Mistaking Legitimate Users for Drug Misusers

There are several situations in which legitimate narcotics users can be misidentified as drug misusers, including the following:

• Pseudoaddiction: Patients whose pain is undertreated may exhibit drug-seeking behaviors ("doctor shopping," etc.) in an attempt to gather enough medication to effectively relieve their pain. Since these behaviors are also common among drug-abusing patients, researchers and doctors can interpret these behaviors as addiction. However, pseudoaddicted patients legitimately need more analgesics to adequately treat their pain, and their behavior will stop once their pain is adequately treated (Robinson et al., 2001; Zacny et al., 2003).

• Therapeutic Dependence: Some pain patients are concerned about losing or interrupting access to their pain medication (e.g., by losing or changing medical insurance, changing doctors). These patients may try to create an emergency supply of medication -- a behavior that, again, can cause these legitimate users to be mistaken for drug misusers (Zacny et al., 2003).

• Confusion Over Terminology: Almost all patients who take opioids for more than a short period of time will develop both tolerance and physical dependence for the drug and will go through withdrawal if they stop taking it. This phenomenon is sometimes erroneously confused with being addicted to prescription opioids (SAMHSA, 2001d). Addiction (or opioid dependence, to be more precise) is characterized by drug cravings and a high likelihood of relapse to opioid misuse; most studies show that almost all legitimate prescription opioid users with no history of substance use disorder can stop taking opioids without craving or risk of relapse once their course of treatment is complete (NIDA, 2000).