I am replying to my own post.. good one haha

but if you had asthma .. and you needed that Ventolin puffer.. that is not addiction is it ?
its necessary

I agree and disagree with you. I work in ERand I also worked in an office. Every addict I ever met says that they have severe, uncontrolled pain. Providers can not judge if pain is real or not, but they can look at person's behavior and figure out the drug seeking behaviors.
One example would be - a 55 y o guy showed up vomiting and guarding his abdomen, doubled over and screaming. I took him ahead of others because he looked so terrible. As soon as he gets on the stretcher he says to me : " I know what it is and i need phenergan and morphin" and then he yelled and screamed that because he has done certain things in his life, he should not have to wait an hour for his medication. Then he refused to drink oral contrast for his CT. Until he got his morphine , he yelled and screamed and disrupted the flow of care for my patients.
After all was said done, can you guess what was wrong with him?
Nothing that needed phenergan and morphine.

Albuterol is a life sustaining treatment.. To medical community benzodiazepines and narcotics are comfort meds...
So we are basically screwed lol

http://en.wikipedia.org/wiki/Addiction

"Addiction is a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences.[7] It can be thought of as a disease or biological process leading to such behaviors.[1][8] The two properties that characterize all addictive stimuli are that they are (positively) reinforcing (i.e., they increase the likelihood that a person will seek repeated exposure to them) and intrinsically rewarding (i.e., they activate the brain's "reward pathways", and are therefore perceived as being something positive or desirable).[1][3][6] FosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions."

Which part of that applies to those in chronic pain?

Well, relieving the pain is "pleasant". Using the medications only helps a bit. No one gets sufficient medication to actually relieve all their pain. So that pleasant feeling is not a motivation for CP'ers.

The adverse consequences would be ending up back in pain. But Cp'ers are not using the medications such that it causes these adversities. Rather, CP'ers use the medications in order to function.

Dependence is what happens to CP'ers. That is adverse reactions when the meds are stopped. But that happens with heart meds, seizure meds, nerve meds, and psych meds. It is common when stopping other things too.

Great subject Sunny!

When the whole back/nerve thing took place with me and I ended up in hospital and was given enough drugs to knock out an elephant I was concerned. Well for the couple of hours that I was 'with it' I was concerned - that what happens if I become addicted to these medicines. I had never had so much morphine and various other strong drugs before. I didn't know if I was ever going to get better, what was wrong with me, will I be like this from now on, etc.

I worked hard in the hospital to convince the pain team that I didn't want to be taking medication if it was not of benefit. ie don't give it to me just to see if it works. only give it to me if you KNOW it will help me.

Today I am still working very hard to reduce my medication to a bare minimum, hopefully none at all. Hey dreams are free!

But I could not imagine what it would be like to 'need' a drug or drugs because you need the pleasure from it. As an addict would.

I don't want to lose control of my mind or body. And that is how I view addicts. They have somehow lost control over themselves. They may not have intended it but it happened.

Am I naive here? I cannot say I know many addicts.....so probably shouldn't comment on their state of mind.

For me, I just would be horrified to find myself in a position of where i require drugs to function (like now) only to be labelled a drug seeker when it is not the case. I have seen some peeps on here go through that sort of thing and my heart does go out to them. I cannot imagine anyone wanting to be in that situation.

Addiction and dependance are very similar, but the need for a high is what drives an addict.

When I was younger I became dependent on Afrin Nasal Spray. Sounds funny, but no so. I had to go on cortisone to get rid of the inflammation. It was not some floating on air event.

I have been on and off of different pain meds. Withdrawal is no fun, but when you have gotten through them, you do not crave what you have gone through withdrawal for. I take exception to Cigarettes, but again that is a fell good item just like alcohol, and addictive pain meds.

I was concerned about becoming addicted to some of the new meds that they have put me on. The doctor told me not to worry about addiction because I would have to be on these meds from now on.

Brightside found an excellent explanation of "addiction". It is the pleasure and the comfort that an addict craves. CP relief does not equal pleasure. To get your pain down to a manageable level is awesome, but when the pain never stops and it just gets level, that is not a euphoric state.

I wish the drug addicts would switch to alcohol or gambling. These people are making our lives miserable, and unbearable at times.

Sorry for the long post. I just get so frustrated at these fakes.

Addiction is psychological. Dependency is physical. You can be addicted and dependent. But, being dependent does not mean you're addicted.

some very good answers. I hope there will be more opinions and ideas.
I don't agree with everything that was said. but most of it I do.
and I did learn some new perspectives

I don't think I get any HIGH affect on anything I have ever taken.

it does make it harder for those of us who need pain medication sure.
but it does not mean I don't feel sad for those people either. it is an illness being addicted or co dependent.

I was like you Ness. I did not want synthetic morphine they kept giving it to me post op .. it just made me sleep half a day
I have a script for it here = for Pancreatitis attack. but I have not even filled it.

I will tell you about my experience in Emergecny TWO years ago.
I have had pancreatitis on and off. an attack once a year but they last a long time.

when I went in last time. they checked my heart first. and I was saying NO I know its not my heart. I have a VSD. that would be on my record but they are not linked to specialists reports due to privacy. Stupid idea I am happy for them to access all my files.
but my bloods were over the top for Pancreatitis. and the nurses were talking about me.. my gf was on that night.. they were saying GOSH LOOK AT THIS>> she must be an ALCHOHOLIC!!
I DONT DRINK .. and my gf saw my name and she said - she dose not drink. I know her.. SO be careful when you judge people coming into ER. of course I had CT scan and MRI.
next time I have path slip and medication and will go to public hospital not private. and be admitted by the specialist

I would prefer to be in no medication and have no illnesses also.
hahah. .DREAMS are free.
BEING SICK Is expensive .

Sunny

**, they increase the likelihood that a person will seek repeated exposure to them ** I liked this line.

Aronia your settings are set to private. so I don't know your diagnoses. sorry .. am I allowed to ask ?

YEah, I never found needing any medications "intrinsically rewarding".
And I don't know many who really enjoy the chronic pain doctor merry go round.

Check out my withdrawal post on the fibro board. I came off 7-8 meds at once. One med alone they say is worse than kicking herion!!

I lost 11 lbs. the first 6 days, and almost wanted to kill myself. May 10 will be one month. All I take now is my thyroid medicine, vitimins, a supplement or I switch off some tramadol (non narcotic), valium, ambien, tylenol pm or muscle relaxers. I have left over, never taking the same med twice, rotating them.

I agree an addict wants the high and a pain patient takes enough to make the pain lesser, not completely gone, but manageable. Not to say a pain patient can turn into an addict.

there can't be very many different "views" on this....addiction is addiction and dependence is dependence. they're completely different things. if your a chronic pain patient on narcotic or psych meds long term your going to be dependent on those meds and if you try to get off of them you will have to detox and go though withdrawals, it's just the way the brain and physiology work. your brain & body get used to having a substance every day, it thinks its supposed to have that substance every day, it gets very confused when that substance just stops being there.

as for ER's I don't think Dr.'s just take a look at someone and deems them a drug seeker or addict, but like Aronia said tests and symptoms can rule out a drug seeker and 9 times out of 10 they're usually spot on. are ER's different and do they treat patients different? sure, the ER I use is awesome, they know me, I'm there 2 - 3 times a month, as soon as I get in a room, which is pretty quick they ask me if I have my pain meds or do they need to get me some and they keep me comfortable the whole time I'm there, usually to the point of me declining meds. I have 6 different debilitating diseases, they know I'm not a drug seeker. It's normal for medical practices to be different, they adjust and adapt to the clientele they regularly treat as well as the general populous; some have to deal with addicts/drug seekers way more than others....does that make it right or fair, no, but fair isn't a realistic choice where life is concerned.

I just wanted to share the diagnostic criteria for Opioid Use Disorder (otherwise known as opiate abuse) from the DSM-V. This is how medical professionals define addiction.

"A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:

1. Opioids are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following (Note: this criterion is not considered to be met for those taking opioids solely under appropriate medical supervision) :
A. A need for markedly increased amounts of opioids to achieve intoxication or desired effect
B. A markedly diminished effect with continued use of the same amount of an opioid
11. Withdrawal, as manifested by either of the following (Note: this criterion is not considered to be met for those taking opioids solely under appropriate medical supervision):
A. The characteristic opioid withdrawal syndrome
B. Opioids are taken to relieve or avoid withdrawal symptoms"

(American Psychological Association DSM-V, 2013)

Okay so actually not all Benzo's are RX'd for Anxiety issues. They're often used in conjunction with other psych meds to complete the proper cocktail to manage BiPolar Disorder for those of us who have it, even though we don't have anxiety issues. As for the withdrawal always being horrific or hell...it depends on the person, their chemical makeup and how they tolerate the half life of the medication. Personally I can use Klonopin off and on and never have any withdrawal effects and have done so for 27 lovely BiPolar years....same with other benzo's I don't develop a tolerance to them and don't have withdrawals when I stop or change them.

Dependence, tolerance, detoxing and withdrawal are not "blanket" issues, they tend to be different for different people. I can also stop and start Morphine with no problems but had to detox and had horrific withdrawals from Percocet and Tramadol....you never know how you'll react until your in the thick of it.

Generally when detoxing from a medication it's never a good idea to start taking a different addictive substance to deal with it. It's just switching addiction for addiction.

I am prescribed Lorazapam { benzo } for the muscle spasms in my neck and shoulders. They will sometimes give me relief when nothing else will. I don't use them veryy often...
Luckily, never had to withdraw from them. I know it can be one of the more dangerous withdrawals.