Dependence versus Addiction

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The page below is a sample from the LabCE course The Toxicology Laboratory's Role in Pain Management: Testing for Opiates. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Dependence versus Addiction

Is everyone who needs opiates to help manage their pain addicted? Are all addicted people dependent?
The difference between addiction and dependency is important to note. Dependency refers simply to biological adaptation to a drug. Drug dependence means that a person needs a drug to function normally. Abruptly stopping the drug would lead to withdrawal symptoms in such a person. Many drugs elicit dependence, not just opiates.
Anyone who takes opiates for a moderate amount of time will become dependent. The drug becomes necessary for normal functioning. Increasing doses may also be needed due to the development of tolerance. Tolerance occurs due to the fact that opiate receptors will down-regulate (reduce their expression) or activity in response to chronic stimulation. As a result, it will take more drug to elicit the same effect over time.
Although all addicts have dependence, not all those with dependency are addicts. Addiction is a more dubious term. Addiction is the compulsive use of a substance, despite its negative or dangerous effects. Addiction is said to occur when a person continues to use a drug or even escalates the use of the drug in spite of the fact that it is causing social, physical, and economic harm to them and others.