Last updated: May 04, 2008
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Though most people will not become addicted, many may develop physical dependency.
(IAN MCDONNELL/ISTOCKPHOTO)
Narcotics are the strongest class of drugs prescribed for chronic pain, and all narcotics are potentially addictive. But despite the bad rap narcotics get, only a small portion of pain sufferers are likely to become addicted. A larger percentage may become physically dependent, but the distinction is important to understand if your doctor prescribes—or if you seek—a drug in the opioid class.


True addiction has a strong aspect of mental dependency and may run in families.

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"Addiction really involves a psychological component," says Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University. "Somebody gets very focused on getting opioids. They often experience a high or euphoria when they take the drug and they crave it."

While there are instances where a chronic pain patient will experience a high, these are uncommon. Experienced doctors will increase the dose slowly to avoid triggering this side effect.

How do you know whether you're prone to addiction?
  • A personal or family history of alcohol or drug abuse raises a red flag. It's now believed that addiction has a genetic component and can be triggered by psychological or social conditions.
  • Any major psychiatric illness—including mood disorders, such as depression, and anxiety disorders—may increase the chance of getting hooked.
Any good doctor will carefully review your history and then monitor your use of the drug. It's also something a spouse or caregiver should watch for when a loved one begins a narcotic regime.


You can abuse them without being addicted
The chance of addiction is statistically low, says Frank Vocci, PhD, director of the division of pharmacotherapy and the medical consequences of drug abuse at the National Institute on Drug Abuse. Vocci estimates it to be around 2%. However, he cautions that the line between addiction and opioid abuse is not always clear. Patients may find themselves more and more reliant on their meds and need to watch for this.

"There are cases when they simply have an increase in their pain. For example, with cancer patients. That's legitimate," says Vocci. "But there are other times when people start to take more than they're prescribed because they're trying to medicate something other than pain. They may be feeling stressed."

An opioid prescription should initially only cover a week or two of medication, says Vocci, to allow doctors to monitor their patients closely, and doctors should watch for instances when patients call saying their prescriptions have run out early.

Dependency requires special treatment
Keep in mind that even if you develop no psychological reliance on a narcotic, you will probably become physically dependent. These are powerful drugs that have a strong effect on the body's chemistry. When you stop taking opioids, there will often be a withdrawal process, which can include sweating, rapid heart rate, nausea, goose bumps, and anxiety. Doctors often wean patients off opioids gradually, even if they have only been taking them for a short while, rather then having them go cold turkey.