(This is a copy and paste, but worth the read to share)
From The National Institute on Drug Abuse Addiction vs. Dependence
"This is what distinguishes the pain patient who is tolerant to and
physically dependent on morphine, from the addict who is also tolerant
to and physically dependent on heroin. Both are self-administering an
addictive drug several times a day. But while the addict takes his
drug to get high, "mellow out," and largely avoid life, The pain
patient takes his drug to get on with life.
This apparently subtle distinction between the contingencies
surrounding drug use lead to a remarkably different outcome for these
two different kinds of users. Heroin addicts are lost to themselves,
to their families, and to society. Not only can't they work, but they
are almost certainly engaged in criminal activity, and they are at
high risk of a variety of infectious diseases, including hepatitis and
AIDS.
Indeed, intravenous drug users have become the major vector for the
spread of AIDS into the heterosexual community in this country.
Current estimates are that more than 55% of addicts in New York City
are HIV positive."
"Pain patients, by contrast, couldn't be more different. Being on an
opioid allows them to interact with their families, to get out of
hospitals, and to go back to work. Indeed, their efforts to maintain
their health are in marked contradiction to the utter disregard
addicts show for their health. If we wish to equate addicts with pain
patients, the more appropriate comparison is with the under treated
pain patient."
"He is in the hospital or inactive at home, he is a major drain on his
family's emotional and financial resources, and he does not contribute
productively to society."
"Another difference between addicts and pain patients comes when it is
time to get off the drug on which they are physically dependent. For
addicts, this is a major hurdle. For the pain patient, it is typically
an uncomplicated process. ... Drugs have a completely different
meaning to pain patients, however...."
"Because of the meaning of drugs in an addict's life, drug addiction
is a chronic, relapsing condition. Because of the very different
meaning of drugs in a pain patient's life, drug addiction rarely, if
ever, occurs after opioid use has stopped.
This is a crucial point. The data most often cited to link addiction
to medically administered opioids were derived from studies with
addicts. In the first place, this group is highly unrepresentative of
the general population. In the second, it is made up of highly
unreliable people. Self-reporting about drug use by addicts is not the
method of choice in studying drug use. The more appropriate data to
address this issue have been derived from retrospective reviews of
large numbers of patients who received opioids to determine how many
became addicts. 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 this discussion are clear:
Dependence and addiction are not equivalent to each other;
Patients who become dependent on opioids during the course of medical
therapy rarely become addicted to those drugs; and
In managing pain with opioids, there is little need to fear addiction.
Tolerance to opioids is rarely a problem because it is possible to
continuously increase the dose. Dependence is only a concern when
prescribing drugs with antagonist properties and in managing
withdrawal."
"If addiction is not a reason to avoid using opioids, many of the
other reasons that have led to widespread under prescribing can be
addressed more directly. Most important among these are the legal
barriers we have erected, to limit the use of opioids. And the lack of
knowledge among health care professionals about the proper use of
these agents."
From The National Institute on Drug Abuse (NIDA) The National
Institute on Drug Abuse (NIDA), is part of the National Institutes of
Health (NIH), the principal biomedical and behavioral research agency
of the United States Government. NIH is a component of the U.S.
Department of Health and Human Services.
