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Unread 07-22-2007, 08:32 PM   #1
TIM
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Default Physical dependence and Addiction, and why.

I wrote the article below to illustrate what I think is the single most important part of understanding addiction and its treatments; The difference between "physical dependence” and "addiction” and why it matters. I think once people have a clear understanding of these terms and why they are different so many other aspects of addiction treatment make sense. I realize this is repetitive for many here, sorry.


Physical dependence and Addiction


There are two separate but related sets of brain adaptations that occur as someone becomes addicted to opioids. The first is normal physiology and is related to tolerance that leads to "physical dependence”. The second is "addiction"; uncontrollable compulsion to take drugs despite adverse consequences. Both affect different parts of the brain and have different symptoms.

Tolerance and physical dependence: As someone consumes opioids on a regular basis, the body requires more and more to achieve the same effect; the body becomes tolerant to the opioids. In the immediate absence of these opioids, the body still requires an above normal amount to feel normal, and is able to compensate by producing more opioids naturally. Eventually, the tolerance escalates to the point that the body can no longer produce enough natural opioids to meet the body’s increasing requirement. At this point the patient becomes "physically dependent” on the external source of opioids to feel normal. This stage is appropriately called "physical dependence” this is normal physiology that does not require treatment. It basically means if the patient stops the opioids they will have withdrawal symptoms. This is not addiction, this condition doesn't ruin lives, and in and of itself is NOT reason to discontinue the opioid, assuming it is being administered in the course of proper medicine.

Addiction is an uncontrollable compulsion to seek or use a substance despite adverse social, psychological, and/or physical consequences, often accompanied by strong cravings. (unnaturally strong urges that cannot be ignored) Addiction is different than physical dependence in that it ruins lives and results in dangerous behavior. It is the brain changes specific to addiction that treatments are aimed at. People can be physically dependent without being addicted. Many longterm pain patients are physically dependent but don't seek drugs despite harm or crave for more and more. People can also be addicted without being physically dependent (Ex. an addiction to gambling) It is the uncontrollable compulsive behaviors of addiction that lead to misery and need to be stopped.

The neurological changes that produce opioid tolerance and physical dependence are well understood. These changes appear to correct themselves within a period of weeks following cessation of opioid use. This explains why many addicted people can recall a time (back when they were only physically dependent)when they were able to stop opioid use, have brief withdrawal and emerge feeling relatively symptom free after a few days to a couple weeks. By contrast, the cluster of symptoms recognized as opioid addiction results from neurological changes that are wider ranging and significantly more complex. These neurological changes do not reverse themselves shortly after opioid use has ceased, but often persist for extended lengths of time. This may explain why someone can have symptoms of depression or mild withdrawal (PAWS) for months after stopping all opioids.

Treatment medications can suppress the withdrawal symptoms associated with both physical dependence and addiction. This in effect buys the patient time to make the necessary behavioral and environmental changes in their lives that will also have an impact on the physical nature of the brain. If treatment is stopped the symptoms will reemerge. The severity and duration of the symptoms will depend on how much the brain has been able to adapt back toward pre-addiction status. Longer treatments allow the brain more time to change. This might be why longer treatment are more successful than shorter "detox” treatments, for patients that have crossed the threshold of "addiction".

Buprenorphine treatment allows the brain changes specific to addiction to begin to adapt back by helping to stop the cravings and compulsive drug seeking and taking, and the cycle of addiction. By reducing cravings and withdrawal, it allows the person to get out of the rut or cycle of addictive behavior and begin to reverse the conditioning and other brain changes that have developed during active addiction.

Once the addiction has been successfully treated (meaning the dangerous behavior has stopped) the patient is still left with the physical dependence to opioids that they had before beginning treatment. This is either managed medically, for patients who choose to remain on maintenance, or a slow taper is initiated to allow the brain to adapt back to opioid free life.


The addiction should be successfully treated before any thought be given to dealing with the physical dependence aspect of the disease.



"…Physical dependence is not that important, because even the dramatic withdrawal symptoms of heroin and alcohol addiction can now be easily managed with appropriate medications. Even more important, many of the most dangerous and addicting drugs, including methamphetamine and crack cocaine, do not produce very severe physical dependence symptoms upon withdrawal. What really matters most is whether or not a drug causes what we now know to be the essence of "addiction”: uncontrollable, compulsive drug craving, seeking, and use, even in the face of negative health and social consequences. This is the crux of how the Institute of Medicine, the American Psychiatric Association, and the American Medical Association define addiction and how we all should use the term. It is really only this compulsive quality of addiction that matters in the long run to the addict and to his or her family and that should matter to society as a whole...”
-- Dr Alan Leshner was the director of NIDA



References and further reading:
Past threads on tolerance, physical dependence, and addiction
http://www.naabt.org/forum/topic.asp...&TOPIC_ID=3338
Dr Alan Leshner was the director of NIDA and wrote a great article titled "Addiction is a brain disease" It is about 10 years old (he uses the word "addict" but otherwise it is up-to-date) and still very relevant, here's the link:
http://www.naabt.org/forum/topic.asp?TOPIC_ID=833#20092
http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf
http://www.drugabuse.gov/pdf/monographs/121.pdf
http://naabt.org/documents/NIDA_Scie..._addiction.pdf
http://www.nida.nih.gov/infofacts/PainMed.html
Why short-term treatments are less effective for opioid addiction
http://www.naabt.org/forum/topic.asp?TOPIC_ID=2669



The American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, recognizes these definitions below as the current accepted definitions.

I. Addiction:
Addiction is a primary, chronic, neurobiologic 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 craving.

II. Physical Dependence:
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

III. Tolerance:
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

consensus document: http://www.painmed.org/pdf/definition.pdf


See glossary for definitions to other terms
Another person's take on it:
http://www.stats.org/stories/2007/ph...d_may14_07.htm
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Unread 07-23-2007, 01:08 AM   #2
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Quote:
quote:Originally posted by TIM

The neurological changes that produce opioid tolerance and physical dependence are well understood. These changes appear to correct themselves within a period of weeks following cessation of opioid use. This explains why many addicted people can recall a time when they were able to stop opioid use, have brief withdrawal and emerge feeling relatively symptom free after a few days to a couple weeks. By contrast, the cluster of symptoms recognized as opioid addiction results from neurological changes that are wider ranging and significantly more complex. These neurological changes do not reverse themselves shortly after opioid use has ceased, but often persist for extended lengths of time. This may explain why someone can have symptoms of depression or mild withdrawal for months after stopping all opioids. (PAWS)
Tim, I think you may have made a little typo in the highlighted sentence. Perhaps you meant to say: "This explains why many dependant people can recall a time..."?
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Unread 07-23-2007, 06:13 PM   #3
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Thanks Frozen, I should have written that better…. I actually meant both… addicted and physically dependent people can recall a time when they were able to stop opioid use, have brief withdrawal and emerge feeling relatively symptom free after a few days to a couple weeks.” Most people who are opioid addicted were physically dependent first and may remember being able to stop.

Some addicted people are unaware that they made the transition from physical dependence” to addiction” and now when they stop they feel those lingering withdrawal symptoms. (PAWS) If they had recently completed a 10 day treatment of buprenorphine (or anything else) they could easily, but mistakenly, concluded that the treatment medication was responsible for their symptoms. Since they may remember back when they were only physically dependent and were able to stop without such withdrawal, this could serve to reinforce their faulty conclusion. It might even look like evidence that 10 days was too long of a treatment, because they think they became hooked on the treatment medication. The tragedy here could be that instead of reentering treatment for a longer period of time they could disregard this type of treatment entirely, as being ineffective and causing bad lingering withdrawal symptoms, even after only 10 days.

Tim
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Unread 07-23-2007, 11:18 PM   #4
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Tim,

I glad you mentioned that some people may not be aware that they've crossed the line between physical dependence and addiction. That's something that I've been doing a lot of thinking about.

You most likely know my story, but what I always wonder about is the fact that, even though I kept increasing my medication while I was bedridden with migraines, once the migraines started to lessen in frequency and intensity, so did my intake if opiates. I obviously was fixated on my pain while bedridden (since I couldn't do anything else) and also trying to numb myself to what had become a pretty horrific daily existence and a good deal of just plain boredom thrown in on top of it, because migraines don't allow much room to do anything productive, much less entertaining or distracting. I didn't do things that would result in any adverse consequences.

So, if I crossed the line into addiction, why did I end up taking less and less opiates the better I felt, ending up with a thousand plus opiate pills not taken. Would I have eventually just continued to follow the path of less migraines, more ability to do things, less need for pills? Would I have continued down that path until I got back to where I started, physcially dependant on very reasonable amount of medication to deal with my chronic pain? Would I have been better off waiting to see if the natural taper would just continue, so I wouldn't have to live with the stigma of addiction stamped all over my medical chart? Maybe, possibly, even probably. I guess I'll never really know the answer to that.

But I know this, at the amount I was taking, I was be putting my life in jeopardy everyday until I got back to that "reasonable" amount, and it would have taken quite a bit of time; and I had already lost enough time. Sub gave me back my life within weeks, not months or even a year. And for that I say thank God, thank Sub, and call me an addict. It was the right choice - for me anyway.

Figured this was a good place for this particular musing. Thanks for all your great info.

Pat
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Unread 09-30-2007, 04:53 PM   #5
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bump, very important, especially for new people.
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Unread 09-30-2007, 06:40 PM   #6
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Thanks for bumping this Suture-it seems that there are many new members that need to see this. It really cleared up some things for me.

Susan
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Unread 09-30-2007, 10:29 PM   #7
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This is great. I had written a lengthy question about this topic earlier today and deleted it. I'm having a little difficulty just writing freely on here so I decided not to post it. Thank you so very much!

Elizabeth




Ok, this is part of my question. ****Please don't anyone personally attack me, I only ever mean to be honest and sincere, this is my life*****

I had a "debate" with my psychologist the last time I saw him. I did not go through a rapid detox, but, due to circumstances, went out of state for a 10 day 'bridge' to Suboxone. My tolerance for my chronic pain medication had grown in the last five years and I was needing an increase. It scared me and I had been looking for alternatives for awhile.

The Dr. in CA told me when I left, when asked, I should tell my local Dr. that I had grown tolerant/physically dependent not addicted. My psychologist spoke with them and he said dependent and addicted are the same thing. Was he right? Could they possibly have given him different information than me and how important is it?

The Dr. in CA kept me in his practice, which he said he usually doesn't do because I was so willing and happy to receive what he offered. So I have been communicating long distance with his NP. I'm afraid she is still angry over a request I made three weeks ago and it is affecting my treatment locally. I had the same Dr. ONLY for 16 years and same pharmacist. I knew my Dr. as well as he knew me and he was going through a negative change of life for some time and during a phonecall he was bullying me and I quietly, through tears said I was angry and he blew up and dropped me and wouldn't take my calls. So trusting Drs. for me right now is at an all time low. I'm confused and scared. I'm supposed to go back to CA on Tuesday.

Does the above make any sense?
Thank you in advance for your help.
Elizabeth
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Unread 09-30-2007, 11:10 PM   #8
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Quote:
quote:Originally posted by Pearl

..."My psychologist spoke with them and he said dependent and addicted are the same thing."

Does the above make any sense?

Thank you in advance for your help.
Elizabeth
Elizabeth:

I thought we had a similar discussion about that creep physician of yours when he tried to cut you off. I can’t understand how a psychologist” with an actual license from a State could possibly believe there’s no difference between addiction and dependence.

The way I would answer you’re question is: No
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Unread 09-30-2007, 11:26 PM   #9
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Quote:
quote:Originally posted by Pearl

My psychologist spoke with them and he said dependent and addicted are the same thing. Was he right?
Elizabeth
Good question and the answer is Maybe…. it depends on what he meant by dependent”, now this gets complicated…”physical dependence” and addiction” are two different things and affect different parts of the brain. But when dependence” is used by itself it can mean the same thing as addiction, here’s why. The psychiatric diagnostic manuals don’t use the word addiction” anymore they use the phrase substance dependence” it means the same as addiction” and is different than physical dependence”

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine all got together and decided to use these definitions consistently.

Addiction:
Addiction is a primary, chronic, neurobiologic 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 craving.

Physical Dependence:
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Tolerance:
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

So if a doctor says there is no difference between physical dependence” and addiction”, then I would be very skeptical of their understanding of addiction treatment.

If you were only physically dependent” then you would not have used despite harm, had uncontrollable compulsions to do drugs even if you were not in withdrawal, craved drugs (as opposed to craving for pain relief)

For example if my grand mother broke her leg, had been given OxyContin, and had to stay on it for a couple months she would get physically dependent” meaning she would have withdrawal if she stopped, but it would eventually go away and she would be back to normal. She would not buy more pills off then internet, seek drugs at all cost, crave the feeling, and be obsessed about getting more drugs…that’s addiction, the uncontrollable compulsion that allows people to put everything else in their lives in the back seat.

This post explains it too:
http://www.naabt.org/forum/topic.asp...&TOPIC_ID=3338
Hope that helps.

Tim
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Unread 09-30-2007, 11:39 PM   #10
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Elizabeth,

Doctors are not Gods, and certainly neither are psychologists! It also seems that the medical profession as well as the insurance companies seem to the the last to understand the distinctions. I wrote my "musing" many months ago, but somewhere in the last few years of migraine hell I let a switch turn on in my head that said it was okay to take as much medication as I needed. Did I use additive behaviour as defined below - no. My doctor willingly gave me the medication, BUT; I knew I was taking more than I really needed to eliminate my real pain to a tolerable level. Eliminating it to a "no pain" level at the "tolerance" I had built up the few years prior, or my "perceived pain level" made it life threatening.

I'm not sure how much it really matters, maybe since you are switching over to a Sub doctor you will need to be listed as an addict. Insurance companies generally won't pay for "off-label" use of Suboxone. While both my doctors have agreed addiction is not a word that would use in my case, they both knew I crossed a dangerous line, and since I choose the Suboxone route, and to have my insurance cover it, I'm most likly listed as an addict, even though my doctor writes my prescriptions for X every 4 hours for pain.

The main thing is these term separate us - within each other, within insurance companies and that's why there's a separate number you call on the back of your insurance card for Psychiatric Care and/or Addiction or Alcohol issues. For of the great things I think Naabt is doing to trying to eliminate these labels, these things that allow doctors and insurance companies to separate us and can eventually allow them to not insure you.

At some point many people here have just gotten tired of constantly taking pain medication and building up the inevitable tolerance and taking more and feeling rotten and muddled and, yeah, you have no pain, but you also have no feelings. Opiates numb everything, that's how they work. And in large doses they can also skew your pain perception. That's why no matter what it took, I was thankful to start Sub therapy. I don't have that tired, muddled feeling. I can actually get stuff done, feel great and be mostly pain free. I'm one very lucky person as far as I'm concerned. My advice, take the rains, TELL the prospective doctor what happened, all of it, and make him or her work for you. That's what they get paid for - don't worry so much about the words at this stage unless it is and insurance issue. Then that's a different thing. Worry about getting quality care and help. Who cares what some therapist out in CA thinks anyway? Put your energies into finding good help, support and building on your new life.

Best, Pat
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Unread 09-30-2007, 11:50 PM   #11
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Pearl,
This is where I had such problems. My regular dr who was prescribing my pain meds was very understanding. She was transferred to another area and I was passed off to another in the group. At our first meeting, without knowing anything about me this new dr said if your going to stay with me you are off narcotics- she said she didn't believe in them and had never prescribed them in her career as a md. I foolishly went along with it until I went into withdrawals. I went to the er and between that dr.(jerk) and the dr who took me off they decided that because of the withdrawals that I was an addict. I haven't been back since-it was such an awful experience. I really wish more drs would become educated and learn the difference between physical dependence and addiction-because of their ignorance too many people are suffering needlessly.
Susan
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Unread 10-01-2007, 12:00 AM   #12
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It is amazing how many professionals don’t know the difference. The saddest thing is when someone is taking opioids as directed for chronic pain, and they are working well, and the patient isn’t experiencing side effects, but forgets to take it one day and has withdrawal, immediately some doctors think that is reason to take the patient off of these meds that were working so well….and the patient is forced to suffer for no reason.

Susan, I’ve seen exactly what you mentioned, an uneducated professional sees withdrawal and automatically labels the person an addict” that is so wrong. Withdrawal is perfectly normal reaction for taking opioids (or many other meds) and then stopping. If there isn’t dangerous compulsive behavior and use despite harm there is no addiction, and thus no need for treatment.

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Unread 10-01-2007, 12:05 AM   #13
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Quote:
quote:Originally posted by TIM

For example if my grand mother broke her leg, had been given OxyContin, and had to stay on it for a couple months she would get physically dependent” meaning she would have withdrawal if she stopped, but it would eventually go away and she would be back to normal. She would not buy more pills off then internet, seek drugs at all cost, crave the feeling, and be obsessed about getting more drugs…that’s addiction, the uncontrollable compulsion that allows people to put everything else in their lives in the back seat.

This post explains it too:
http://www.naabt.org/forum/topic.asp...&TOPIC_ID=3338
Hope that helps.

Tim
Tim:

Ok, now I am confused. In your hypothetical, grandma took oxies for a couple of months. Let’s say grandma took oxies for a few years so obviously her dependency grows as does her tolerance. Would she benefit from Buprenorphine treatment?

When I reread you’re additional post above I came across this:

http://www.naabt.org/forum/topic.asp...&TOPIC_ID=3338

TIM
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1496 Posts Posted - 05/11/2007 : 09:58:16
________________________________________
jascade,


quote:
________________________________________
Originally posted by jascade

Tim,
Thanks for posting this, it helps me to sort things out. The problem that I have found is that some of the dr's don't differentiate between the two. According to them if you are dependent on a medication you are addicted to it….
________________________________________


Addiction experts will be familiar with the diagnostic code books where addiction” is called substance dependence” so when they say dependence” by itself, they could mean addiction” Medical experts speaking amongst themselves would be able to discern from the context of the conversation whether they were talking about addiction” or physical dependence”…that’s experts. As you've discovered and as I’ve also witnessed physicians who clearly did not differentiate between the two, at least before they took the 8 hour course. It is a common mistake to think just because some has withdrawal upon cessation of a substance that they are addicted to it, they could be, but they could also just be physically dependent.


quote:
________________________________________
Originally posted by jascade

..…When the specialist treating me for back issues could no longer do anything I went to my family practioner hoping she would guide me on where to go from there. She was willing to give me a prescription to taper off with. From there I went to the er where another dr. without knowing my medical history told me that I was an addict. At that point I had no where to turn and found sub. When I went for my pre-induction appt. the woman interviewing me suggested that I was physically dependent and no-one had a problem giving me sub for it. In your opinion should sub be given to someone who is 'just' dependent-?...
________________________________________


Great question, sub is only approved for the treatment of opioid dependence” which, as you know, is equal to addiction” not physical dependence” If a physician does not make a distinction between the two he/she could be making a misdiagnosis and prescribing sub for something it is not FDA approved for. Doctors have the right to prescribe sub for physical dependence” but it would be considered an off-label” use of the medication. I would guess most docs would first attempt a taper off the opioid the person is physically dependent on, and maybe some medications that help with the initial withdrawal symptoms. Most people treated for pain and dosed appropriately, would be able to get through the withdrawal and begin to return to normal.(By Hozz: "I'm not sure I agree with you here") If however they began to show signs of addiction uncontrollable compulsion” and use despite harm, then the doc would probably reassess to see if the person is actually addicted”.



I have to disagree with you. Well, not me but my addiction specialist and I believe Reckitt Benckiser. The insert to my prescription says this drug is approved for addiction and dependence of opiates. Bottom line is I don’t believe my physician is prescribing me Subutex OFF LABEL” because I was dependent on opiates.

This seems to be a question of semantics to me. However, there is no question in my mind that there is a difference between addiction and dependence.
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Unread 10-01-2007, 12:39 AM   #14
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Quote:
quote:Originally posted by HozzI have to disagree with you. Well, not me but my addiction specialist and I believe Reckitt Benckiser. The insert to my prescription says this drug is approved for addiction and dependence of opiates.
Let me explain, Sub is only approved for opioid dependence” which is addiction. I agree it is very confusing but notice nowhere do they say it is approved for physical dependence” It is not approved for physical dependence” because that is not a condition that requires treatment only a taper from whatever drug the person is taking.

It is important to distinguish between opioid dependence” (which is addiction) and physical dependence” (which is not addiction) the word dependence” by itself should not be used because nobody knows which dependence you are talking about…I know,it’s no wonder people get confused.

"Substance dependence" and "opioid dependence" = Addiction
"physical dependence" is not = to Addiction


"Substance dependence" (used in the DSM-IV)
"Opioid dependence" (used by the FDA and pharmaceuticals companies)
"Addiction" (used by The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine, and NAABT)

All mean the same thing

Quote:
quote:Originally posted by HozzMost people treated for pain and dosed appropriately, would be able to get through the withdrawal and begin to return to normal.(By Hozz: "I'm not sure I agree with you here")
Millions of people are prescribe opioid pain killers each year and only a fraction become addicted, the rest taper and stop.

Quote:
quote:Originally posted by Hozz
Ok, now I am confused. In your hypothetical, grandma took oxies for a couple of months. Let’s say grandma took oxies for a few years so obviously her dependency grows as does her tolerance. Would she benefit from Buprenorphine treatment?
Theoretically she should be able to do a slow taper off of the oxys. Bupe might make the taper easier. We are assuming Grandma is only physically dependent” so there is no need to stay on bupe for any period of time because the brain changes associated with PD are quick to reverse themselves. a few weeks.

Source: …The [brain] abnormalities that produce physical dependence, are well understood by science, and appear to resolve after detoxification, within days or weeks after opioid use stops...”-- Thomas R. Kosten, M.D. - The Neurobiology of Opioid Dependence: Implications for Treatment-- http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf
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Unread 10-01-2007, 12:49 AM   #15
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Thank you, thank you so much. Pain trashed my life, pain medication was the answer for a number of years. I never felt euphoric. I didn't seek through the internet or 'doctor shop'. When my one and only Dr. did what he did..I sought another way. That is the reason I went all the way to CA. He prescribed suboxone off label for pain and said I had become tolerant/physically dependent. I was compliant, willing and happy to be treated by him. They asked that I get a physical therapist a psychologist locally. They never mentioned NA/AA or any other group. The local psychologist is the one that I had the debate with, after he spoke with CA. At my first appointment he didn't know why I needed him and I didn't either except that I was complying with my CA Dr. I too really don't care except for insurance and if the box 'addict' is checked on my medical records, it will follow me for the rest of my life and I still consider myself a young person. I really, really don't care, but there is a stigma in the medical profession.
Keeping with the suboxone, exercise, diet, etc. is my main focus. I am going to CA to get my medical records, say goodbye responsibly and thank them. I'm not going to do to them what my longtime Dr. did to me. Does this make sense? I'm sorry, the trip is Tuesday and I really don't want to go ;} Thank you for all of the information. I am going to copy and print the above and other resource documents from the site that I have found over the last couple of days.

Pat, thank you for your post and I understand. Living day to day these issues just aren't that important. It is when I have to deal with Drs. that I begin to panic. I believe you understand.

Susan, I unfortunately was on RX opiates for a very long time. I took them as prescribed...blah blah, my blah blah... from what I have read about your situation, you weren't on them very long were you? I know my receptors got flooded and the pain medication was actually causing more pain. Therefore, my tolerance was increasing. Do you still struggle with pain? I just have come to dislike Drs. very strongly. Perhaps I will meet a good one, one day!
It seems you ran in to a militant anti-pain Dr. I read about that when I was researching and that is why I went the sub. route. lol, I actually thought there would be less intolerance from the medical profession.

Thank you all again....I'm going to take a valium.

HAA not! Just kidding.
Gratefully, Elizabeth
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Unread 10-01-2007, 01:05 AM   #16
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Quote:
quote:Originally posted by TIM


Quote:
quote:Originally posted by HozzI have to disagree with you. Well, not me but my addiction specialist and I believe Reckitt Benckiser. The insert to my prescription says this drug is approved for addiction and dependence of opiates.
Let me explain, Sub is only approved for opioid dependence” which is addiction. I agree it is very confusing but notice nowhere do they say it is approved for physical dependence” It is not approved for physical dependence” because that is not a condition that requires treatment only a taper from whatever drug the person is taking.

It is important to distinguish between opioid dependence” (which is addiction) and physical dependence” (which is not addiction) the word dependence” by itself should not be used because nobody knows which dependence you are talking about…I know,it’s no wonder people get confused.

"Substance dependence" and "opioid dependence" = Addiction
"physical dependence" is not = to Addiction


"Substance dependence" (used in the DSM-IV)
"Opioid dependence" (used by the FDA and pharmaceuticals companies)
"Addiction" (used by The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine, and NAABT)

All mean the same thing

Quote:
quote:Originally posted by HozzMost people treated for pain and dosed appropriately, would be able to get through the withdrawal and begin to return to normal.(By Hozz: "I'm not sure I agree with you here")
Millions of people are prescribe opioid pain killers each year and only a fraction become addicted, the rest taper and stop.

Quote:
quote:Originally posted by Hozz
Ok, now I am confused. In your hypothetical, grandma took oxies for a couple of months. Let’s say grandma took oxies for a few years so obviously her dependency grows as does her tolerance. Would she benefit from Buprenorphine treatment?
Theoretically she should be able to do a slow taper off of the oxys. Bupe might make the taper easier. We are assuming Grandma is only physically dependent” so there is no need to stay on bupe for any period of time because the brain changes associated with PD are quick to reverse themselves. a few weeks.

Source: …The [brain] abnormalities that produce physical dependence, are well understood by science, and appear to resolve after detoxification, within days or weeks after opioid use stops...”-- Thomas R. Kosten, M.D. - The Neurobiology of Opioid Dependence: Implications for Treatment-- http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf
OK. Last post before I try and get psychologically prepared for my cataract surgery in the morning. I just don’t understand how opiate dependence” means addiction?

Using this rational, if I was physically dependent on opiates” then I wasn’t addicted and could just wean of without treatment. I don’t think so. I tried and tried many times.

During my first visit with my addiction specialist he told me I was the ideal candidate” for Buprenorphine treatment because I wasn’t addicted to the morphine and the percodans only physically dependent on them and if I stopped suddenly I would go through incredible withdrawals.

Well I did and for 72 hours I was climbing walls. I wouldn't wish that experience on my worst enemy. Have a nice evening.

(On edit: On my last line I changed "would" to "wouldn't" ...Big difference!) Good night everyone...
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Unread 10-01-2007, 04:24 PM   #17
TIM
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Quote:
quote:Originally posted by Hozz

.... I just don’t understand how opiate dependence” means addiction?
This is what makes it all so confusing. Part of the medical community started using the phrase substance dependence” instead of addiction” as a way to reduce the stigma they thought addiction” led to use of the word addict” so the started using substance dependence”. To differentiate between substances they made sub-groups; opioid dependence, cocaine dependence, methamphetamine dependence, and so on.. The FDA adopted this language too. All pharmaceutical companies must use language consistent with their FDA drug label. That’s why we have opioid dependence” which means the same as addiction” but is very different than physical dependence.”

This gets very confusing especially when someone is using the word dependence” by itself. You have to examine who the intended audience is to determine which dependence they meant.

Because of the confusion this has caused there is talk about changing back to addiction” and not using substance dependence as an official diagnosis. The DSM-IV (see glossary) is the leading diagnostic code book in the US and is the source of all of this confusion.

The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine all got together to discuss this problem in the industry and decided to use the words addiction, physical dependence, and tolerance and they all agreed on definitions for these terms, but not all of the medical community is on the same page yet, hence the confusion.

This thread talks about it too:
http://www.naabt.org/forum/topic.asp...&TOPIC_ID=3338

Hope your surgery went well!!
Tim
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Unread 10-01-2007, 04:46 PM   #18
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quote:Originally posted by Hozz

.... Using this rational, if I was physically dependent on opiates” then I wasn’t addicted and could just wean of without treatment. I don’t think so. I tried and tried many times.
If you were only PD and not addicted, you would have withdrawal for a few days to a few weeks, then be relatively normal, you wouldn't experience the long-term lingering withdrawal (PAWS) that people who have been addicted get

Quote:
quote:Originally posted by HozzDuring my first visit with my addiction specialist he told me I was the ideal candidate” for Buprenorphine treatment because I wasn’t addicted to the morphine and the percodans only physically dependent on them and if I stopped suddenly I would go through incredible withdrawals.
That sounds consistent.

Quote:
quote:Originally posted by HozzWell I did and for 72 hours I was climbing walls. I wouldn't wish that experience on my worst enemy.
That is expected, but in a few months you would be fine, IF you were only PD, now it should be said that there are stages in between, someone doesn’t go from PD to addicted in a day, it is a slow transition and if they were on their way to addiction they could still have some withdrawal a few months out. They might not know they were becoming addicted because not all of the signs were clear yet.

Tim
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Unread 08-20-2009, 08:53 PM   #19
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The addiction should be successfully treated before any thought be given to dealing with the physical dependence aspect of the disease.


This statement is a bit confusing to me. I would have asumed the opposite. Physical dependence with an increase in tolerance, I thought, preceded behavior associated with addiction. The only time I ever contemplated engaging in illegal behavior, such as writing my own or altering script, was for one reason. I wanted out of wds. Once I had my pills, I would spend the rest of the day in the public library reading. I never viewed taking pills as a party drug.

As far a successfully treating addiction, success can be hard to define. A person often has to define it for themselves. There is no cure for addiction. The disease may be dormant but is always there, just waiting. It can grow to a greater to extent, in the absence of using. No such thing as starting over.

Relapse is recognized, by those in the know, to be part of the disease of addiction. Yet, if a person relapses and reverts back to old habits, treatment often times is not viewed in terms of being successful. So, I guess 'successful' treatment has to be looked at differently from the ultimate outcome.

I cannot count the times I was totally committed to working the program, as they refer to it. I looked foward to going to meetings.I would fare well for a couple of months. In all the times I relpased, there appeared nothing in comon as to what led up to it. The only thing that was similar was the time frame, 2 months clean. During the times I felt my best, I relapsed. Feeling good physically with no depression was a double edge sword for me. It was easy to forget the agony of wds.

Then methadone came along and not once in the ten years I was on it did I even feel the slightest urge to go to a meeting. It did nothing for me except keep me out of legal trouble. But still there were times when I would run out of meds early. And all I could do was wait until time to get more methadone. No ther drug came close to stopping wds. That has been methadone's legacy as far as my life is concerned. While it helped me socially, it did nothing to facilitate the successful treating of my addiction. I really did just swap seats on a sinking ship.

Wayne
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