SAN FRANCISCO – Talking to elderly patients with chronic pain about the differences between addiction, dependence, and tolerance of drugs may help them overcome some fears about using opioids, Kathryn Healey Keller, Pharm.D., said at a joint conference of the American Society on Aging and the National Council on the Aging.
Treatment with opioids is becoming more acceptable for persistent noncancer pain, despite the common fear of addiction, especially among older patients, said Dr. Keller of the University of California, San Francisco, and a medical liaison for Purdue Pharma LP, a pharmaceutical company that specializes in pain medications.
She recommended explaining to patients that physical dependence is inevitable with continuous exposure to opioids because of the characteristics of these drugs, but this is not the same as addiction and “it's not a moral, personal issue,” she said.
Give examples of other drugs that cause dependence with chronic use, such as prednisone or clonidine, she suggested.
Tell patients that dependence means they will have a rebound or withdrawal reaction if they stop taking any of these drugs, and alert them to the potential consequences if they stop opioid use suddenly.
Tolerance to a drug means that patients need more of the drug to maintain the same level of response. Coffee is a good example–people need to drink more of it over time to maintain the same caffeine buzz. Tolerance to opioids is slow to develop when treating stable disease, Dr. Keller noted.
Addiction is a neurobiologic disease involving a genetic predisposition and environmental factors that promote addiction. She said that patients who fear they're becoming addicted to opioids can consider “the four Cs” that help define addiction: Compulsive use, lack of Control, Craving for the drug, and Continued use despite harm to oneself or others.
Properly managed patients on opioids rarely become addicted. Chronic pain can be treated successfully even in patients addicted to opioids if they have the stable support of family and pharmacists, Dr. Keller said.
She recommended that physicians consult guidelines produced by the American Geriatrics Society Panel on Persistent Pain in Older Persons (J. Am. Geriatr. Soc. 2002;50[suppl.]:S205–24), which contain information on nonopioid analgesics, opioid options, and more.