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If you were an addict, you'd know. Right? All addicts have drawn faces, pockmarked arms and can't cope with daily life. As we see here, the truth of opiate addiction may be quite different.

We all have an image in our heads of what an addict looks like. Addicts are miserable, skinny, pockmarked people; they steal to fund their habit. They can't cope with life, and are frequently unemployed.

That may be the case for some addicts, but there is another group of addicts: addicts to prescription opiate medications. It is estimated that up to 36 million people abuse opiate medications worldwide, with 2.1 million people in the United States being addicted to prescription opiate medication (including morphine, codeine, oxycodone, and hydrocodone).

Myth: It's impossible to be addicted to a medicine

Fact: Prescription opiates trigger the same areas of the brain as heroin, and triggers the release of pain-relieving endorphins. They make you feel relaxed and may cause a feeling of being "high". Due to this euphoria, there is the unique potential for opiate medication to cause addiction, especially if opiates are misused (for example crushed, or taken at a higher dose than prescribed) or used when you are not in appropriately strong pain.

Myth: Everyone who takes opiates becomes addicted

Fact: 100 million people take opiate medication in the US every year for chronic pain (mostly for chronic back pain, or osteoarthritis). Of those 100 million, only 2.1 million will develop an addiction (not including the people who develop physical dependence or tolerance). While that is statistically significant, it does show that - if taken responsibly - not everyone who uses opiates will develop an addiction.

Myth: Tolerance, dependence and addiction are the same thing

Fact: These are three different physiological mechanisms.

Tolerance: Due to using a drug for a prolonged period of time, as can be the case with chronic pain, its effectiveness has declined and a higher dose can be required to achieve the same effect.

Physical dependence: Often accompanying tolerance, physical dependence often occurs in people who take a medication (not only opiates, but also sedatives, antidepressants, anti-epileptic medications, certain anti-psychotics) for a long period of time. This can occur even if you take medication as you should. With opiate use, your body becomes dependent on external opiates to trigger your natural pain-killing endorphins. When those external opiates are removed, you may feel physically unwell. A managed withdrawal can help manage symptoms and trigger your natural endorphins. This sounds a lot like addiction, but it's not. This is merely a natural physical reaction that can occur with the withdrawal of any substance, including caffeine.

Psychological Addiction: Addiction is a disease. It is characterised by cravings (there is no addiction without cravings), obsessive thoughts about drug use (including counting down the time until you can take your next dose), taking your opiate dangerously so to achieve a higher sensation (more than the maximum dose, crushing your pills, etc), and using the drug compulsively despite any harm you may be doing to yourself or others. In addiction, not only do you feel unwell, as you might with physical dependence, you will feel you cannot cope without the drug.

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