The difference between addiction and dependence with opioids

Elizabeth Newman
Elizabeth Newman

While I love long-term care and the people who work in it, I don't think anyone would assert that it's cool.

You know who was cool? Prince.

So my brain spun this week around the idea that there's a Venn diagram overlapping these two topics through the tragic lens of opioid addiction.

Far better journalists than me have written about Prince's contribution to music, and to be clear, there is not yet a definitive answer to his cause of death. But in an New York Times piece this week, the paper reported opioid addiction specialists had been called in to help before Prince's death in April, and friends had expressed their concern. What made his passing surprising was that, unlike many of his contemporaries, the legendary musician not only did not use drugs and alcohol, no one else on his tour could either. In 2001, he became a Jehovah's Witness.

But despite a clean lifestyle, much like many direct caregivers, the singer had spent a career doing physical work. Prince, 57, had hip surgery about 15 years ago. While splits, dancing or and guitar playing in platform heels looks far more glamorous than lifting a morbidly obese singer, both endeavors take physical stamina.

That leads us to an excellent piece in Slate this week by Jerrold C. Winter, a professor of pharmacology and therapeutics at the University of Buffalo, who deliniates the difference between opioid addiction and opioid dependence. He writes that it is critically important “to draw a distinction between physical dependence, which is a pharmacological phenomenon, and addiction, a term with multiple definitions, none of which is entirely satisfactory.”

In the meantime, there are multiple facets of the opioid issue in long-term care facilities: We have residents who have physical dependence due to pain. Strong opioids include morphine, fentanyl and methadone, with the former often being given to terminally ill patients. It's hard for physicians to find the right dosage when a senior does not have a terminal illness, but rather a degenerative one that is impacting quality of life in a meaningful way. It's reasonable to ask, as this piece does, whether the future will include more physicians who are trained in pain management and addiction.

Next we have patients or perhaps residents who are seeking whatever drugs they can get, which may lead them to prescription drugs, recreational drug use, alcohol abuse, etc. They could be seen as more traditional addicts. Finally we have long-term care employees, who can fall into either category. Before I read Winter's piece, whenever I wrote or read about an employee stealing narcotics, I assumed if it hadn't been hydrocodone it would have been something else. Now I hope to assess what that person's career was and ask about their physical pain and dependence. If it's a clinical caregiver or nurse who may well have injured herself on the job or through years of lifting, it changes my understanding. Instead of calling these employees “bad apples,” we should see what led them to desperate measures.

That doesn't necessarily make it easier for administrators under enormous pressure to make sure potent medications are given to the right person. Certain medical groups, such as the American Hospital Association, are actively pursuing education around this issue. There are no easy answers, only a hope that scientists can develop a drug that makes people feel better but also has reduced potential for dependence and addiction.  But until then, when we hear of an overdose death and think “addict,” we can perhaps take a step back to ask about the larger story.

Follow Elizabeth Newman @TigerELN.


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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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