Issues of addiction in opioid therapy

B. L. Wilsey, Scott M Fishman

Research output: Contribution to journalArticlepeer-review


National surveys of members of Boards of Medical Examiners revealed a prevalent belief that any physician who prescribed opioids for a period in excess of 6 months to a patient with non-malignant pain should undergo investigation. Such pronouncements have had a 'chiling effect' on opioid prescribing and have been a disservice to those who might otherwise have benefitted from this form of therapy. Treatment with opioids should emphasize improvement in functionality to assuage the critics of this form of therapy. Treating chronic pain with opioids is difficult, in part because of its potential for adverse effects related to addiction. Unfortunately, excessive fears of this adversity can be a substantial barrier to effective therapy. There are many tools and strategies that can make such therapies less risky and more efficacious. These include contracting, urine toxicology screens and using functionality as the main treatment goal. Pain is an inherently subjective experience and treating it poses the difficulty of monitoring treatment responses without being able to observe objective proof. Thus, treatment of chronic pain should focus primarily on objective signs of functional improvement. In direct contradistinction, addiction is marked by objective signs of dysfunction. Thus, efficacy from treating chronic pain with opioids produces improved function while addiction does not. After treatment has begun, patients suffering addiction may take increasing amounts of abusable drugs while patients with effective pain control tend to find a stable dose. A practitioner should learn to utilize functionality to differentiate the patient from the 'addict'. Improvement in functionality is a more objective means of determining the effect of opioids in chronic pain patients. Consequently, one does not have to pursue a goal that may be unattainable (analgesia). Additionally, it introduces goal setting (improvement in activities of daily living) as an outcome that, in and of itself, is desirable in the chronic pain population.

Original languageEnglish (US)
Pages (from-to)71-84
Number of pages14
JournalProgress in Anesthesiology
Issue number5
StatePublished - 2000

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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