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The terms physical dependence and tolerance often are confused with addiction, so clarification of terms is important (McCaffery, Herr, & Pasero, 2011). The definitions proposed in a 2001 consensus statement by the American Academy of Pain Medicine (AAPM), the American Pain Society, and the American Society of Addiction Medicine (ASAM) are as follows:

  • Physical dependence is a normal response that occurs with repeated administration of an opioid for more than 2 weeks and cannot be equated with addictive disease. It is manifested by the occurrence of withdrawal symptoms when the opioid is suddenly stopped or rapidly reduced or an antagonist such as naloxone is given. Withdrawal symptoms may be suppressed by the natural, gradual reduction of the opioid as pain decreases or by gradual, systematic reduction, referred to as tapering (ASAM, 2001).
  • Tolerance is also a normal response that occurs with regular administration of an opioid and consists of a decrease in one or more effects of the opioid (e.g., decreased analgesia, sedation, or respiratory depression). It cannot be equated with addictive disease. Tolerance to analgesia usually occurs in the first days to 2 weeks of opioid therapy but is uncommon after that. It may be treated with increases in dose. However, disease progression, not tolerance to analgesia, appears to be the reason for most dose escalations. Stable pain usually results in stable doses. Thus, tolerance poses very few clinical problems (ASAM, 2001).
  • Opioid addiction, or addictive disease, is a chronic neurologic and biologic disease. Its development and manifestations are influenced by genetic, psychosocial, and environmental factors. No single cause of addiction, such as taking an opioid for pain relief, has been found. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving (ASAM, 2001).

The consensus statement reinforces an important message-that taking opioids for pain relief is not addiction, no matter how long a person takes opioids or at what doses (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). Individuals taking opioid drugs for relief of pain are using them therapeutically.