I edited the title because it’s been pointed out that “dependence” isn’t the right word. I knew this but was paraphrasing the article title, which uses that word instead of addiction, even though they are clearly talking about opioid misuse. We can thank the DSM-5 for this confusion.
Development of dependence following treatment with opioid analgesics for pain relief: a systematic view – June 2012
Aims: To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.
Spoiler alert from the happy conclusion:
The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence. Continue reading
What Is Addiction? And What Are Its True Causes? – By Wolfgang Vogel – Feb 2019
Here’s another article pointing out that addiction isn’t lurking inside drugs like opioids, but rather inside the individual.
This seems so obvious because hundreds of millions of people are routinely prescribed opioids for post-surgical pain and if all or most of them became addicted, there would hardly be any non-opioid-addicted people left.
Unfortunately, most individuals know little about what addiction actually is, and even less about what causes it. Continue reading
What’s in a Word? Addiction Versus Dependence in DSM-V | American Journal of Psychiatry – by Charles P. O’Brien M.D., Ph.D., Nora Volkow M.D., T-K Li M.D. – May 2006
…completely revised diagnostic classification published in 1987 known as DSM-III-R. This was an important contribution to the mental health field because it provided a clear way of defining addiction as compulsive drug-seeking behavior using criteria that turned out to have excellent interrater reliability and applicability to all forms of drug addiction.
The classification was adopted with only minor changes in DSM-IV.
One of us (C.O.) was a member of the committee who attended every one of the committee meetings throughout the 1980s. There was good agreement among committee members as to the definition of addiction, but there was disagreement as to the label that should be used. Continue reading
The Science of Drug Use and Addiction: The Basics | National Institute on Drug Abuse (NIDA) July 2018
Here’s what our own government’s experts of the National Institute of Drug Abuse (NIDA) believe about addiction. It’s an amazingly realistic appraisal, very different from PROP’s anti-opioid rhetoric.
Addiction is defined as
- a chronic, relapsing disorder characterized by
- compulsive drug seeking,
- continued use despite harmful consequences, and
- long-lasting changes in the brain. Continue reading
Can You Really Become Addicted to a Drug After Just One Hit? – VICE – by Matilda Whitworth |Oct 22 2015
The idea that one toke on a crack pipe destroys your life is popular, but it contradicts what we know about brain chemistry.
You know the story. The one that says some drugs are so enjoyable, so insidious, that just one try will get you hooked. And you’d be forgiven for believing this as the media really backs the theory.
- “The Danger In Just One Hit of Cocaine,” reports the Daily Mail.
- “Official: 1-Hit Addiction to Meth No Myth,” announces the Times Daily.
- “It Only Took One Hit to Get Hooked,” writes news.com.
But is it actually true? Can a person become addicted to a drug after using it a single time? Continue reading
Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies — NEJM – Nora D. Volkow, M.D. [Director of the National Institute on Drug Abuse (NIDA)], and A. Thomas McLellan, Ph.D. – Mar 2016 – free full-text article
I’m reposting this classic paper, which ironically came out the same month as the CDC Guidelines. Those guidelines showed zero understanding of the latest research and facts about opioid abuse and chronic pain that our own government is aware of.
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage.
The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction Continue reading
With what we know about addiction these days, it makes no sense to split the “substance dependence” diagnoses into groups by the specific drug. Addiction happens when the brain habituates to a malfunction of satisfying cravings despite increasing harms.
It’s the users that become addicted and have a problem, not the substance!
Wikipedia information on DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). Continue reading
Only 1 in 4 troops have an opioid prescription in a given year – By: Karen Jowers – Dec 2018
Nearly 1 in 4 active-duty service members had at least one prescription for an opioid at some point in 2017, according to Defense Department research.
About 1 in 4 retirees also had at least one opioid prescription.
That doesn’t necessarily equate to opioid addiction. Opioids are prescribed for moderate-to-severe pain after surgery, injury, or for pain from conditions such as cancer.
THE TROUBLE WITH HEROIN
I found this intimate description of heroin withdrawals so compelling I began to squirm as I read (. I’m sharing it here so those of us taking opioids for pain can understand the dilemma of those who begin taking opioids for recreation. What starts as “fun” quickly turns into a desperate compulsion to avoid truly unbearable misery.
A lot of people are physically sick when taking gear [heroin] for the first time. The body is reacting naturally by dispelling poison from its system, heroin is a poison to the body. The body quickly adapts to regular heroin intakes, the speed of the addiction is revealing, after a few days your body can tolerate and then require regular top ups to feed the tolerance. Continue reading
Opioid Withdrawal Not Deadly? Wrong | Medpage Today – by Jeffrey E. Keller, MD Nov 2018
I’ve seen enough patients withdrawing from opioids [in a jail medical practice] that I think I am reasonably knowledgeable on the topic. Because of this, I was quite surprised when I ran across this sentence in a recent edition of The Medical Letter: “Opioid withdrawal is not life-threatening.”
The problem is that although this sentence seems quite self-assured, it is flat out wrong. In fact, it is not just wrong; it is also dangerous.
People do die from opioid withdrawal. I know of several such cases from my work with jails. Continue reading