By R Carter
Things are not always what they seem; the first appearance deceives many; the intelligence of a few perceives what has been carefully hidden.Phaedrus
Are addiction and physical dependence the same thing?
It has been known for decades that addiction is a complex condition of mind, body and spirit which has deep roots in environment and economic factors, genetics, bodily maladies, family emotional dynamics and mental health. In today’s opiate crisis world, the same subjective fears and prejudices which have plagued those falling into addiction, are now ascribed to chronic pain patients by default, for no other reason than, a key element to treatment is the prescribing of opiates. Such unconscious bias when carried out without proof is nothing more than bigotry.
Proponents favoring increased restrictions will argue that prescription opiates have contributed to the opiate crisis. On this argument I agree and support steps taken to close loop holes in our healthcare system which have contributed to the opiate crisis. But such actions fall short of addressing the broader issues. As more regulations designed to remedy government concerns land on the shoulders of healthcare professionals, governments fail to provide remedies or clarification which limit professional liability concerns. Prescribing guidelines have shifted away from healthcare professionals and increasingly defined and controlled by state governments. This should be an alarming concern for all, not just chronic pain patients. The government has never been and never will be, qualified to diagnose and prescribe on a individual basis. It should limit it regulatory efforts at defining equitable solutions for business, industry and citizens. As doctors scramble to protect themselves, patient rights are increasingly under attack and sometimes ignored out right.
In the government publications, I’ve read, authors routinely group and count chronic pain patients and illegal drug users as one and the same, for no other reason than both groups have opiate related deaths. Government spends hundreds of millions of dollars collecting data and having healthcare experts on their payrolls who can explain the difference between these two groups, yet to date, I’ve seen no effort to separate the two in any meaningful way. In Ohio, after three years of research, I have yet to come across a state publication which makes a distinction between illegal opiates and prescribed opiates other than the source from which they come. Therefore chronic pain patients taking opiates face the same mountain of bias and prejudice ascribed to illegal opiate abusers.
While there’s still a possibility a patient with a legitimate medical condition may turn to illegal drug use, the chances today are significantly less given the education of physicians and the monitoring programs implemented by state governments. The very nature of self-medicating while under a doctor’s care is something which can now be quickly identified.
The language of opiate abuse today needs revision to recognize the difference between illegal opiate abuse and prescribed opiates. There is a distinct difference most people know little about. All opiates produce physical dependence which is why, physical dependence + self-medicating + drug seeking behavior = addiction. For a patient under the care of a doctor, physical dependence is a managed side effect of treatment. Doctors put time and effort into monitoring this side effect and in educating patients about it. That said, I personally believe more could be done in the area of education, but most doctors I know are reluctant to educate beyond providing informed consent, either seeing it as an effort which carries with it no revenue generating reimbursements, or believing that doing so may enable patients to misuse prescribed medications. The future of chronic pain management with opiates may need to take a page out of the NA handbook with regards to advocacy to better manage a patient’s response to treatment. More about that in future posts.
In our conversations on the use of opiates, these distinctions should be made and recognized.
Chronic pain patients:
- Practice acceptance that physical dependence is a side effect of treatment
- Doesn’t chase after a high
- Have a doctor who:
- Is the gatekeeper for access to opiates
- Monitors patient use and compliance
- Monitors for misuse or abuse of other substances
- Supports alternative non-opioid treatments
- Use prescribed opiates monitored by a state drug monitoring program
Self-medicating illegal drug abuse:
- Don’t practice acceptance, take larger amounts avoiding symptoms of physical dependence
- Chase the high
- Don’t have a gatekeeper to moderate access
- Have a source which promotes ever increasing doses
- Not monitored, frequently using multiple controlled substances
In a society sensitive to labels and political correctness, the author would like to see a distinction made between the terms addiction and physical dependence as being the difference between socially acceptable behavior and that which is not.
Yet as long as there are commercials which forward the idea that addiction can occur in as little as five days, there will continue to be a minority within our society bent on an agenda which promotes fear and prejudice over education, rationality and support.