Opioid is an analgesics prescribed for chronic pain. Repeated opioid consumption for recreational purpose induces addictive behaviour and craving of high dosage of narcotics. Excessive opioid consumption for mood changes follows addiction and craving for opioids.

Opioid Dependence vs Opioid Addiction

Coming to the Opioid Addiction and Opiod Dependence, addiction is a disease and opioid dependence is a side effect of opioid consumption. It can be rightly said that a person is suffering from opioid addiction when he or she with or without pain is unable to stop consumption of the opioid drugs. Patient with history of opioid addiction continues consumption of opioid in spite of being aware of the danger of continuous intake of opioids.

The opioid addicted patient is voluntarily unable to withdraw the use of addicting medications. On the contrary opioid dependent patient is depend on opioid for optimum pain relief. Patient tries to consume more and more opioid pills to achieve optimum pain relief, thus becoming dependent on higher and higher dosage of opioid. In both conditions patient may increase consumption of opioids. Opioid addiction and dependence is often associated with opioid withdrawal, tolerance and resistance. The article will primarily focus on the major differences between Opiod Dependence and Opiod Addiction.

Know About Opioid:

Natural Opiates are actually the alkaloids present in the resin of opium poppy. Morphine, Codeine etc. are some of the natural opiates. Any compound that resembles morphine or any other opiates in its pharmacological effect is termed as Opioid. There are synthetic and semi synthetic opioids. These opioids actually bind to the opioid receptors in the Central and the Peripheral nervous system and also in the gastrointestinal tract. Opioid has got its medicinal use and helps in relieving pain during various conditions. However it is only safe as a drug in an appropriate amount. There are cases where people get addicted towards the drug and meet with a serious condition or can say a dangerous disease known as Opioid addiction. This is actually harmful and cause serious risks to the life of the addicted person and others too.

Opioid Addiction

Few individuals with genetic abnormalities may get addicted to harmful or harmless substances. Harmless addiction is a compulsive ingestion of certain harmless drugs or food in large quantity. The example of harmless addiction is consumption of excessive coffee or tea. The habit of excessive consumption of these substances can be easily managed with alternative behavioural therapy or psychotherapy. Individual with addictive personality may consume excessive coffee to stay awake or similarly consume excessive opioid for ecstatic and carefree feeling.

Anything used for a longer period continuously, surely makes one addictive to that substance. There comes a time when the person is unable to stop using the opioid substance and persistent use of same substance results in addiction. The compulsive and persistent use of harmful substance is termed an addiction. Addiction is caused by a continuous long-term use of drugs. The recreational drugs that induces addiction are alcohol, marijuana and opioids. Addiction prompts a destructive behaviour that generally roots in the altered brain biology. Addiction results in strong uncontrollable craving for drugs like opioids. The compulsive use of the addictive substance often causes emotional and physiological side effects. Opioid addiction is associated with opoid tolerance and increased resistance to therapeutic response if prescribed for pain. Discontinuation or lowering of dosage causes withdrawal symptoms.

A strict quotation from Russell Brand comes as, "Addiction is a serious disease, it will end with jail, mental institutions or death!"

Opioid Dependence

Patient may often need higher dosage of opioid for optimum pain relief. Such patient may consume more number of pills than prescribed by physician. Consumption of more pills for adequate pain relief often results in condition known as opioid dependence. Opioid dependence is not an addiction even though patient often consumes large number of opioid pills. Physical dependence to opioid (also called opioid dependence) is a benign condition. Physical dependence follows when chronic pain stops responding to daily dosage of opioid and instead needs higher dosage. Frequent need to increase dosage to relieve pain results in a medical condition known as Opioid Dependence. Physical opioid dependence is actually predictable and can be easily managed with the help of medications. Opioid dependence is associated with opioid tolerance and increased resistance to therapeutic response. Discontinuation or lowering of dosage causes withdrawal symptoms.

Opioid Tolerance-

In patient suffering with opioid dependence, the therapeutic effect of opioid is achieved only at very high blood level of opioids. The phenomenon is known as increased tolerance to opioids. Patient exhibits tolerance to normal expected dosage of opioids to achieve therapeutic effects. The increased opioid tolerance condition suggests opioid is no longer working as analgesics at previous effective dosage. Opioid Tolerance is something that occurs due to some compensatory changes like the down-regulation of the central nervous system receptors where the person requires a higher dose of the drug to have the same effect.

Opioid Withdrawal Symptoms

Stoppage or lowering of opioid dosage causes progressive withdrawal of opioid from blood with time. Withdrawal of opioid in chronic pain patient causes sudden feeling of severe pain. The recurrence of symptom suggests inefficiency of opioid to relieve chronic pain at previous therapeutic dosage. Decreased blood level of opioid also causes withdrawal symptom. Patient suffering with physical opioid dependence suffers with withdrawal symptoms when blood level of opioid decreases or lesser number of pills are consumed. The most common opioid withdrawal symptoms are sweating, anxiety, nausea and diarrhea. The symptoms may last for prolonged period if not treated. Withdrawal symptoms are less severe or absent when opioids are discontinued after short term treatment. The presence of endogenous peptide in blood masks the withdrawal symptoms. Our body produces enough endogenous opioids like endorphins so as to prevent withdrawal symptoms following short term treatment or during initial few week of therapy.

Uncontrolled Craving For Opioid

Unlike the opioid dependence, opioid addiction causes uncontrolled feeling and need to consume opioid. Opioid addiction is classified as a disease and causes a real danger to self and others. It is known that the cravings are rooted in the altered brain biology. Opioid addiction is dangerous and requires strong therapy involving the replacement of the addictive behaviours with some healthy alternative behaviors.

Behavioural Changes-

The opioid addiction causes following behavioural changes-

  1. Abnormal Drug Seeking Behaviour-

    • Uncontrollable cravings for opioid
    • Compulsive use of narcotics
    • Inability to control the use of drug even after being aware and even after experiencing the harm caused to self and others practically.
    • Mixing opioid with other street drugs
    • Doctor shopping for pain medication
    • Simultaneous use of other medications like marijuana, alcohol and diazepam.
  2. Cognitive Behaviour Changes

    • Drowsiness
    • Loss of control on emotion
    • Often angry
    • Violent response to irritable situation
    • Destructive behaviours
    • Depression.

Differences Between Opioid Dependence And Opioid Addiction:

  1. Increased Opioid Consumption-

    Physical Dependence of Opioid or Opioid Dependence is defined as an increase in need of opioid dosage to obtain optimum pain relief. Opioid addiction results in increased consumption of opioids to maintain euphoric and erratic mood. Addiction begins as social drug consumed for recreational purpose or create a euphoric surrounding. Later addiction results requiring higher quantity of opioids, which follows in craving, withdrawal and altered mind.

  2. Biological Changes:

    Opioid dependence follows increased resistance of opioid receptors or receptors responds only at higher dosage of opioids. Opioid dependence affects the thalamus and the brainstem.

    However opioid addiction is actually a disease that is encountered in genetically, biologically and psychosocially vulnerable person. It is not a predictable drug effect. Addiction occurs when there is an overlapping of genetics, environment and drug use. Opioid addiction affects the reward pathways of the brain which include the mesolimbic pathway and the mesocortical pathway.

  3. Difference Of Sign & Symptoms In Opioid Dependence And Opioid Addiction:

    Opioid Dependence causes following symptoms and signs-

    • Opioid dependence is associated with increased need of opioids for pain relief because of increased tolerance to opioids.
    • Increased tolerance is associated with increased resistance to opioid receptors.
    • Lowering the opioid dosage causes severe withdrawal symptoms. Withdrawal symptom is often observed in patient taking opioid daily for pain relief.
    • The lower concentration of opioid in blood causes withdrawal symptoms.
    • Withdrawal symptoms include sweating, anxiety, nausea, breathing problems etc.

    Opioid Addiction causes following symptoms and signs-

    • Constipation
    • Uncontrolled craving
    • Impaired control
    • compulsive use
    • Continuous use of opioid drugs.
    • Loss of motivation.
  4. Dangers To Self And Others:

    Opioid dependence is not dangerous though the withdrawal symptoms may be unpleasant and irritating. Opioid addiction causes abnormal systemic effects. Systemic effects are actually harmful to the individual who is abusing the drug. The physiological abnormal effects of opioid observed are fibrosis of lungs, anatomical structural changes of left side of the heart and carotid artery narrowing. The abnormal effects of lungs, heart and carotid artery affects blood and oxygen supply to brain, which results in abnormal cognitive behavior. The systemic effects of opioids are observed mostly in patient who are inhaling the opioids. So when the drug is smoked, it enters the lung and affects the airway passage and alveoli (lung). The continuous presence of opioid particles damages the delicate breathing membrane. The opioid particles are then absorbed into blood system in lungs and carried to heart. The opioid damages heart membrane and muscles. Consistent presence of opioids in blood damages the delicate mucosal layer in blood vessels and muscles. Such effects causes narrowing of the blood vessels.

  5. Detoxification:

    Detoxification is discontinuation of opioids intake under medical supervision. The side effects are medically treated if seen during detoxification. Detoxification is either rapid or slow in duration. A person who is diagnosed with opioid physical dependence and undergoes detoxification might suffer from withdrawal symptoms. Detoxification helps to get rid of the opioid dependence. Opioid addict following detoxification often succeeds in discontinuation of opioids. But few individual patients undergo relapse and begin taking opioids. However once someone is known for having opioid addiction and undergoes detoxification he or she can end the physical dependence of opioids for short period. The relapse is depends on the genetic abnormalities and brain malfunction. Few patients often go through a long ongoing struggle in life.

  6. Treatments:

    Treatment For Opioid Withdrawal

    • Discontinue all opioid medications
    • Treat anxiety and apprehension with antianxiety medication like diazepam or clonazepam
    • Treat dehydration with intravenous medication.
    • Treat diarrhea with antidiarheal medications.
    • Treat nausea and vomiting with antiemetic medications.
    • Treat increased heart rate and blood pressure with appropriate medications.
    • Opioid physical dependence is possible with appropriate medications taken on a prescribed way.

    Treatment To Prevent Relapse In Opioid Addiction-

    • Pain and addiction is treated with long ating opioids like methadone
    • Addiction is treated with suboxone.

    Alternative Therapy-

    • Exercise
    • Maintain healthy life style.

    Treatment for Behavioural Abnormalities-

Final Note:

"You know every day is a second chance. Do not make it the last one." It is good to destroy the thing which destroys you. If you are one of those who is meeting with opioid addiction issues, do consult your dear ones, reach an expert, join the effective programs to leave the drug, take the necessary treatments to have effective recovery from the addiction and feel the notes of life to its best.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: March 10, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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