Opioid Dependence Versus Addiction

Opioid Dependence Versus Addiction–The Difference

  When a human body adapts to a drug, requiring more of it to achieve a certain effect over time such as pain relief (tolerance development) and eliciting drug-specific physical or mental symptoms if the drug is suddenly stopped (withdrawals) without tapering the dosage down over time (titration).  If opioid use is to be stopped, tapering the dosage down over time can eliminate or minimize withdrawal symptoms.  Many substances and medications can result in physical dependence–not just opioids–including anti-depressant medications, caffeine, nicotine, and sugar.

Addiction:  Compulsive drug use despite harmful consequences characterized by a supposed inability to stop using a drug and failure to meet work, social, or family obligations, and depending on the drug, tolerance development and withdrawal symptoms if the drug is suddenly stopped.  Drug addicts typically abuse drugs including opioids at much higher doses than would be used medically (often 5 times higher or more).  As such, they are prone to withdrawal sickness, cravings, and may devote more of their drug use to avoiding withdrawals than to getting high.

Many drugs result in dependence, not just opioids.  For example, diabetics may be dependent on insulin, but they are not addicted to it.  Addiction is a whole different concept from dependence and there is much confusion over the two, sometimes presented intentionally.  For example, as part of the anti-opioid hysteria, journalists are calling physical dependence addiction when it is not.  Furthermore, some opioid pain medication users may erroneously think they are addicted when they are just physically dependent.  The distinction between dependence and addiction is stark and should not be confused, though it often is.

While every long-term user of opioids will become dependent and will have to reduce the dosage over time to prevent withdrawals should they need to stop using the medication, they are not addicts.  The vast majority of legitimate, legally-prescribed opioid users will not become addicts and abuse their medication to get high and use the drug compulsively resulting in ruining their lives or death.  Only a very, very small subset of the population (a fraction of one percent) has any problems with opioids and they are usually younger than age 45 while most opioid users are over the age of 45.  Most of the people getting short-term prescriptions for opioids following surgery are older and most chronic pain sufferers using opioid are older as well, while most drug abusers and addicts are younger.  If medical use of opioids led to addiction, then most opioid abusers and heroin addicts would be older but are not.

Symptoms of opioid withdrawal

While many drugs can produce withdrawal symptoms, the focus here is on opioid withdrawal symptoms.  All opioids can produce withdrawal symptoms if used long enough or at high doses including medically-prescribed morphine, oxycodone (Percocet), hydrocodone (Vicodin), oxymorphone, hydromorphone, fentanyl, and of course, illegal street drugs such as heroin, opium, carfentanil, and others.

Early symptoms of opioid withdrawal include:

  • Muscle aches and pain, possibly severe
  • Anxiety and agitation
  • Excessive sweating
  • Watery eyes
  • Runny nose
  • Restlessness
  • Insomnia
  • Yawning frequently

Later symptoms include:

  • Flu-like symptoms including nausea, vomiting, and diarrhea
  • Abdominal cramping and pain
  • Goose bumps on the skin
  • Dilated pupils

Withdrawal symptoms usually improve within 72 hours with the withdrawal sufferer usually back to normal within a week.  Withdrawal symptoms are not life-threatening but can result in dehydration if one does not replace fluids lost through vomiting and diarrhea.

Withdrawal symptoms can be triggered after abrupt cessation of opioids following long-term use or from short-term use of high doses such as would be medically necessary following a severe accident or from recreational drug abuse.

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