Panic and confusion about the opioid endemic are causing the rapid spread of misinformation throughout the United States.
Here we debunk some of the most common misconceptions about opioid abuse, especially as it relates to chronic pain.
1. “Addiction” is the same as “physical dependence” or “tolerance.”
Addiction is a disease made up of both physical and psychological components. It may include physical dependence or tolerance, but these elements are not required. Physical dependence is characterized by withdrawal symptoms upon cessation, or by the development of tolerance in which an increase in substance use is necessary to achieve an effect. This confusion in terminology has caused some patients to fear taking opioids because they believe that tolerance, which naturally forms from long-term use, equates with addiction. The confusion has also caused some physicians to avoid prescribing opioids, even in clinically appropriate cases, for fear of fueling a non-existent tendency towards “addiction.”
2. Individuals who use medication-assisted therapy are just “trading one addiction for another.”
Medicines like methadone and buprenorphine are not simply substitutes for opioids. These drugs are called opioid-agonists and while they do bind to the same opioid receptors in the brain, they do so in a different way. They act slowly and at steady concentrations, stabilizing physiological processes that are altered by drugs of abuse. They also protect against the risks associated with illegal opioid abuse while facilitating recovery.
3. Addiction is caused by moral failure; it is just a series of poor choices.
Once again, it should be emphasized that addiction is a disease; it is no more of a moral failing than diabetes or asthma. The reward system in the brain is altered so that drug-seeking behaviors are enforced, and sheer force of will is not enough to overcome those shifts. The misconception that addicts are just individuals with poor self-control only serves as a form of discrimination. These patients deserve quality care and compassion, but are faced with mistrust and skepticism instead. Many health care professionals ignore research regarding treatment methods as a result of this misconception, and patients are less likely to reach out for care when needed.
4. Patients with pain cannot become addicted to their opioid medications because they are not taking it recreationally.
No one is immune; even patients who take opioids for legitimate medical reasons can become addicted. Medical necessity does not “protect” against addiction, yet this misconception is causing some physicians to overconfidently write opioid prescriptions without monitoring for addictive behavior. Medical professionals must always be on the lookout for warning signs and be ready to intervene as needed; even patients who take the drugs exactly as prescribed can become addicted.
5. Only long-term opioid use causes addiction.
Addiction cannot be attributed solely to properties of the drug; for example, individuals who are especially vulnerable to addiction can become addicted after short-term opioid use. This misconception can cause physicians to over-prescribe opioids, thinking that the risks are only associated with long-term use when actually the duration of medication is only one factor that needs to be considered.
6. Opioids are effective for treating long-term chronic pain.
As a general rule, opioids are not considered effective for treating long-term chronic pain. Repeated use leads to drug tolerance; in other words, increasingly higher doses are required as time passes because lower doses of the drug fail to trigger a satisfactory level of analgesia. Additionally, studies have shown that opioids cause generalized, heightened pain sensitivity (hyperalgesia) over long periods of time. For example, you might start out taking opioids for chronic hip pain but, as time goes on, you realize that your ankles are starting to hurt for no particular reason as well. The CDC recommends that opioids be used primarily for short-term pain relief, and cautions against long-term use without appropriate rationale and monitoring.
7. Opioids are bad and everyone who takes opioids becomes addicted.
The reality is that legal opioids are highly effective for treating pain, and only a small percentage of patients prescribed opioids become addicted, even among those with highly addictive tendencies. It should be noted, though, that the risk of addiction does slightly increase for individuals who take opioids for a long time (more than three months) or at high doses (over 100 morphine milligram equivalents (MMEs)). The risk also increases for adolescents, and individuals with depression and/or substance use disorder(s). Additionally, genetics account for 35-40% of the risk associated with addiction.
If you (or a loved one) are struggling with opioid addiction and/or chronic pain, please call us today at 504-510-2331.
Longo, Dan L., Nora D. Volkow, and A. Thomas Mclellan. "Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies." New England Journal of Medicine N Engl J Med 374.13 (2016): 1253-263. Web.