Opioid Addiction, Dependence and Tolerance

When managing the patient with opioids, it is vital to establish the differences between physical dependence, tolerance, and addiction.

The American Society of Addiction Medicine and American Academy of Pain Management define physical dependence as a state of adaption that is manifested by a drug class for which specific withdrawal syndrome can be produced by abrupt cessation, rapid dose reduction, decreasing blood levels of the drug, and/or administration of an antagonist. Tolerance, however, refers to a state of adaption in which exposure to a drug induces changes that result in the diminution of one or more of the drug effects over time. Neither dependence nor tolerance in and of itself is indicative of addiction. Addiction is defined by the American Academy of Pain Management and American Pain Society and the American Society of Addiction Medicine as a primary chronic,

neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: Impaired control over drug use, compulsive use, continued use despite harm, and cravings. However, abuse is generally characterized by

conscious, often psychosocial motivated use of illicit substances and medication outside the scope of usual medical practices. Still, the patient can stop the drug when harmed. Addicts, however, cannot stop use despite harm. The majority of legitimate pain patients do not develop an addiction to their analgesic medication. There is a normal biological phenomenon to develop issues related to tolerance and dependence. It is the physician’s responsibility to address the problems related to tolerance and dependence by monitoring patients carefully and adjusting medication accordingly to avoid sequelae of tolerance and dependence. Dictated but not proofread.