Am I Opioid Dependent?
At Marina Medical in Normandy Park, WA, Michael Brown, MD and his team welcome and care for patients throughout the greater Seattle area. They address concerns about opioid addiction or dependence and chronic pain, and answer questions about treatment with Suboxone.
The terms “opioid dependence” and “opioid addiction” are often used interchangeably. Is there a difference between the two?
The difference is often not clear, even to many physicians. General guidelines are as follows:
Dependence: a person is “dependent” on a medication for the treatment of a disease or condition. For example, a diabetic is “dependent” on insulin.
Addiction: a person is using a substance or behavior for something other than a disease, and will continue to use that substance even when it is clearly harmful to oneself or to others.
I have been taking an opioid to treat my chronic back pain, and I can’t seem to quit. Does that mean I’m addicted?
This situation is very common and becomes a concern of people taking opioids on a daily basis for more than a few weeks. Why? Because all opioids quickly cause a physiological* need for the medication; without it, very unpleasant “withdrawal” symptoms quickly arise. Certain receptors in the brain (primarily mu receptors) quickly get accustomed to the presence of high levels of opioids. These receptors are “feel good” and “pain relieving” receptors as long as they have an opioid molecule attached to them. When suddenly deprived of their companion opioid molecule, they become very unhappy and literally become “feel bad” and “pain causing” receptors.
*Physiological in contrast to psychological. This means opioid withdrawal symptoms are due to biochemical causes, not psychological “weakness”, for instance.
Okay, fine. But if I can’t quit because of something going on in my head, I still feel like I’m addicted. Am I?
Exactly. This is why addiction and dependence are difficult to distinguish, even medically. Ultimately, when it comes down to wanting to stop the opioid, it doesn’t really make much difference.
Whether a person started smoking oxycodone in high school to get “high”, or was prescribed morphine by a pain management physician and the pain is no longer an issue, stopping the opioid can be difficult and for some people next to impossible. If you are one of these people, you may relate to the following scenarios.
Scenario #1: I started using oxycodone in college, then started smoking oxycontin. When this drug was no longer accessible, I started heroin and have been at about ½ gm per day. I’ve been through detox twice and a 30-day inpatient treatment program. I’ve lost my job, my house, my spouse and kids. I’ve tried NA, AA, gotten a sponsor, and I’ll stay clean for a while, but then something comes up in my life and “Bam!” I’m right back where I started.
Scenario #2: I injured my back 12 years ago and ended up having a laminectomy, then three years later a fusion of L4-5. My pain was intolerable and I am on disability. Two years ago I started an exercise program under the direction of my physical therapist. I’ve been prescribed methadone 40 mg daily and oxycodone 10 mg four times daily. I have tried to taper this dose but after three days I am miserable. I want to get off these drugs and see if I can live without them because my back is actually not very painful anymore.
These two examples bring up several important points. First of all, few people who find themselves clearly addicted (persisting in a behavior in the face of harmful consequences such as jail or divorce) actually want to be. Yes, ‘using’ creates momentary relief of emotional pain, but the aftermath is just not worth it. And the person in scenario #2 possibly no longer needs opioids for pain relief, but is finding it equally difficult to stop. Why? Read on . . .
Why is it so difficult to stop?
To understand why it is so difficult to stop using opioids, it is important to know some scientific facts and current theories. Please read "Opioid Brain Changes & Long-term Treatment".
Can you give me an idea about what the treatment process is like and what it costs?
Okay, I want to get help. What is the first step?
We recommend that you call Marina Medical at (206) 878-8600 and speak with one of our staff. If you still have questions, consider making a MEET & GREET appointment. This brief appointment is informational only and free of financial risk (no out-of-pocket payment from you). It will give you an opportunity to meet us, and give us an opportunity to learn about your particular situation and determine how best we may help you with treatment using buprenorphine. You can expect an attentive and compassionate conversation. No treatment will begin until you understand and agree to start the program. Click below to schedule a MEET & GREET appointment.
Feel free to email us regarding any scheduling or general questions!
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19901 First Avenue South Suite 409, Normandy Park, WA 98148
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