The Pain Information Newsletter
Provided by MGH Cares About Pain Relief
Volume 1, No. 7

A major barrier perhaps the most important barrier to effective and consistent approaches to pain relief is widespread misconceptions about opioids. These misconceptions lead to fear and prejudice throughout our society. They interfere with the ability of clinicians to provide appropriate care, and contribute to distrust and non-adherence to treatment on the part of patients.

1. Opioids are very safe and effective when used appropriately.

2. People who take opioids as medication to relieve pain do not become addicted.

3. Addiction is a psychological condition that, like an eating disorder, has a physical component. Addiction to opioids in the general population is very low, approximately 1% of all Americans over the age of 12. Studies of people who have been prescribed opioids for pain show that considerably less than 1% become addicted.

4. A far more likely problem is that in the health care setting a patient�s pain will be under treated due to withholding of or inappropriate prescribing of opioids. Ironically, this can lead to �drug-seeking behavior,� more likely a sign of inadequate analgesia than of addiction. In 2001 the American Pain Society, the American Society of Addiction Medicine, and the American Academy of Pain Medicine developed a consensus statement on definitions of addiction, dependence, and tolerance that are adapted below. Please note that development of tolerance and/or dependence are not symptoms of nor risk factors for addiction.

5. ADDICTION is a primary, chronic, neurobiologic disease. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use for effects other than pain relief, continued use despite harm, and craving. (Patients with a history of addiction who have pain can be successfully treated with opioids, a controversial topic to be discussed in a future issue)

6. Physical DEPENDENCE is a state of adaptation that is manifested by a withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, and/or administration of an antagonist. (Dependence can develop in about 7 days. When reducing doses in a person who has developed dependence, reduce by no more than 25% per day to avoid withdrawal syndrome.)

7. TOLERANCE is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug�s effects over time. (Tolerance is quite variable from patient to patient. One should suspect disease progression or acute psychosocial stress as well as tolerance if the need for analgesics suddenly increases.) Don't let fears of opioid addiction deprive patients of important drugs that can help them live well: educate patients, families, and colleagues about common, inappropriate, fears and misunderstandings.