Pain Meds: Addiction vs. Dependency

So I'm aware I haven't posted in a while.

My posting scarcity basically is the result of two factors. First, I haven't felt like it (which is reason enough unto itself). Second, I don't want my life to be defined either by RA or by a blog about RA. I realize that blogging about RA may be therapeutic for some people (indeed, sometimes I find it to be so). But I'm trying to fit RA into my life (as opposed to trying to fit my life into RA). So, what works for me is occasional posting rather than daily posting. And that's pretty much it. I hope that despite my daily inattention, some may still find this blog to be funny, informative, and useful.

I guess we'll see.

Anyway, as you know, teh interwebs are a great thing: they put so much information at our fingertips and frankly, can seem to make geniuses of us all. So, there's a lot of information out there. But my concern is for the quality of the information available to us.

Fairly frequently, the subject of pain medications rears its head on RA/arthritis forums. I have to say that I often am astounded by the lack of good information that is presented by posters on these forums. I'm just not sure whether it's because there's a dearth of information about the medications (which I kinda doubt: look at rxlist.com, for example) or whether there's a dearth of understanding about how the medications work. I think it's the latter, however.

For example, my jaw literally drops when people say things like "oxycodone is a slow-acting narcotic." Well, actually, it depends on the form in which the medication is received. Percocet, for example, is a fast-acting form of oxycodone (which also contains acetaminophen). Oxycontin, on the other hand, is a controlled-release (i.e., long-acting) form of oxycodone (which can be stripped of its long-acting powers by crushing and snorting it.).

My point is, there are significant differences between the two medications, both of which contain oxycodone.

But if people cannot be made aware of the differences, then they cannot make educated decisions about their treatment.

Speaking of educated decisions....

It seems as if many RAers, when talking about pain medications, refuse to use them because they say that they are "afraid that I'll become addicted." 

Look, I am a former addictions counselor, and I can tell you that there are significant differences between dependency and addiction. It's critical that RAers learn these differences, or we'll risk being in more pain than we need to be during our lifetimes.

So what's the difference between dependence and addiction?

In a nutshell: Dependence occurs when your body becomes physically dependent upon the presence of any sort of medication in your system and that medication improves your quality and function of life. For example, I am on Lyrica, which technically is an antiseizure medication (for neuropathy), and Cymbalta, which is an antidepressant (for migraine prophylaxis and neuropathy). My body has become physically dependent upon these very powerful medications -- enough so that if I were to stop them cold turkey, I would experience withdrawal symptoms that could get really, really ugly. But am I addicted to these medications? Nope. What's more, because they decrease my pain, they improve the quality and function of my life.

Of course, the same type of physical dependence can happen with narcotics. But, as demonstrated above, physical dependence, by itself, is not the same as addiction.

Admittedly, physical dependence can be, and often is, a part of addiction. But so much more is involved in addiction. For example, anyone who has watched Intervention on A and E knows that addiction also involves powerful biological and psychological forces that compel the addict to satisfy -- again and again -- his or her needs for a specific substance or high, regardless of the (usually negative) outcome. In addition, addiction is characterized by extreme decreases in the quality and function of addicts' lives.

Yet another significant difference (that is implied, though not directly stated above) between dependence and addiction is that addicts typically use medications to feel some sort of high. Patients who are drug-dependent feel no such high when they take their medications.

Anyway, there we have it: my rant for the week.

Comments

[WarmSocks]

Good job explaining the distinction between dependence and addiction.

[Cheryl]

I was so glad to see your entry on addiction vs. dependence - and also the Intervention reference as I love the show. I get the difference you put forth, and I'm happy to see it described so clearly. I try to treat my RA with natural medicine as much as I can, but I also am on Lyrica, so sometimes wonder about the dependency.

One thing that I've used that I thought you and your readers might benefit from is the ChiliPad: http://www.chilitechnology.com - It's a mattress pad that lets you cools or heats the bed, mine lets me set any temperature between 46 and 118 degrees. They also make ones with two temperature zones. It really helps with pain and swelling - and sleeping problems.

[superb*tch]

I just found your blog. This is my fav. post. I am one of the only RAers who are vocal about my use of pain meds. I feel no shame. I KNOW w/out a doubt that I show no signs of dependency. Like you, I have some background in drug counseling. The pain receptors in our brain are looking for relief. We are not looking for a "high" like non-chronic pain users. In the past 2 years that I have had to rely on pain drugs to ease symptoms, I can tell you that I have NEVER experienced a "high" or even a subdued effect. I basically just feel an edge come off my pain.

I think more RA patients need to consider pain meds. so that those of us who do insist we need them won't look like we're "users."

-RA SB

[Kim H]

I also wish I weren't made to feel so guilty for asking for adequate pain relief. My pain relievers do, as you said, "take the edge off," but the only other effect they seem to have on me is to make me tired.

[Superb*tch]

Yes Kim, you are right! I find that my drs. are very reasonable and don't find my search for effective pain relief troubling, but it is the people in my life that aren't used to seeing me have to swallow so many pills that act strangely. I think they don't realize that 95% of the meds. I take are actually just trying to lower my immune system or fight inflamation. And honestly - there are so many rules regarding pain mngmt. usage, I wouldn't know how to party with drugs even if I wanted to. I wish I could explain all that to people, but the more you protest, the more you sound like a raving lunatic! So I just try to live my life knowing I am making the right decisions for me and my health and keeping open communication about meds. with my drs. and husband, as he is my health advocate. In the meantime, it helps to know there is someone with whom to compare efficacy of prescriptions for RA!

I am enjoying your blog!

-RA SB

[Kim H]

Thanks, I enjoy yours, too.

I sometimes wonder if I should go see a PM specialist, since I also get migraines and the neuropathy. (My RD treats me ONLY for RA; not for any side effects like the neuropathy. I feel so fucking parceled out, you know?)

[Superb*tch]

Oh Yes, I DO know. I think I've gotten hit with six co-pays this month alone, which at 60 bucks a pop is breaking the friggin' bank!

But of all my co-pays, I would say my PM is the MOST worth it. First, b/c she's not afraid to write scripts for things outside of her specialty. I guess if you are already writing scripts for narcotics, the other things are no biggie. Second, she seems to understand the IMPACT of my disease on my life the most. She "gets" the financial impact its having, and the confidence-drainer it can be, and even that we have to keep a sense of normalcy for the town becuase of my husband's position.

She is both pragmatic and sympathetic, which I love. For instance, she wrote me a script for knee braces last month, but whispered I didn't have to wear them out if I didn't want. I just love that she understands things most doctors do not or are not even willing to try to understand. Maybe it is because she deals with the most basic of human emotions: pain, but Kim, I think you should go. It is another weapon with which to fight this disease.

At your first visit, the stupid health care worker will look at you suspiciously b/c that is their job, but upon one meeting with the doc, he/she will know you are not a drug seeker, and when they inform the staff, they will work with you kindly. OMT: also expect TO see some drug-seekers and weirdos in the waiting room! That helps to explain better why the medical staff acts the way they do!!!

-RA SB