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Old 11-22-2010, 09:08 PM   #1
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chronic pain med use vs. addiciton

in order for someone to be considered "dependent" (commonly referred to as addicted) on a drug, the following has to be present. This is taken from the DSM-IV-TR. Many, many professionals have spent decades deciding on these criteria. Note that the drug is taken to achieve "intoxication," not for a legitimate medical purpose. The use needs to lead to distress or impairment. Note this is not the pain leading to impairment, but the drug use itself. This is the definition virtually all substance abuse professionals and insurance companies and medical facilities use. HERE YOU GO:

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)


JUST FOR KICKS, I added the criteria for "opioid intoxication"


Diagnostic criteria for 292.89 Opioid Intoxication
(cautionary statement)

A. Recent use of an opioid.

B. Clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, opioid use.

C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use:

(1) drowsiness or coma
(2) slurred speech
(3) impairment in attention or memory

D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Specify if:

 
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Old 11-23-2010, 10:09 AM   #2
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Re: chronic pain med use vs. addiciton

What exactly was the purpose for this post? I know you have one because it had to have taken a long time to type it. I think most folks who take meds for chronic pain are well aware of the difference between dependency and addiction. I'd even bet a number of folks here could teach a class on it! Are you trying to come at it at a different angle? Please let me know.
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Old 11-23-2010, 10:43 AM   #3
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Re: chronic pain med use vs. addiciton

My Doctor alsway says Dependency is you NEED the meds for pain and Addiction is you WANT it for kicks or a high..

 
Old 11-23-2010, 12:05 PM   #4
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Re: chronic pain med use vs. addiciton

I love reading the DSM IV, the language is enough to make one, well, crazy (by their definition of course).

I think that addiction and dependence are very much linked, they feed each other as do many other 'wants' and 'needs' that we have.....

Last edited by Isotope; 11-23-2010 at 12:06 PM. Reason: typo

 
Old 11-23-2010, 12:34 PM   #5
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Smile Re: chronic pain med use vs. addiciton

I used to use this example when explaining it to my parents. I'd ask them, would you ever call a diabetic a junkie because they "have to" shoot medicine in themselves many times a day. They will physically suffer if they don't. The obvious answer is "no". The individual has an ailment, they need a drug to manage it, end of discussion. Now substitute a chronic pain patient and narcotics. For me, they are the same outcome. I have an ailment (chronic pain) that requires medication to manage (a narcotic). I take it as prescribed and that's the end of it. I know this is a simplified example but this is the best way I know of to explain it to a "rookie".

Hope this helps someone out there.
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Old 11-23-2010, 07:08 PM   #6
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Re: chronic pain med use vs. addiciton

mju58 - this post was created because in another thread a poster stated that I was "addicted" to my medication simply because I had developed a tolerance. If you are not aware, it is a VERY" serious thing to be labeled and addict, and not one I take lightly. If you are going to claim someone it an addict, then I think you should understand the diagnostic criteria for it.

I stated I did not think I was at risk for becoming an opiate addict. I am very attuned to my body and I have never had even a remote sensation of craving the effects of the narcotic medication or feeling the "euphoric" feeling that addicts claim to have. The vast, vast majority of addicts become addicts because of the intense euphoria they feel from using. I honestly have never felt this. Some people are very genetically predisposed to addiction and some people are very genetically protected from addiction. I am one of those people that seems to be protected from addition. I even smoked cigarettes for quite a while but I never ONCE craved a cigarette. I only smoked because everyone else at work was taking a break so I joined in. Nicotine is one the the most addictive substances on earth and I never became addicted, even after repeated exposure. This is included to illustrate my point. Many addicts use once and they know right off the bat the have to have more. I am not one of those people. I think it's an interesting topic and included it my post. Someone responded and said I was indeed addicted. I am not in fact addicted and I post this information to prove my point. The topic of addiction comes up often on this board and I want to educate readers about the criteria used to diagnose it.

 
Old 11-23-2010, 07:28 PM   #7
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Re: chronic pain med use vs. addiciton

I hope you aren't referring to me? Our discussion was a theoretical one, therefore addiction and dependence was being defined and examined. You may be a bit hyper-sensitive to these topics for some reason? I believe in a follow-up post I was questioning my own Norco intake and wondered if I was addicted.

You Posted your Med regimen as such:

-------------------------- Toonces1-------------

Long-acting: Kadian 50mg every 12 hours (2x per day) - increased 6 months ago

Break-through: oxycodone 10/325 1-2 every 4 hours (up to 4 per day) - increased 4 months ago

also: Neurontin 400mg 3x per day

also: Soma 350 up to 3x per day

I would like to ask for an increase in either the Kadian or the Oxycodone, but I'm scared as most people are of being branded a drug-seeker.

---------------------------Toonces1--------------------------



Please recall that my Regimen is one Norco a day, and I feel at least dependent if not addicted. Clearly you have concerns about your above med regimen. No need to lash out at me and continue to assert your non-addicted status. I personally don't care about the terminology but you seem to need to repeat it. Why is that?



Have a Wonderful Day~

Last edited by Isotope; 11-23-2010 at 07:39 PM. Reason: Clarification

 
Old 11-23-2010, 07:44 PM   #8
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Re: chronic pain med use vs. addiciton

I may be a bit hypersensitive, but I think it's for a good reason. Chronic pain patients are at risk every single day of being labeled an addict. The ability for us to get adequate treatment is often interfered with because of the behavior of drug addicts. I know my treatment has been disrupted at least once because of an assumption that I was an addict, and it caused me much distress and suffering. It has probably made me hypersensitive to this issue. I think a lot of us has experienced this. I think it does each one of a us a great disservice to confuse the issue of drug addiction with the medical issue of tolerance for legitimate chronic pain sufferers.

I am no stranger to drug addiction. I work with an increasing number of opiate addicts every day of my working life. Trust me, their behavior and their experience is very different than that of those of us experiencing predictable tolerance to our medications. I do not want to be lumped into that category.

And I don't think this is just an issue of semantics. Addiction is a disease that really doesn't have much to do with chronic pain. Sometimes treatment for chronic pain triggers the beginning of an addiction in people who are predisposed to addiction and addictive behaviors. If you spend some time reading the addiction board, you will see very different behavior being exhibited there than what you see here on the pain mgmt board.

My intent is to try to educate people on this board to reduce the confusion. No harm in intended, just trying to explain.

And while this may put me at risk of sounding snarky, which is not my intent, the reason it needs to be reasserted is because it is an issue that keeps coming up and it is a very serious issue. I would guess the vast majority of long-term pain management folks would say that the issue of being suspected of being an addict is one that has presented itself more than once.

Last edited by Toonces1; 11-23-2010 at 07:47 PM. Reason: addition

 
The Following 2 Users Say Thank You to Toonces1 For This Useful Post:
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Old 11-24-2010, 06:09 AM   #9
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Re: chronic pain med use vs. addiciton

I think you're trying to educate yourself. You think we don't know about that?

My doctor told me Oxycodone goes directly to the pain and that's why I don't feel "high". and if somebody who doesn't have pain will take Oxycodone he or she or it;;;;would feel "high".

We all know about that.I told my doctor I would rather go shopping than take medication. Sometimes, narcotics is our last hope. I've been on it for over a year on and off, no addiction, no sweat etc perhaps cause I'm on and off it all the time but I have high tolerance to it JUST LIKE YOU. I've told you why. It's cause it's located in your NECK area.

 
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