Why is there so much confusion about this concept? Addiction and dependency and tolerance are totally different things. Sometimes related but often not related at all. Oh and we must really get away from derogatory terms regarding our patients who suffer from legitimate diseases. Just like we dont call obese patients “fatsos”, we dont call patients suffering from addiction or dependency “hooked” or “druggies”. Those are terms used in the past that carred the connotation that these patients could simply “wish away” their problems if they really wanted to.
Most patients problems develop in the following way. Ill walk you through a typical patient that comes to my office:
1) DEVELOPMENT OF DEPENDENCY: Mr Jones, CEO of a large corporation in the Denver Tech Center tells me that 5 years ago he was prescribed oxycodone/percocet for his broken ankle. The injury required a few surgeries and over 6 months the ankle healed but the doctor kept prescribing him the pain pills. He noticed that he couldn’t easily stop because he would get withdrawals. He is now “dependent”. This means nothing more than “if you stop you will get physical symptoms”. My diabetics are “insulin dependent”. They will have severe physical problems if they stop. They are dependent, not insulin addicts!. So dependency will happen within the first few months of taking such pain meds.
2) DEVELOPMENT OF TOLERANCE: over time Mr Jones,CEO notices that while 1 or 2 pills/day used to work for his chronic ankle pain, he now needs 2 or 3? but he thinks to himself that this is not a huge problem, afterall, the meds are prescribed so they must be safe. A month or 2 later it now takes 3 or 4 pills/day.. this is tolerance building up. Needing more and more to take care of the same problem. There is no end to this story. Many patients start with 10 or 20mg oxycodone/day and soon before they know it, they are up to 200mg/day. There is NO end to tolerance…. Not true, there is one end… death. Patients will routinely tell me “you know doc, im up to 200mg and im just so sure that if we just added a tiny 20mg to the program id do great. Im totally sure that 220mg will be all ill ever need….” sound familiar? There is no end to this.
3) DEVELOPMENT OF ADDICTION: addiction is more of a behavior. Addiction means you are taking medicaitons outside of what it says on the bottle, for a problem that you know you shouldn’t take it for and spending time, money and effort getting it when you should be spending that time, money and effort elsewhere. At this point many patients will try to get pills from other doctors, dentists, relatives, the internet and lastly from dealers in town.
Ill elaborate much more on each of these as we go along… stay tuned