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Comment & Response
September 2016

Not All High-Dose Opioid Users Are Addicts

Author Affiliations
  • 1Accretive Health, Regulations and Education, Chicago, Illinois
JAMA Intern Med. 2016;176(9):1407. doi:10.1001/jamainternmed.2016.4118

To the Editor Dr Katz’s excellent summary of opioid prescribing for chronic pain1 in a recent issue of JAMA Internal Medicine hits the mark on all points and lays out a reasonable recommendation for physicians, but I disagree with his characterization of the patient who is on high-dose opioids as “addicted” and presents to his practice owing to insurance change, relocation, or other factors. The use of high-dose opioids does not indicate addiction. The National Institute of Drug Abuse defines drug addiction as “a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and changes in the brain, which can be long lasting.”2 The patient profile presented demonstrates none of those characteristics; in fact, many patients on high-dose opioids are on high-dose opioids solely because their physician prescribed them when they indicated that their pain was not controlled rather than offering adjunctive treatments. These patients are often very compliant with their treatment regimen knowing that the consequence of missing appointments, self-escalating their doses, or using other controlled substances is that they will be labeled an addict, and that label will follow them through all future encounters with the health care system, tainting the view of every physician they see.

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