Tramadol

"Charlie Wilkes" wrote in message
news

I question whether many people can become physically dependent on
narcotics without also developing a psychological craving.

Any person who uses opioids for more than a short time is going to become
physically dependent. This is just how the body operates and that is why
stopping opioids abruptly will result in withdrawal symptoms, but this is a
physiological reaction, not a psychological reaction. In some instances,
people do develop a psychological craving, and that's when they would be
considered "addicted," and start displaying the behaviors I previously
described, things like:

1. They start increasing their dose of medications without asking the
doctor, then they run out of medication before it is time for a legitimate
refill.
2. They will claim that their medications have been lost or stolen and they
need a refill.
3. They will try to obtain prescriptions from multiple doctors or seek
drugs illegally.
4. They will routinely show up at hospital emergency rooms in the hopes of
getting narcotic meds, etc.

Most of the time, the above doesn't happen. Most of the people who receive
prescriptions for opioid pain meds (including methadone which has a
legitimate use as a medication for chronic pain) take only the prescribed
dose, in accordance with the doctor's instructions, and do not request early
refills on their meds or increase the amount their taking. They do not
develop a psychological craving and are able to easily wean off the
medication if it becomes ineffective or if they want to switch to
non-narcotic medications, or they start having side effects or whatever
reason. There are a number of people who suffer from chronic pain syndromes,
and for some people, narcotic medications are the only meds that relieve
that pain. Typically, they are prescribed these opioids at the pain clinic.
Once they are stabilized on a certain dose, they are discharged back to
their primary care physicians who take over prescription writing for that
particular dose. Oftentimes, the patients are prescribed other non-narcotic
medications called "adjuvants" that help to boost the effectiveness of the
pain meds so that they can keep the doses of the opioids to a minimum.

But, I don't
know. My reason for challenging you was your use of the term
"tolerance," which doesn't square with my understanding, i.e., "drug
tolerance occurs when a subject's reaction to a psychopharmaceutical
drug... decreases so that larger doses are required to achieve the same
effect." (http://en.wikipedia.org/wiki/Drug_tolerance)


Now, I see. The above statement is the definition of "drug addiction" NOT
"drug tolerance." Many chronic pain patients stay on the same dose of
opioids for years. If the opioid starts to lose effectiveness, this can
usually be resolved by doing an "opioid rotation" to a different opioid (but
at an equivalent dose) or adding an adjuvant medication. In general,
Wikipedia is not a reliable source for information. The accuracy of
Wikipedia is hit-or-miss (on any given topic).
Best regards,
---Cindy S.