DSI Newsletter: Is This Narcotic Addicting?

DSI Newsletters, Issue 33:
Is This Narcotic Addicting?

There are several different words that mean "addiction" all with different clinical meanings and significance. It is common to ask the doctor if a given narcotic is addicting. The quick answer is yes. But, it depends on what you mean by the term.
For example, cigarettes are highly addicting. Most people who smoke find it very hard to stop. This is not true of narcotics as few people have any trouble discontinuing them.
Addiction: Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence" and "psychological dependence." Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction as they are easily overcome by slowly tapering down the dose over time.
Analgesic Tolerance: Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. Analgesic tolerance may or may not be evident during opioid treatment and does not equate with addiction.
Chronic Pain: A pain state which is persistent and in which the cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease.
Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Physical Dependence: Physical dependence on a controlled substance is a physiologic state of neuroadaptation which is characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence is an expected result of opioid use. Physical dependence, by itself, does not equate with addiction.
Pseudoaddiction: A pattern of drug seeking behavior of pain patients, who are receiving inadequate pain management that can be mistaken for addiction.
Substance Abuse: Substance abuse is the use of any substance(s) for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed.
Tolerance: Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect or a reduced effect is observed with a constant dose.
In my experience, I have never given a patient a narcotic and subsequently have trouble discontinuing it. I feel the small group of people that get into trouble with narcotics were looking for trouble from the very first doctor's visit. That is, they never had any pain at all and were faking pain in order to feel the euphoria (get high). They then proceed with a series of lies to the doctor, family and friends to obtain more narcotic even though it is obviously hurting them. This is quite different from a legitimate pain patient who takes a narcotic and then experiences an improvement in their activities of daily living. In fact, in my practice I recommend narcotics in combination with NSAIDs and Tylenol early on as low doses of different classes of pain medicines not only work well together but are safer than going higher on a single pain medication.

Sincerely:

Joseph Saponaro, MD, DABIM, FACP, CPI, CCI, CCRI, CCRC, CCRP
Board Certified Internist, JPMC
Principal Investigator, DSI
Diplomat American Board of Internal Medicine
Fellow American College of Physicians
Certified Physician Investigator by the AAPP
Certified Clinical Investigator by the DIA
Certified Clinical Research Investigator by the ACRP
Certified Clinical Research Coordinator by the ACRP
Certified Clinical Research Professional by SoCRA
Member: The American College of Preventive Medicine

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