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Editor's Correspondence
April 8, 2013

Dependence Is Not Addiction and “Tolerance” Declares Addiction

Author Affiliations

Author Affiliations: Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts, and Nashua Pain Management Corp, Nashua, New Hampshire.

JAMA Intern Med. 2013;173(7):595-596. doi:10.1001/jamainternmed.2013.3045

Ballantyne et al1 accurately reported opioid dependence reflecting non –life-threatening withdrawal symptoms but fundamentally mischaracterized associations between dependence, tolerance, and addiction.

Abrupt termination of opioid use simply precipitates withdrawal nausea. As such, dependence on continued opioid consumption does not necessitate any treatment. However, if opioid access is terminated, then dependence requires gradual taper to avoid nausea in addition to acceptance that previously suppressed pain will return with consequential increased effort to continue functional full-time work.