The myth of addiction

              Many cancer patients, as well as some health care professionals, fail to manage cancer pain well because of needless fears of patient addiction to the medications that represent the front-line of cancer pain management, opioids.

     This is an unfortunate situation, not only because it can be the source of needless suffering, but also because these fears are founded in ignorance of the FACTS about the use of opioids for cancer pain and the enormous difference between "addiction", "physical dependence" and "tolerance."

    Addiction:  Addiction is a psychological dependence and a compulsion to use drugs for non-medical purposes other than pain relief.  The key word here is "psychological."  People who are addicted are driven by craving for the substance, not by physical pain. This craving is physical and emotional, and an addict needs his drug the meet psychological needs and to get "high."  People in pain want medication to feel relief -- not to feel drugged. A study of patients with cancer who used opioids to manage their pain reported that of 24,000 patients, only 7 became addicted to their medication  [Friedman 1990]

    Physical dependence: This describes the result of the use of some medications, including opioids, on the body of someone who has been taking these medications for a period of time. One's body adapts to the presence of the medication, and when the medication is no longer needed, it's necessary and prudent to slowly taper off the use of these medications, in order to avoid unpleasant physical side effects like nausea, cramps, restlessness, and more. Your physician or nurse can provide information on how to do this.

     Tolerance:  Tolerance is a term health care professionals use to describe the actual process a person's body undergoes to adapt to using opioids and some other medications. Over time, in many instances, it is expected that a person will need to increase the amount of medication taken to achieve the level of pain relief needed, usually increasing the amounts by small doses at a time. Tolerance is an expected development, and is readily managed once the medication is no longer needed, by gradually decreasing the medication levels to zero.

     Some people in pain are reluctant to take opioid medications not only because of fears of addiction, but also because they fear that taking the medications will "cloud the mind."  This is where the assistance of a health care professional with knowledge of the use of opioids is very important. These experts will work with you to find a level of relief and alertness that gives you the quality of life you want, without depriving you of your ability to work and live a productive life.

    Sometimes health care professionals are reluctant to provide cancer patients and others in pain with opioid medications in sufficient quantities to handle the pain being experienced. This reluctance is often based in a lack of understanding about the use of opioids.  If your health care provider is not providing you with appropriate medication, it will become important to find someone who will do so.  One approach in this situation is to ask for the assistance of a pain care specialist.  These are physicians and nurses who specialize in managing pain, and they will have the knowledge (without the prejudice against opioids) to provide relief.

     Opioids are the most effective medications there are for cancer pain relief. Don't let ungrounded fears, held by you or by members of your family, keep you from enjoying the best quality of life possible without pain as a constant and disabling companion.