The Opioid Spectrum-From Prescription to Dependency, to Addiction

There are unquestionably different levels of opioid use and dependency; I refer to this as the opioid spectrum. On one end of the spectrum are patients who have been prescribed opioids for a short term due to an acute injury or trauma, including surgery. On the other end of the specturum is a chronic opioid addict whose life has completely devolved in to ruins. There are many possible liminal states of opioid use.

Somewhere in-between are folks who keep taking more and more opioids because they become less and less effective and they develop what is called a physical dependency, or tolerance to opioids. Another group of individuals, newly emerging in news articles, are functional heroin users who started out taking prescription medication and found that they required self-medication once their script ran out but they couln’t afford the pills. (https://www.cnn.com/2018/02/27/health/functioning-heroin-addicts/index.html)

Because of the confusion brought on by terms such as dependency or addiction, the CDC coined a new term: Opioid Use Disorder (OUD), which they describe as …”any problematic pattern of opioid use that causes significant impairment or distress.” Dependence most often refers to patients who’s body relies on a external source of opioids to prevent symptoms of withdrawal. New studies have noted that dependency can occur within one short week, so anyone prescribed opioids for even a short amount of time may need assistance with withdrawal symptoms, which are deemed “normal”.

On the other hand opioid addiction is abnormal and classified as a disease, manifesting as uncontrollable cravings, inability to control compulsive drug use, and continuing to use opioids despite doing harm to oneself or others. So, physical dependency  does not constitute addiction, but is often seen alongside addiction. This distinction is difficult to make, and the terms dependence and addiction are often used interchangeably as opioid dependency often morphs in to opioid-opiate addiction.

Visit Dr. Catherine Browne, DAOM’s clinic in North Carolina for assistance in opioid withdrawal

Most would associate opioid dependency as the pre-addiction state, and would classify opioid addiction as a severe, chronic disease. I named my book Natural Therapies for Dependency and not addiction because the patients that I see in clinic have not digressed to full-tilt chronic addiction; they simply need assistance with the withdrawal symptoms that accompany opioid dependence. In reality, the therapies that I describe in the book are can also be applied to opioid-opiate addiction. However, in reality, addicts are typically too unorganized to to follow a structured treatment protocol. Additionally, chronic opiate addicts have often burned through their resources and family good-will making herbs and acupuncture treatments economically unattainable. Ideally, these proven treatment modalities will by paid for in a comprehensive federal drug rehabilitation programs in the future.

References:

Retrieved September 2018: https://www.cdc.gov/drugoverdose/prevention/opioid-use-disorder.html

Retrieved September 2018: https://www.webmd.com/mental-health/addiction/news/20170316/opioid-dependence-can-start-in-just-a-few-days#1

Morgan, M. M., & Christie, M. J. (2011). Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human. British Journal of Pharmacology164(4), 1322–1334. http://doi.org/10.1111/j.1476-5381.2011.01335.x

Laxmaiah Manchikanti, MD, Kavita N. Manchikanti, BA, MS IV, Vidyasagar Pampati, MSc, and Kimberly A. Cash, RT.Prevalence of Side Effects of Prolonged Low or Moderate Dose Opioid Therapy with Concomitant Benzodiazepine and/or Antidepressant Therapy in Chronic Non-Cancer Pain. Observational Study. 2009;12;259-267. Retrieved September 2018 http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=12&page=259

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