Opioids have long sparked fears of addiction among both patients and doctors. Indeed, studies found that fear of addiction led both to be leery of these strong pain relievers.
It is now clear that the risk of addiction when opioids are used as directed to treat true pain is very low. That does not mean the risk is zero, though. But most addiction cases are associated with poorly monitored opioid use, and people who have a previous history of drug abuse.
Understanding the risk of opioid addiction requires knowing the distinction between addiction, physical dependence, psychological dependence, and tolerance. If you are prescribed an opioid, we urge you to educate yourself about these issues and discuss them with your doctor. We give you a capsule briefing here:
Physical dependence is when the body becomes accustomed to a drug. Another word for it is habituation. This happens with all opioids and to all people who take them for more than a week or so. It does not mean you are “addicted.” In practical terms, it means when you stop taking the drug, your body will have to adjust. You may have some “withdrawal” symptoms, such as sweating, shakiness, irritability, restlessness, feeling jittery, insomnia, cold flashes, and involuntary muscle movements.
People differ in the degree to which they experience these symptoms. A lot depends on the dose you have been taking and for how long. Withdrawal can be significantly eased by gradually lowering the dose over time until you stop.
Addiction is when you become psychologically dependent on a drug. It involves elements of physical dependence, but goes beyond that. You lose the ability to control the amount of drug you take, and your ability to make judgments about that. For example, you’ll take the drug independent of your level of your pain.
Who becomes addicted? Experts believe some people are genetically susceptible to becoming addicted to opioids. But there’s no test for this — yet. People who have a history of drug or alcohol abuse are at much greater risk of addiction.
In general, if your pain is severe and treated over a relatively short time (weeks or a few months), you are less likely to become addicted or feel any euphoria when you take an opioid (though you may enjoy the sedation and calming effect). About 5 percent of people who take opioids for one year will develop an addiction, according to the National Institutes of Health.
Tolerance is the term used to describe the fact that many drugs have decreasing affects over time. With opioids, this is both good and bad. Good because you may have fewer side effects as your body adjusts to the drug; bad because the pain relief declines, too. To sustain the pain relief, a higher dose is needed. So you can see, tolerance complicates both physical dependence and the risk of addiction. Higher doses lead to more physical dependence, tougher withdrawal, and a greater risk of addiction.
All these problems make it essential to take opioids with care and under the watchful eye of a doctor who knows how to tell when you may be getting addicted. Family and friends should also be on alert. Tell-tale signs of addiction: craving the drug, asking for more of it than you really need for pain relief, running out of a month’s supply in two to three weeks, not being able to function well, and increased sedation and sleepiness.