United KingdomJanuary 20, 2010 - Long-term opioid therapy is associated with little risk for addiction when given to selected patients with chronic non-cancer pain and no history of substance addiction or abuse, according to a review published online in the January issue of The Cochrane Library.
Meredith Noble, MS, ECRI Institute, Plymouth Meeting, Pennsylvania, and colleagues found that only 7 (0.27%) of 2613 patients in the studies reviewed who received opioids for CNCP for at least 6 months reportedly developed an addiction to the medication or took the medication inappropriately.
Oxycodone, morphine, and methadone were among the opioids prescribed and doses also varied considerably within studies due to individual differences in pain level, opioid tolerance, and titration.
Richard Chapman, MD, University of Utah, thought the review was "a nice piece of work," especially given that the evidence investigators had to work with was not derived from well-done controlled clinical trials, as they would have preferred.
Edited September 25, 2015 to add
I would always draw a line between addiction and dependency.
To me, addiction is when you are craving the drug purely for recreational purposes and don't want it for pain. It is when you obtain the drug for that reason alone and don't want or can't quit because you like the buzz and the high. It has more psychology to it than physiology.
Dependency is something that happens to you during your appropriate use of the drug for pain management. You wouldn't take it if you didn't need to and would willingly wean yourself off them. Having the side effects of a sudden cessation of intake doesn't produce in you a desperate need to obtain them at all costs though the pain that is emerging probably makes you quite eager to get a new prescription. There is a distinct difference.
The definition of addiction is "the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, such as narcotics, to such an extent that its cessation causes severe trauma".
On the other hand, people can become dependent upon them which means if they stop them suddenly, they might experience uncomfortable symptoms such as shakes, chills, hyperactivity and such. What they don't do is end up craving them or taking more frequent or bigger doses and then getting into a panic if they are told they can't have any more to the point of doctor shopping to get more prescriptions or even resorting to street trade! So, though most people can stop taking them without a problem, they nevertheless should be cautious about it. If perchance, they experience any symptoms, the medication should be recommenced and then the dosage gradually reduced over a period of weeks - which is what will happen normally as the pain diminishes and you find yourself forgetting a dose here and there which is totally as it should be.
Here is a suggested schedule for cutting back on prescription pain medications. Stay at each level for 3-4 days or even longer if you notice the pain symptoms increasing. This schedule assumes you are starting with one pill every 4 hours before beginning the reduction process.
1 pill every 6 hours and 2 at bedtime
1 pill every 6 hours and 1½ at bedtime
½ pill every 4 hours and 1½ at bedtime
½ pill every 6 hours and 1½ at bedtime
½ pill every 8 hours and 1½ at bedtime
½ pill every 8 hours and 1 at bedtime
1 pill if you are really doing something active during the day and 1 at bedtime
It is usually better to wean off these meds over several weeks, not several days. But.....if you are still having pain, then your body is healing and you still need pain relief. And in this case, I would discuss your pain management with your GP instead of your surgeon.
Meredith Noble, MS, ECRI Institute, Plymouth Meeting, Pennsylvania, and colleagues found that only 7 (0.27%) of 2613 patients in the studies reviewed who received opioids for CNCP for at least 6 months reportedly developed an addiction to the medication or took the medication inappropriately.
Oxycodone, morphine, and methadone were among the opioids prescribed and doses also varied considerably within studies due to individual differences in pain level, opioid tolerance, and titration.
Richard Chapman, MD, University of Utah, thought the review was "a nice piece of work," especially given that the evidence investigators had to work with was not derived from well-done controlled clinical trials, as they would have preferred.
Edited September 25, 2015 to add
I would always draw a line between addiction and dependency.
To me, addiction is when you are craving the drug purely for recreational purposes and don't want it for pain. It is when you obtain the drug for that reason alone and don't want or can't quit because you like the buzz and the high. It has more psychology to it than physiology.
Dependency is something that happens to you during your appropriate use of the drug for pain management. You wouldn't take it if you didn't need to and would willingly wean yourself off them. Having the side effects of a sudden cessation of intake doesn't produce in you a desperate need to obtain them at all costs though the pain that is emerging probably makes you quite eager to get a new prescription. There is a distinct difference.
People think it's like that but it's actually incorrect - the 'highly addictive" label is grossly overplayed, in my opinion. They are easy to become "dependent" on but that and "addictive" are two quite different things.
The definition of addiction is "the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, such as narcotics, to such an extent that its cessation causes severe trauma".
On the other hand, people can become dependent upon them which means if they stop them suddenly, they might experience uncomfortable symptoms such as shakes, chills, hyperactivity and such. What they don't do is end up craving them or taking more frequent or bigger doses and then getting into a panic if they are told they can't have any more to the point of doctor shopping to get more prescriptions or even resorting to street trade! So, though most people can stop taking them without a problem, they nevertheless should be cautious about it. If perchance, they experience any symptoms, the medication should be recommenced and then the dosage gradually reduced over a period of weeks - which is what will happen normally as the pain diminishes and you find yourself forgetting a dose here and there which is totally as it should be.
Here is a suggested schedule for cutting back on prescription pain medications. Stay at each level for 3-4 days or even longer if you notice the pain symptoms increasing. This schedule assumes you are starting with one pill every 4 hours before beginning the reduction process.
1 pill every 6 hours and 2 at bedtime
1 pill every 6 hours and 1½ at bedtime
½ pill every 4 hours and 1½ at bedtime
½ pill every 6 hours and 1½ at bedtime
½ pill every 8 hours and 1½ at bedtime
½ pill every 8 hours and 1 at bedtime
1 pill if you are really doing something active during the day and 1 at bedtime
It is usually better to wean off these meds over several weeks, not several days. But.....if you are still having pain, then your body is healing and you still need pain relief. And in this case, I would discuss your pain management with your GP instead of your surgeon.
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