Please use the form below to submit comments. Also provide an e-mail address and name. Your e-mail address and/or name will be used only to communicate with you about this or future comments you may submit. I am particularly keen to receive references to published material that contradicts the assertions and arguments I have made.
By submitting the above comment, I grant to Ross Alan Hangartner the right to incorporate the comment in full or in part, literally, paraphrased, or conceptually, as he sees fit, into State of Pain or other writings that he may create in the future. However, I don't grant permission to include my name or e-mail address, or to use them in any other way than to contact me for follow-up. I understand that by submitting the comment I acquire no right of any kind in State of Pain or other writings of Ross Alan Hangartner.
Last updated: Wed, Jul 31, 2024
The DSM criteria for "substance dependence" include some criteria that are always met by those who are taking opioids for long-term pain treatment, including "physical dependence" and "tolerance." For this reason, it is not clear how many chronic pain patients are problematically substance-dependent, or in fact what exactly that might mean. However, when substance dependence numbers for chronic pain patients are reported, they are usually high, often about 25%.
A review of 67 studies of addiction in chronic pain patients who were started on opioids showed a rate of new instances of addiction over 3%. However, in studies in which participants were screened for pre-existing addiction problems, the incidence of addiction decreased to about 0.2%.1
Substance dependence is certainly a significant fact for chronic pain sufferers who use opioids. However, substance dependence in the absence of addiction is not usually problematic for the sufferer. The situation for pain care providers, especially those who carry prescription pads, is different. The patients who present themselves to these providers are highly likely to be at least dependent. This, in the context of drug-control policies, puts the provider in the unfortunate position of feeling an obligation to distinguish bona-fide pain sufferers from drug seekers. (See Pharmaceuticals in Pain Treatment for more on opioids in pain treatment.)