How the opioid crackdown is backfiring

[moriah]

37. Beg to differ *slightly*.

Physical dependence will occur on most any drug, as in taking the drug itself alters brain chemicals in a way that the brain learns to compensate to deal with -- and ideally unlearns by tapering vs abrupt discontinuation. For example, benzodiazepines. GABA is a necessary inhibitory neurotransmitter, and benzo-treated patient's brains learn to compensate in necessary areas when too much GABA is bad. Abrupt discontinuation of the thing making GABA work better leaves the brain still acting like it's used to getting a GABA-enhancer, and worst case scenario is seizures they can't stop. Second-worst is manic psychosis. Both can be fatal and are easily prevented with a proper taper.

A person can become physically dependent on an opiate as a result of even a brief acute episode of use, if the dose isn't titrated by patient or provider correctly, regardless of the actual physical pain levels that would exist after a "knockout withdrawal" process (the European method, using barbiturates to induce a coma through the worst, then tapering the GABA agent). This is why orthopedic surgeons are especially cautious with painkillers, if they expect the operation to be a success. During my ankle ligament repair surgery, they created far more pain than I had from the retear of the ligament itself -- drilled a hole in my fibula. They know that they're creating pain to stop it, and concerns about appropriate tapering was why I took the Tramadol at the end vs just tossing the script. It didn't do anything for my perception of pain during PT, but I recognized it might prevent rebound perception of worse pain after slamming my brain with painkillers I'd never had before during the immediate recovery process.

Tolerance is another issue, but closely related. Everyone taking a substance that messes with brain chemicals long enough develops tolerance to its worst effects, and therefore also to its desired effects -- which can require dose escalation and it be proper, if done in a careful manner. Truthfully, one *should* start low and titrate up as base pain and tolerance require.

Therefore, every long-term opiate ingester, whether they need the drugs to keep a standard of life vs just keep them from residing in their bathroom for a week or two, is by definition both dependent and tolerant to opiates. Needing a higher dose isn't always an indication of addiction. If opiate use is titrated appropriately, dose escalation is an expected part of the process -- if none is needed they likely overshot the original necessary dose and the patient did the titration themselves by halving doses to avoid early nausea, etc.

Addiction is, as you said, when the person's use of the drug is causing more harm than it solves for them yet the psychological reinforcing effects of taking it overcome the logic circuit. Yet even addicts may need pain management outside of hospice, and denying appropriate pain relief just because they have an addiction history is inhumane. And when the harm is from, for example with MMJ patients in non-MMJ states, the illegal way they obtain a drug they actually need.... who is really at fault? The doctor who wrote them off and left them seeking fake street pills laced with IMF vs considering Suboxone?