Differences Between a Pain Patient and an Addicted Patient

Pair Patient

Addicted Patient

Not out of control with medications

Out of control with medications

Medications improve quality of life

Medications cause decreased quality of life

Will want to decrease medication if side effects are present

Medication continues or increases despite side effects

Concern about the physical problem

Unaware or in denial about any problems

Follows the agreement for the use or the opioids

Does noL follow the agreement Tor use of the opioids

Frequently has medicines left over

Does not have medicines left over, loses prescriptions, and always has a "story"

Figure 2 Differences between a pain patient and an addicted patient. Source: From Ref. 28.

Figure 2 Differences between a pain patient and an addicted patient. Source: From Ref. 28.

The terms "modified release'' and "long acting'' are often used interchangeably when referring to the opioid class of drugs. This has caused some confusion, especially when considering the pharmacologic characteristics of these medications. In fact, there are relatively few truly long-acting opioids available for clinical use, such as methadone and buprenorphine.

Opioids may be divided into short-acting and long-acting agents. The short-acting group may be further divided into immediate release and modified release. It is important to note that at the receptor level, the drug remains the same in both preparations. The primary effect of the modified-release system is to reach and maintain steady levels of the parent molecule. This becomes extremely important when comparing risk of misuse of various forms of the same drug. These comparisons rely on the delivery system used to modify the rate of release of drug remaining intact. Given that with sufficient time and determination, all clever delivery systems can be defeated, some more easily than others, it is important not to lose sight of the intrinsic abuse liability of the parent molecule.

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