I recently had a few operations and was on various opiates during recovery.
I was recently told this: You can’t become addicted if your body is in pain and actually needs the relief.
It has always been my understanding that opiate addiction was a physical dependency that developed from long-term use.
Can someone knowledgeable enlighten me?
Please note that I do not believe that I am currently addicted or dependent, nor am I seeking medical advice about how to beat addiction.
Lots of WW1 wounded got addicted.
This shows up in postwar accounts I’ve read, & is a staple in genre popular writing, fiction & non, of the era.
So, IMHO, the “no addiction” theory…phooey.
When you start using words like “addiction,” “dependency” and “tolerance” you sort of get into a war of semantics. Long-term opiate use will lead to physical dependency and if abruptly discontinued, withdrawal symptoms are unavoidable. The severity depends on the amount and the length of use, but yeah, your body will eventually become dependent on opiates to avoid withdrawal sickness.
Addiction, on the other hand, is usually the term used to describe the psychological compulsion along with the physical dependency of long-term opiate usage. We’re getting into semantics now but my purely anecdotal data of over twenty years of knowing people addicted or dependent on opiates for chronic pain or recreational abuse tells me that if you’re predisposed to addiction, you’re more likely to become addicted even with a valid need for opiates. If you enjoy the heck out of the opiate buzz even when you’re using it for legit reasons, you probably need to be very careful.
I guess the answer to your question is yes, there will eventually be a physical dependency and increased tolerance with long-term usage. However, this doesn’t necessarily classify you as an addict. It just means you won’t have the horrible psychological crap that goes with it when it comes time to taper off.
Fiveroptic, I appreciate the semantic distinctions, and hadn’t thought about that during the discussion. Perhaps she was making the same distinction between addiction and dependency.
DSM uses “dependency” and does not use “addiction.”
My understanding, regardless of terminology, is that you don’t get the strong euphoria/dopamine/reward pathway response when you’re in pain, so it’s not reinforcing in that way, but still can develop tolerance (physiological changes) which is one of the hallmarks of addiction/dependency.
Physiological addiction to opiates will happen to anyone who is given enough opiates over a long period of time. Whether one develops a dependency (a compulsive need to obtain and use opiates) is another story.
Many former opiate addicts (including myself) have noted that when they were given opiates to treat significant acute pain, the euphoric effects, along with the compulsive need to use, were much blunted, or even absent.
However, this does not mean that the recovering addict is cured, and may now use opiates with impunity.
Please understand that by no means do I speak as a medical or mental health professional, but as one who is a former opiate addict who continues to hang out with others who’ve either beaten it or are trying to get off the crazy train. The semantics and the terminology really don’t matter to me but oh boy, can they cause some heated arguments.
Like QtM, I recently required a legitimate use of opiates for a few days and was rather surprised that I didn’t feel that familiar warmth of long ago when I was abusing drugs. It killed the pain, though, and that sure as heck made me happy enough. I’ve also been absolutely up front with my doc about my history just to make sure that there’s a safety net in place should I ever feel cocky and decide that “just once for old time’s sake won’t hurt.”
Because you see, for me it will hurt – but that’s because I was an addict, not just physically dependent due to physiological changes. And there are those damn semantics again. Whatever terminology one is most comfortable with, I’m just glad as hell to be off the train.
It takes about 3 days of “weaning” to reverse the physiological dependence encountered with long term use for pain.
Whomever told you that is so misinformed that it’s scary. You can and often DO become addicted to opiates, even after small intervals of use.
I was a bedside critical care nurse for 40 years. Of course, there were patients who developed a psychological addiction after long term opiate use for pain, but they were the exception rather than the rule.
Physiological dependence is easily reversed, in a controlled setting.
How exactly do you define “small intervals of use”? That’s a pretty wide statement you’ve made.
I read an autobiographical account of learning to be a doctor - maybe it was Intern, by Dr. X, or maybe one of Nolan’s books, or some other. He describes this very point as something that he learned - that people getting narcotic meds for pain don’t get addicted. He also adds a footnote years after the original writing, saying that they don’t become addicts in the commonly understood sense, but that they do go through some withdrawal symptoms. People recovering from serious medical problems go through lots of things, though, while people who are recovering solely from narcotic adiction just go through the withdrawal parts.
And I can observe that when I took 1200 Percocets over many months for a back problem, they alleviated much of the pain, and they also provided a pleasant euphoria that was a very useful counterbalance to the depression and anxiety of going through a scary medical problem with somewhat uncertain outcome. While I wouldn’t be eager to try to argue the point with insurance companies or narcotics agents, I do think this euphoria amounted to an important part of the treatment, whether anyone intended it to or not. That being said, I went through various unpleasant sensations when cutting down and stopping their use. But the nature of this unpleasantness was more a part of the long road back from an injury than it was the stuff of popular accounts of drug addiction horrors.
I was on Vicodin for almost 3 months do to a bastard of a kidney stone just recently. The pain was, shall we say… intense… and the opiates did take the edge off most times. Only when in the most writhing agony would I not feel any of the euphoric effects, but also, the pain killers didn’t take away much of the pain either.
Eventually, I had to have a procedure to remove the stone, and was on Vicodin about a week after for soreness. I didn’t get addicted, but I sure didn’t mind the buzz either, although I did notice that my body just hurt when I stopped cold turkey (like chronic pain). Eventually it went away, and now I’m hunky-dory, but my opinion is that anyone can become psychologically addicted whether they are in honest pain or not, so long as they REALLY love that feeling, once acquainted, they might yearn for it. And dependency seems like an inevitability if taken long enough, although not too hard to overcome, IME.
Not to hard for you to overcome. Your experience is not universal.
And that is where the heated discussions over the semantics of “addiction vs. dependency” comes to play.
Still this comment by diggleblop makes me very uneasy:
I need “small intervals” to be quantified, because I think a statement like this only serves to frighten people who are already misinformed about the “evils of opiates.” Using them for a few days doesn’t cause physiological dependence. Even using them for a few weeks in prescribed amounts may only cause mild physiological dependence and mild withdrawal symptoms if they’re not tapered down when they are no longer needed. Even then, a few weeks of opiate therapy doesn’t necessarily mean you’ll become dependent.
Opiates aren’t evil medications. Hell, they aren’t even dangerous meds when used judiciously. I would truly hate someone in need of pain management to go without analgesia due to a fear addiction based on media hysteria.
Agreed, of course. I don’t deny that for some, if not many, it may be an incredibly overwhelming experience. (of course, I’ve only taken Vicodin. Other, more powerful opiates, I’m sure, have much more addictive qualities.)
Thirded. Because it’s possible does not mean it’s easy. I’ve never taken “street” drugs but I needed opiates (or was prescribed them) due to a skull fracture. I developed a physiological dependance on them. Getting off of them was easily the hardest (and most painful) thing I’ve ever done. There was a BIG psychological downside to getting clean but it paled to the physical part.
I’ve never known of anyone who has been on them for only a few days to need to taper off. I’ve also never known anyone who has been on them for longer than several weeks comfortably taper off in only three days, as described upthread by picunurse. Again, my experience is anecdotal (myself and many friends and associates) but the most compassionate taper happens very, very gradually, over many weeks under supervision by a knowledgeable practitioner.
And good god, let’s not even veer off into benzodiazepine addiction and withdrawal. I’m breaking into a cold sweat just thinking about it.
I’ve tapered many, many patients, and been tapered myself.
Unless one is on a long-acting opiate, such as methadone, there’s really no physiological need for much more than a 3-4 day taper. That’s the nice thing about most opiates: The withdrawal is over fairly quick. The physical withdrawal anyway. The psychological withdrawal lasts longer, but if one is aiming to be off opiates due to dependency issues, lengthening the taper only prolongs those issues.
And my professional experience concurs with the observation that short-term use rarely results in physiologic addiction or requires a taper.
Often people who have been using opiates for a long period of time, when they have treatment that reduces their pain are then able to stop their opiates easily and are not psychologically dependent on them. e.g. cancer patients who have radiotherapy to control the pain of bony metastases are able to stop their opiates, people who have had chronic back pain due to disc prolapse can stop their painkillers after corrective surgery etc.
As someone who used heavy duty opiates one week out of four for several years for endometriosis, I had absolutely no issues not using opiates the other three weeks. Nor did I feel the need to continue their use when I had successful treatment which reduced the pain to a level where opiates are no longer necessary.