may ask, B-cause my doctor understands the ouality of life issues assosiated with chronic pain an is not afraid of the some government agency comming in and taking the medical licence,
    yes you do become dependent on the medication when you are on it for the length of time i have been on it,
    the key in my opinion is to find a doctor be honest, and take only the amount that they prescribe, if you feel you need to adjust your dose over time, just talk to your physicain, if you have always been honest with them in the past they will have no reason to doubt you in the future, and togeather you can work out a dosing regim that will control your pain
    good luck to all of those who still suffer,

  14. Orphen says:

    It’s OPIOIDS! Not “opiods”. The article is very well-written, but please correct this misspelling.

    Thanks for spelling “withdrawal” correctly though.

  15. Beth says:

    YEAH, IM SO GLAD IM NOT BY MYSELF, FINALLY AFTER THREE YEARS OF PAIN I WILL BE GETTING SURGERY, BUT AM ADDICTED TO PAIN KILLERS, WHATS GONNA HAPPEN AFTER THE SURGERY WILL THE DOCTOR STOP PRESCRIBING PAIN KILLERS?

  16. susan says:

    Hello,
    I’ve had all kinds of headaches for over 25 years. I take fiorinol with aspirin and caffene but refuse to take more than two every six hours. Sometimes it will dull the pain just enough for me to get through the day, I have tried all the usual drugs and preventive drugs and suffered the side effects too. I refuse to take anything else and my fiorinol is not half as bad as many of the other drugs. I have one or two headaches weekly now but usually take only one pill if I don’t wait too long.
    I have been unable to work for over ten years because of headaches and the discrimination we suffer from employers and people at the workplace.
    I am fortunate that I can stay home.
    My headaches have improved tremendously over the past five years since I started reading labels and paying attention to what I eat. I used to drink diet pepsi, one per day, but if you all read about aspertain, you’ll want to break that habit. And the food ingredient MSG, well it causes my head to throb two or three days everytime I accidentally eat something that contains it. And if I leave the house without a bottle of water or two and I get busy shopping or something I will feel my head begin to tighten as if maybe i’m dehydrated.
    I started taking magnesium, vitamin B-6 and feverfew. You don’t have to take it all the time, just for a while until the headaches improve and then take a few times a week.
    I have been without my fiorinol many times and it was an awful experience but I learned from that and now I hoard all can even if only take ten or fifteen per month I go ahead and call the doc. I wont be left hanging again. The emergency room is no place to be when your head hurts.
    Please start reading labels, our foods are loaded with things that hurt us and make us sick.
    Sincerely,
    Susan

  17. Mindy says:

    Beth suboxone! Its probably too late for you now, but anyone else thats having problems coming off of your medication Lortabs, percocets, its even said to be used for methadone and heroine. SUBOXONE! Some drs (primary care providers) prescribe it you can take it at home instead of locking yourself in rehab. I was on lortab 10s for a year and a half 4x daily, I decided against medical advice that I no longer wanted to be on pain medication. After planning vacations around when I could pick up my medicine, god forbid you have to pick up your medicine a day early even with plane tickets in your hand! Going to the dr 2x a month once for a pill count once for a drug test. Because of my rapid heartbeat, withdrawls could be extremely dangerous. I agreed to the suboxone treatment and I never got sick. The pain is still there, but even on the meds it was still there.

  18. Sam says:

    I have read all the comments and sympathize with all of the real pain you are all going thru. I am 36 and have had 7 back surgeries. I have severe spondylolisthesis II and scoliosis.Yes, I spelled that right.After 20 years you know how to spell what is wrong with you. I had my first surgery at 18 and have been suffering with my pain for 20 years. I have been taking Loritab 10 for that long. I have been real worried as to what drug they will be able to give me to control the pain now that this has stopped working.My tolerance level is so high now. I hate taking pills. But, I hate to be in pain. I hate knowing that I have to depend on anything to be able to function for the day. I teach. I have my 2 girls. I don’t know what to do. All the drug use in America is astounding to me. I have always been worried about the labels they put on me because I’m in pain and have to take opoids to function. I would love to be able to find anyone who could fix my back just so I could have the JOY of telling them where to shove the damn pills. I have started having severe stomache problems due to the prolonged use of Loritab. Is there any hope for me? I am afraid to get on anything stronger but the Loritab doesn’t work for the pain anymore and is tearing my body down. I’m having to treat more than just my back now.What other ways can I get relief? I have tried all I know.Increase in doseage? I’m at my limit with Loritab.I also have to take soma for the severe muscle spasms.
    That is how I found this site. I was looking for new ways to cope with this problem.

  19. Susan says:

    I think that its ridiculous the way the doctors say they will help manage pain and they even say that you will build up a tolerance but then when you tell them that your meds are not giving you relief anymore they give you that look like your a junkie. Its ridiculous. They told me I had three cracked, not ruptured dics in my back as well as two anterior tears on the dics and said “wow, you must be in agony”. I’ve been thru two rounds of therapy and it just gets worse! I can’t have surgery, I’m a single mom living in a fairly new area, I can’t have surgery, who will take care of the kids? Not to mention can’t afford to miss work! I used to be a restaurant mgr and had employees who used to sell all kids of pills. I never did any of that. That’s the issue is that people sell their meds so the people like us who need pain relief can’t get it. Just plain sad when you can’t even play with your kids cuz you can’t move! What do you do???

  20. lauren says:

    At 24 I have had chronic pain that has interrupted my day to day life for eleven years. I went to school for criminal justice and extra edu in the area of mental health/drug abuse (co-occurring disorders)…it took six years and I had to have an entire semester removed off my record because I spent the last month in and out of the hospital. Although it was a struggle I learned a lot about pain and pain meds. Those if you who are being treated like drug addicts I am sorry…I’ve been there. First of all, find a pain management doctor!!!!! I had a seizure because I had a general doc that wasn’t an expert in pain meds and you really need an expert. A specialist will also help when you do become tolerant to meds, because it will happen. Humans are built to adapt and return to homeostasis or normal so they do. A quick example is sea sickness… the first time the body is exposed to something new the body is affected making a person ill (ie pain relief), but as the person is continually exposed the body adjusts (tolerance). Depending on the person the body will either react or be tolerant. Going on my sea sickness example: the more boats you are on the more your body will remember what to do to balance itself. This pattern makes a single treatment impossible!!! I know the dance of finding a treatment or drug that helped and I thought ‘it would all be ok’, and then in 4-6 months I was a mess again…the meds didn’t work but I couldn’t stop taking them… or I would try so hard not to take my meds only to “have to” making me either feel like pain ruled my life or I was an addict. The good news is that knowing one treatment will eventually have to be changed can be planned for and thought through so the ‘crisis’ doesn’t happen at the end of treatment.
    As many of you have said you have been on pain meds for years and there is no euphoria only relief…You are wrong!!! You just don’t feel it because it’s become normal ie your brain is used to it…. now lets take the meds away from your brain…. you will find your are depressed. It can take a year to feel normal again with out opioid, even when complete pain relief is achieved.
    Another point that needs to be made: I have heard lorcet, oxycodone, fentynal, and morphine named. WRONG WRONG WRONG those are short acting pain relievers made for short term pain…. no wonder the dea is pissed… there are much better drugs. Long acting opioids (or opiods which are slightly different but are now used interchangeably) are what you should be on (mention longer half life to your dr they’ll understand, i hope). Please research Opana, Kadian, Avenza, and extended releases. They will take longer to kick in so a small short acting dose of meds may be needed. There are also TENS units, lidocaine patches, nerve blocks, massage, diet changes, and other options. Even with other help you still will probably hoard/hide meds, sometimes run out early, be upset by condition, feel like an addict, go through withdrawal because you are out of meds or have decided just to stop, have anxiety about meds and clock watch for doses or what ever else…you are allowed to be a little paniced when pain is involved.
    Last point: pain will affect your memory, motivation, mood, consentration, energy, relationships, behaviors, sleep, and many other things. Feeling like you are losing your mind is normal, and NO ONE who has never experience CHRONIC pain will ever understand fully. A pain management therapist can really help a great deal.

  21. dee says:

    This is for todd.Do you suffer from DEGENERATIVE DISK DESEASE?If you dont you have no business saying that people who are in pain 24/7 are drug addicts.You have no IDEA how debiliting this desease is and very painful.The only time I dont have pain is when I,m sleeping.Dr afraid to give us to high of a dosage of pain pills.Down the road I,ll be in a wheel chair.The pain is soo severe I feel like killing my self just to stop the pain.I have 5 disk that are degenerating in my lower back.Go on Daily strenghth you.ll find all the people on their who suffers with chronic debilitating desease.My nerves are pinched because of the disks that have collapsed.

  22. Anthony says:

    I just laugh when I see people saying “I am prescribed OxyContin and Fentanyl for pain, not to get high”. So what you’re saying is just because you’re actually in pain, that somehow these extremely powerful narcotics don’t get you high? Sorry but you are all full of shit. I am prescribed 30mg Roxicodone and I get high every time I take one, and I love the high I get. Being dependent and addicted are the same thing. The only difference between me and you is that I get free pills every month, while you spend thousands getting them off the street.

  23. Sharon says:

    I went to a pain specialists today and I not stopped crying all day. Ten years ago I had a really large aneurysm that was opened during sinus surgery. To survive they had to coil the aneurysm and the whole right carotid artery. Then a year later I had a bled-out from a hemangio. It is to dangereous to operate so I live with it. I have had headaches every day since. After trials of many many preventive after seven years I started opiods. It 3 a day at 10 mg. but that dose isn’t helping at all. When I asked my doctor to go up by 10 tablets he freaked. Then I saw a pain doctor and was so belittling and mean.He said no one should take opiods for headaches and he was going to write my doctor. I had actually gone because I have read about Botox helping with headaches. But he was like is that all you came for to get drugs etc. It was so humiliating. I lost my insurance with the divorce and have to have disability which here is like welfare. Reading this finally got me to stop feeling so ashamed

  24. Sharon says:

    Wow- I read my own comment and its a little embarrassing all the typos. Note to self-read before sending.This is my first time writing on a site. Anyway a few things to add in case anyone has had similar things the bleed-out was a cavenous hemangioma deep in the brain. I started the opioid vicodin four years ago and have had the same dose since, which is probably why they aren’t helping much anymore. Pain doctor also told me my bad posture was probably causing the neck pain and (incredibly) the headaches that started after the brain procedures. He dismissed my PT even after I told him I had physical therapy with her for one and a half years. He said she probably wasn’t as good as the one he recommends.He also said he was going to write my primary that he should not be using opioid for headaches.

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