Drug Abuse, Physical Dependence, Tolerance, Addiction

Drug abuse

Opioids not only provide relief from pain, they can also cause an exaggerated sense of well-being or pleasure (euphoria). People sometimes begin to use medications in higher doses and more frequently to experience this sense of pleasure, rather than for pain control. This is known as drug abuse. Taking higher doses of a drug can lead to life-threatening respiratory depression, since opioids (narcotics) depress the area of the central nervous system that controls breathing. The side effects of opioids become even more dangerous when they are combined with other medications that depress the central nervous system such as alcohol, antihistamines, barbiturates, benzodiazepines etc.

Physical dependence

Chronic use or abuse of opioids can result in physical dependence. Physical dependence means that the body has adapted to the presence of the drug and withdrawal symptoms occur if the dosage of the drug is reduced too quickly or stopped. Symptoms of withdrawal include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes with goose bumps ("cold turkey").

Physical dependence can be treated by withdrawing the drug slowly or by using an opioid pain killer that leaves the body slowly.

Tolerance to the effects of an opioid (narcotic) can occur with long-term use. Tolerance means the drug becomes less effective over time so much higher doses are needed to achieve the same effects.

Addiction is a strong physical and/or psychological dependence on a substance. The habit or compulsion is so strong that it drives the person to seek out and use a drug despite negative and sometimes dangerous consequences.

Prevention and treatment for addiction

Some people are afraid to take medications to get sufficient pain relief because they are afraid of addiction. Addiction is less common in people who have an identifiable cause for pain, such as serious injury, cancer or disease. Taking medications on a regular basis rather than on an as needed basis decreases the likelihood of addiction and abuse. Addiction is more common when pain is not present.

It is important to determine if there is a mood disorder such as depression or other mental illness. People often become addicted because they are using a pain killer to dull the suffering that comes from mental illness. Treating mental illness with appropriate medications and counseling can decrease the likelihood of mental illness leading to addiction.

Treatment for drug abuse or dependence begins with recognizing the problem. Denial of the problem is commonly reported with addiction. It is important to realize denial occurs less frequently in people who are dealt with in an empathetic and respectful manner and higher in people dealt with in a confrontational manner.

Treatment depends on the drug being used. The patient is usually gradually weaned off the drug (detoxification) and provided with support to remain drug free.

There are many community support groups to treat addiction. Support groups include: Narcotics Anonymous (NA), Ala-Teen, and Al-Anon, SMART Recovery and Life Ring Recovery. Most groups follow the 12-Step program used in Alcoholics Anonymous (AA). SMART Recovery and Life Ring Recovery do not use the 12-step approach. You can find support groups in your phone book, through your mental health clinic, or health care provider.

Reference:

Arrowhead Publishers: New Insights into the Global Market for Pain Management, Retrieved October 30, 2008 http://www.arrowheadpublishers.com/news/archives/2007/11/new-insights-into-the-global-m.php