Thursday, January 22, 2009

OxyContin Addiction or Dependence?

Pain patients may sometimes develop a physical dependence during treatment with opioids such as OxyContin. This is not an addiction. A gradual decrease of the medication dose over time, as the pain is resolving, brings the former pain patient to a drug-free state without any craving for repeated doses of the drug.

This is the difference between the formerly-dependent pain patient who has now been withdrawn from medication and the addicted patient:

The patient addicted to OxyContin continues to have a severe and uncontrollable craving that almost always leads to eventual relapse in the absence of adequate treatment. It is this uncontrollable craving for another “rush” of the drug that differentiates the “detoxified” but opiate addicted patient from the former-pain patient.

Theoretically, an OxyContin abuser might develop a physical dependence, but obtain treatment in the first few months of abuse, before becoming addicted. In this case, supervised withdrawal (detoxification) followed by a few months of abstinence-oriented treatment might be sufficient for the non-addicted patient who abuses OxyContin.

If, however, this patient subsequently relapses to OxyContin abuse, then that would support a diagnosis of opioid addiction. After several relapses to opioid abuse, it becomes clear that a patient will require long-term treatment for the opioid addiction.


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