Continued Use Despite Harm: The Under-Utilized Criterion for an Opioid Use Disorder Diagnosis
Over the last few years, I have argued that we need to rethink the nature of opioid use disorder in the population of people who take opioids as prescribed for moderate-to-severe persistent pain. I’ve done so in various formats, including in presentations as well as here at the Institute for Chronic Pain, in both web pages (Should the Definition of Opioid Addiction Change? and Opioid Dependency & the Intolerability of Pain) and blog posts (The Central Dilemma in the Opioid Management Debate and Dreaded or Embraced? Opioid Tapering in Chronic Pain Management).
I do so because I think that the fields of both pain management and addiction are overly focused on loss of control as the primary indicator of when a person on long-term opioids for pain management crosses the line into the problematic state of an opioid use disorder (OUD). The argument these fields tend to use goes something like the following:
Opioid Dependance and Addiction
Opioid, or narcotic, pain medications are beneficial in a number of ways. Terminal cancer patients, for instance, benefit from their use. The short-term use of opioid pain medications is beneficial, especially while recovering from an acute injury or a surgery. However, the long-term use of opioid medications for chronic, noncancer, pain remains controversial. While a number of issues contribute to this controversy, the main reason for the controversy is addiction. Opioid pain medications are addictive.
This controversy makes opioid pain medications a highly sensitive issue for patients who take them.