Drug Dependence

This is what they tell you:

“Hydrocodone may be habit-forming. Patients should take the drug only for as long as it is prescribed, in the amounts prescribed, and no more frequently than prescribed.”[1]

“DRUG ABUSE AND DEPENDENCE

Abuse and Dependence: Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of narcotics; therefore, this product should be prescribed and administered with caution. However, psychic dependence is unlikely to develop when hydrocodone bitartrate and acetaminophen tablets are used for a short time for the treatment of pain.

Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, assumes clinically significant proportions only after several weeks of continued narcotic use, although some mild degree of physical dependence may develop after a few days of narcotic therapy.

Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia, is manifested initially by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. The rate of development of tolerance varies among patients.”1[2]

This material above is quoted from the definitive prescribing information reference source below and is not my material. Any use should be drawn from that material directly as UCB Parma, Inc. hold the copyright.

Why your doctor may be worried:

"The prevalence of opiate abuse among patients with chronic pain is unknown but is believed to be no greater than the prevalence of opiate abuse in the general population.^{[ref. del.]} Some studies disagree and estimate the danger of addiction or abuse for pain patients to be higher than the norm.^{[ref. del.]} Other medical literature has put the prevalence of addictive disorders among patients who sustain major trauma as high as 60%.^{[ref. del.]} Despite the common use of opioid analgesics in the treatment of chronic pain, considerable fear exists among physicians that prescribing opioid drugs may contribute to opiate abuse or addiction."^[5]

This is what they don't tell you in plain English anyway:

Four critical definitions you should know when using opiates/opioids:

Addiction: "A term referring to compulsive drug use, psychological dependence, and continuing use despite harm. Addiction is frequently and incorrectly equated with physical dependence and withdrawal. Physical dependence, not addiction, is an expected result of opioid use.^"[6]  In other words, the addict will do just about anything to continue the drug use even when the pain is gone.

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.^"[7]  In other words, using opiates/opioids for even a week or two causes the body to adjust to having them in your system.  The body will have to readjust when they are not there.  These are the withdrawal symptoms that can start showing up in as few as 6 - 8 hours after the last dose.  This is NOT addiction.  Tapering off should minimize the symptoms.  Talk to your doctor about this process and get his approval of a plan.

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."^[7]  In other words, the longer one uses certain drugs like opiates/opioids the less effective they become as the body adapts and the more you need to take to obtain the same level of relief.  Talk to your doctor about this if you think you are building tolerance.

Pseudoaddiction:  "Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may 'clock watch,' and may otherwise seem inappropriately "drug seeking." Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated."^[7]  Talk to your doctor if you are not getting adequate relief from pain.

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[3] http://www.streetdrugs.org/pdf/CSAPscrip1_03.pdf March 7, 2003, "Prevention Alert" Volume 6, Number 4. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Asministration.

[4] http://www.drugabuse.gov/PDF/CEWG/AdvReport604.pdf page 40

[5] http://www.medscape.com/viewarticle/471663 Lynn R. Webster, MD, 03/26/2004 "Assessing Abuse Potential in Pain Patients"

(c) 2006, 2008Steven C. Martin www.positive-way.com/recovery

Permission for use:  You may duplicate and use any or all of this material for non-commercial use without any further permission on the following two conditions: 1. the copyright information, my name and the website www.positive-way.com/recovery and 2. the following disclaimer must be included on every page.  Your compliance is appreciated.

Disclaimer: Please note that everything here is personal opinion that is not intended as a substitute for medical advice.  It is highly recommended that you review your case with a medical doctor who is familiar with your medical history before you start any narcotic or drug withdrawal process or obtain treatment for any illness or injury.

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