Drug dependency does not necessarily mean addiction

Don’t be so quick to label people

Health care professionals should not prevent sick and dying patients from taking medication to ease their pain because they fear the patient is becoming addicted, a national pain management expert says.

"Certain people have chronic pain problems that persist despite our best efforts to remedy the situation and cure them," says J. David Haddox, DDS, MD, medical director of the Pain Rehabilitation Program at the Center for Pain Medicine of the Emory Clinic in Atlanta. The Emory Clinic is an arm of the Emory University system of health care.

Haddox points to rheumatoid arthritis as an example. "These patients often have ongoing pain with a very legitimate reason for medication."

If patients with that disease take morphine-like drugs on an ongoing basis, they will become physically dependent on the medication, Haddox says.

This means they will have withdrawal symptoms if the medication is withheld.

"The mistake is that people think if you have to have the medication to prevent withdrawal, then you must be addicted to it," Haddox says.

"The point I’d like to articulate is that physical dependence is a feature of certain drugs, and it will happen with a very high reliability with certain drugs, and it will not happen at all with other drugs."

For example, opioids — the morphine-like drugs, some nerve pills, certain sleeping pills, nicotine, caffeine, some nasal sprays, and certain blood pressure medicines all can lead to physical dependency.

Then there are drugs such as Tylenol, Motrin, and antibiotics that never cause physical dependency.

Haddox explains that addiction, on the other hand, is an individual occurrence.

"Some people have a genetic tendency to become addicted to certain types of drugs, and in the right environment that genetic tendency can be expressed as an addiction," he says.

Addicts are preoccupied with obtaining and using their drugs. They spend a lot of time either using or recovering from the effects of the drugs, and they use the drug despite the harm it can cause. They lose control over the drug, and their quality of life deteriorates, Haddox says.

On the other hand, taking an opioid under medical supervision for treatment of pain improves the quality of life even if the patient becomes physically dependent, Haddox says.

"If I have a cancer patient who is doing better because of pain medication, then I don’t care if the patient is physically dependent," he says. "But if I see a person who is missing work because of drug use and is hung over and stoned or who is having medical complications for using a drug, then I start thinking addiction."

Haddox says the misconceptions people have about cancer or chronic pain patients and drug addiction have caused too many sick people unnecessary obstacles to receiving the medication they need.

"I can’t tell you the number of cancer patients with clear-cut evidence of metastasis disease who have been labeled addicts."

Some patients have legitimate needs

Haddox and an oncologist colleague named David E. Weissman, MD, published an article in 1989, in the journal Pain, in which they coined the term, "pseudoaddiction."

"We used that term to describe the process by which a person with legitimate medical needs is labeled an addict and treated as an addict, and the patient naturally gets angry and acts out, and the health care team says, ‘See, we were right because see how he is behaving when he doesn’t have his drugs,’ and this just escalates into a crisis," Haddox says.

Studies have shown that if a patient has not exhibited addictive behavior in the past and is given pain medication for a medical reason, then he or she has less than a .5% chance of becoming addicted, Haddox reports.

"Your chance of getting into an auto wreck and losing your life is much worse than that."

Another common myth among health care professionals, Haddox says, is believing that a patient is addicted if he or she needs larger quantities of the pain medication to achieve the same effect.

Patients can build up a tolerance for some drugs such as morphine, Demerol, and Dilaudid, he says. But this doesn’t mean they’re addicted. "Some of the other reasons for increasing drug doses late in the course of cancer is that the patient has increasing needs as the disease progresses," Haddox says.

"I would rather make the error of believing the patient who says he has pain, and treat the patient appropriately," he says. "Then if they respond inappropriately you could sort out what’s going on.

"But my concern here is these patients are basically mistreated because of this fear of addiction, and we’re withholding medications based on our own fears and ignorance and bias, and I think that’s a tragedy," Haddox says.

Once a patient who is physically dependent on a painkiller is cured of his or her disease or pain, then it’s very easy to wean the patient off the drug, he says.

A physician simply will gradually taper off the dose over time.

"What you’ll find is many cancer patients who start feeling better don’t want the opioid anymore," Haddox says.