Fear of Addiction

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Policy-Makers
Regulatory Agencies
Mass Media
Patients
Fear of Addiction
GPs Medical Specialists
Pharmacists
Medical Educational Institutions
World Health Organization
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Terminological Confusion

ABUSE ADDICTION DEPENDENCE
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Confusion No.1
Drug laws prohibit DEPENDENCE No! They exist
to prevent DRUG ABUSE
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What is Drug Abuse?
DRUG ABUSE Excessive Non-Medical
Use Medical use, whether it results in
dependence or not, is NOT Abuse

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Confusion No.2
Habituation Addiction Dependence DEPENDE
NCE ADDICTION

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No! Dependence is NOT Addiction !

Dependence Carries no connotation of the degree
of risk to public health or need for a particular
type of drug control ADDICTION Drug Abuse by
Dependent-Users
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Confusion No.3


Withdrawal -gt Physical dependence Physical
dependence Dependence WITHDRAWAL
DEPENDENCE
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No! Withdrawal is NOT Dependence!
WITHDRAWAL is only one of the 3 requirements
for DRUG DEPENDENCE
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Definition of Dependence
A need for repeated doses of the drug to feel
good or to avoid feeling bad (Lexicon) A
cluster of physiological, hebavioural and
cognitive phenomenon in which the use of a
psychoactive substance or a class of substances
takes on a much higher priority for a given
individual than other behavjours that once had
greater value (Exp. Committee)
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ICD-10 Guidelines

• DEPENDENCE SYNDROME
• Three or more of the following have been
  experienced at some time during the previous
  year

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Six symptoms of Dependence
(a) strong desire/sense of compulsion to take the
drug (b) difficulty in controlling drug-taking
behaviour (c) physiological withdrawal
state (d) tolerance (e) neglect of alternative
interests (f) persistent use despite trouble
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Confusion No. 4
Repeated use develops dependence No ! It may,
but not always. Cancer patients rarely develop
dependence.
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WHY SO RARE???
They do not feel opiate euphoria They
can take withdrawal discomfort much better than
others They are under medical supervision
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Drug Dependence in ADR database
Butorphanol 570 Nicotine resin 515 Diazepam
462 Alprazolam 376 Lorazepam 278 Tramadol
236 Flunitrazepam 201 Methadone 46 Codeine
34 Morphine 24
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Withdrawal Syndrome in ADR database
Paroxetine 1,644 Alprazolam 799 Hyoscine
503 Venlafoxine 464 Sertraline 430 Fluoxetine
343 Methadone 292 Tramadol 222 Morphine
19 Pethidine 11
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CONCLUSIONS
BENEFIT gtgtgt RISK Dependence is one of the
common Adverse Drug Reactions. It rarely occurs
in cancer patients receiving opioid
analgesics. If it ever occurs, it can be managed
by gradual dose reduction.