The Opioid “Epidemic”--what the studies REALLY say about addiction to opiates.
The "opioid epidemic" mentality is doing a horrendous job separating the chronic noncancer pain patients, from the depressed, high short-term dose patients.
Opioid misuse risk factors include the male sex, short-acting as needed dosing, less education and younger age (Grattan, Sullivan, Saunders, Campbell & Von Korff, 2012). Higher pain and depression were also associated with misuse, but not addiction (Zenz, Strumpf & Tryba, 1992). Individuals with a history of addiction or a genetic vulnerability to any substance are more likely to misuse or develop an addiction to opioids--the same cannot be said for noncancer chronic pain patients who, even during breakthrough pain will receive higher opioid doses, will return to the lower dosage without problems (Ballantyne & LaForge, 2007; Portenoy & Foley, 1986). Even then, those with genetic vulnerability (estimated to make a difference anywhere from .3 to .5) and a history of addiction are not guaranteed (or even likely) to develop and addiction to regularly prescribed opioids (Ballantyne & LaForge, 2007; Fishbain, Cole, Lewis, Rosomoff & Rosomoff, 2008). Based on the findings by Fishbain, Cole, Lewis, Rosomoff and Rosomoff in their study, "What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review":
[T]he reported incidence of opioid abuse/addiction on COAT (Chronic opioid analgesic therapy) exposure...appears to be quite low (3.27%). This number is well below the accepted prevalence of addictions (approximately 10%) in the general population" (Fishbain, Cole, Lewis, Rosomoff & Rosomoff, 2008).
The misuse and misunderstanding of the differences between addiction and dependence are more of a problem in the opioid epidemic than any of the data around opioid use suggests.
A very well known study on the topic states, "Opioid-treated pain patients often develop overt physical dependence and analgesic tolerance with no behavioral change, therefore these must be considered separate phenomena from addiction" (Ballantyne & LaForge, 2007).
Here's a handy little comparison between the two:
http://www.naabt.org/addiction_physical-dependence.cfm
It's incredibly important to consider the fact that there is little evidence to support the opioid epidemic and misuse/addiction with chronic noncancer pain patients when putting laws in place to make opioid medication more difficult to prescribe. It deters doctors from prescribing medications necessary to allow non-addict chronic pain sufferers able to function and destroys their chances to have a comfortable life for no reason at all thanks to bias research and invalid evidence.
Ballantyne, J., & LaForge, S. (2007). Opioid dependence and addiction during opioid treatment of chronic pain. Pain, 129(3), 235-255. http://dx.doi.org/10.1016/j.pain.2007.03.028
Fishbain, D., Cole, B., Lewis, J., Rosomoff, H., & Rosomoff, R. (2008). What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review. Pain Medicine, 9(4), 444-459. http://dx.doi.org/10.1111/j.1526-4637.2007.00370.x
Grattan, A., Sullivan, M., Saunders, K., Campbell, C., & Von Korff, M. (2012). Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse. The Annals Of Family Medicine, 10(4), 304-311. http://dx.doi.org/10.1370/afm.1371
Portenoy, R., & Foley, K. (1986). Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases. Pain, 25(2), 171-186. http://dx.doi.org/10.1016/0304-3959(86)90091-6
Zenz, M., Strumpf, M., & Tryba, M. (1992). Long-term oral opioid therapy in patients with chronic nonmalignant pain. Journal Of Pain And Symptom Management, 7(2), 69-77. http://dx.doi.org/10.1016/0885-3924(92)90116-y
