C.W. WIEBE MEDICAL CENTRE
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Mrs. G, a 65 year old lady, recently came to see me. She was quite concerned that she may be addicted to hydromorphone, a pain relieving medication in the opioid class. She had been prescribed it for postoperative pain following major surgery. It worked well for her, but when she tried to stop taking it, she felt unwell. She had headaches, muscle aches and pains and felt a little “down in the dumps”.
I work in Winkler as a family doctor with a special interest in addictions. It seems these questions keep resurfacing with my patients. Am I addicted? Will I get addicted if I use this medication? Do you think my loved one may be addicted? We, as health care providers, often ask similar questions when treating our patients. Is this patient showing signs of addiction? Am I putting him/her at risk for addiction by prescribing this particular medication? After all we are supposed to be trained in medical school to be vigilant for the signs of addiction. Addiction is a serious disease that can cause great harm to the person and their family. What complicates matters is that there are conditions that can mimic addiction. It can be difficult to distinguish between the two.
The good news is that the majority of people who take prescription drugs will not get addicted to them. The American Society of Addictions Medicine (ASAM) defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
ASAM’s definition continues: ”Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
Thankfully ASAM has a more concise definition called the 4 Cs. It is easy to remember and can be used as a guide to help determine if someone may be struggling with addiction. It is not intended to replace the detailed assessments done by addictions specialists. Those struggling with addiction often lose Control or find themselves fighting for control over their use of the substance. They tend to have severe Cravings to use the drug and end up Compulsively using it. They Continue to use the drug in spite of negative Consequences.
Back to Mrs. G. A detailed history revealed that she was “physiologically dependent” on hydromorphone and had none of the 4 Cs mentioned above. Physiological dependence is one of those things that can mimic addiction. When an opioid medication is taken over a period of time one develops tolerance. Meaning you would eventually have to take a higher dosage than you started on to continue to get the same effect. Also, if you suddenly decided to stop taking the opioid, you would experience withdrawal, which can include symptoms like headaches, muscle aches and pains and depressed mood. Tolerance and withdrawal are normal phenomenon that virtually everyone who take opioids experience. On their own they are not signs of addiction and can be treated.
If you have questions or concerns about drug use, please discuss this with your primary health care provider or contact the Addictions Foundation of Manitoba.
This article can also be found published in The Voice (December 15th edition)