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What is Pseudoaddiction?

A pseudoaddiction mimics the symptoms of addiction. 

Whether a pseudoaddiction is a fake addiction or real addiction is largely up for debate. After all, the prefix “pseudo” comes from Latin and means “fake” or “not real.” 

Pseudoaddictions are clinically complicated. This is because it’s difficult for doctors to tell when a patient is genuinely undertreated and needs more pain medication and when they are abusing them.

Patients with legitimate pain can alleviate that pain with a prescription drug. But, if they don’t get enough opioid therapy to assuage discomfort, they may exhibit drug-seeking behaviors that can be mistaken for true addiction. This would be a pseudoaddiction.

But it’s tough to tell the difference in patients. While some patients are at a higher risk of developing a real opioid addiction than others, it can happen to anyone.

The History of Pseudoaddiction

The term pseudoaddiction was coined in 1989 by Weissman and Haddox in reference to patients who had under-treated pain. They described pseudoaddiction as an iatrogenic syndrome because iatrogenic refers to an illness caused by medical treatment or intervention. 

However, in the case of a pseudoaddiction, harm is caused from withholding treatment or a lack of intervention.

The researchers first suggested that patients with pseudoaddictions go through three phases:

  1. Stimulus. They receive inadequate treatment for their pain, so they ask for more.
  2. Escalation. They realize that they have to convince their doctor that their pain is legitimate in order to receive more medication.
  3. Crisis. Their pain persists without treatment, so they engage in bizarre drug-seeking behaviors. This creates distrust between the clinicians and patients.

While pseudoaddiction was only identified in the late 80s, it has been around much longer. For as long as doctors have been prescribing the use of opioids, patients have been suffering from pseudoaddictions.

Is Pseudoaddiction Fact or Fiction?

There is ample research on pseudoaddiction, and more research is being done. But the concept has not yet been empirically verified. There is no evidence to support that a pseudoaddiction is clinically diagnosable. There is not any evidence of objective signs or specific treatment plans for pseudoaddictions either.

It’s still hard to say whether a patient is dealing with undertreatment of the patient’s pain or opiate abuse. Either way, it’s important for doctors to take pseudoaddiction and addiction both seriously.

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What are the Signs of Pseudoaddiction?

The signs of pseudoaddiction are very much like the signs of drug addiction. They include, but are not limited to, the following:

  • Feeling a need to take the pain medication
  • Asking for more and more of the pain medicine
  • Taking larger and larger amounts of the pain treatment 
  • Maintaining a convenient supply of the medication
  • Spending a lot of money on the drugs
  • Using the drug despite some side effects it may have
  • Engaging in risky behaviors to obtain the pain medication
  • Deteriorating mental health without the medication

Why is it Important to Acknowledge Pseudoaddiction?

It’s important to talk about the concept of pseudoaddiction because it plays a role in the opioid crisis. Between 21 and 29 percent of patients who are prescribed opioids for chronic pain misuse them.

And addiction doesn’t just stop at opioids. An estimated four to six percent of people who abuse prescription opioids start using heroin. In fact, about 80 percent of people who use heroin have misused prescription opioids before. Many carry on with other forms of substance use or misuse and dangerous drug use.

An opioid pseudoaddiction can be mistaken for addiction. But it can also lead to addiction. If patients are undertreated, they may seek out opioids in alternative ways, which can be dangerous. Doctors need to be able to assess their patient’s mental health and real reasons for seeking higher doses.

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How to Differentiate Pseudoaddiction from Addiction

Pseudoaddiction and addiction both produce similar symptoms. For example, a patient may show a craving for painkillers. While some may be seeking out the drugs for pain relief, others may be seeking them out to feed their addictions. It can be hard to tell the difference, and doctors need to use their best judgment.

If someone is seeking pain medication for a surgery or procedure that was done weeks ago, it can be a red flag. 

For example, if the general downtime is three to five days, and they’re still seeking painkillers weeks or months later, this might be a sign of addiction. But if it’s day two and the relief just isn’t cutting it, they may really just need more medicine or a different type of treatment.

Ultimately, doctors have to use their discretion to tell when a patient is reaching out because they genuinely need more pain management. 

Can Pseudoaddiction Turn into Addiction?

Yes, pseudoaddiction can turn into addiction. The reality is that opioids are very addictive. So if a patient keeps using painkillers to treat pain, they can grow dependent upon them. They may start to seek them out even long after their pain has subsided.

Between 8 and 12 percent of people who use opioids to treat chronic pain develop an opioid use disorder. Even though painkillers are prescribed, they can still lead to addictions.

Addiction is dangerous for obvious reasons. Drug addiction takes a toll on abusers’ mental and physical health. Worse, an addiction can be deadly.

Nearly 841,000 people have lost their lives from a drug overdose since 1999. And two out of three drug overdose deaths in 2018 alone involved an opioid.

How to Treat Pseudoaddiction

It’s important for doctors to create cultures of trust in their medical establishments. They need their patients to trust that they have their best interests in mind.

Patients need to feel like their caregivers believe their pain is real. They need to know that all their doctors are trying their best to control the pain. If they can feel confident in that, they’re less likely to start seeking out painkillers in dangerous ways.

Treating a pseudoaddiction can be like treating an addiction. Patients may need to wean off of the drug that they are taking. Instead, they may be prescribed other courses of treatment to help them manage their pain.

For example, terminal patients who need some form of pain management may benefit from opioids. But they also may be better off with palliative care. People who are dealing with chronic pain or are recovering from surgery may have other options, too.

Someone with chronic back pain may be better off with physical therapy. And a patient who is recovering from wisdom tooth extraction surgery may do just fine with over-the-counter medications like aspirin or ibuprofen.

Possible Consequences of Neglecting Treatment for Pseudoaddiction

If a patient goes undertreated, their pain can get worse. Sometimes, chronic pain can lead to other health issues. The stress alone from chronic pain can take a toll on their physical and mental health.

If doctors do not treat pseudoaddiction, there’s a chance that it can transform into addiction down the line. It’s dangerous for patients to start seeking out more and more painkillers to manage their pain on their own. Without a doctor who can safely and slowly increase their dosage, they can go off the rails.

Similarly, if a patient loses trust for their healthcare professionals, they will be less likely to engage with them. A lack of trusted medical support can create an environment in which a patient may be more susceptible to addiction.

Patients may simply be better off with other types of pain control like physical therapy or over-the-counter medicines that aren’t addictive. That’s why it’s important for health care providers to assess each patient and gain a clear understanding of why they are seeking out more opioids — for pain relief or addiction.

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Resources

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(DCD), Digital Communications Division. “Opioid Crisis Statistics.” HHS.gov, Https://Plus.google.com/+HHS, www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html.

“Drug Addiction (Substance Use Disorder).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Oct. 2017, www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112.

Greene, Marion S, and R Andrew Chambers. “Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature.” Current Addiction Reports, Springer International Publishing, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4628053/#CR42.

Passik, Steven D, et al. “Pseudoaddiction Revisited: a Commentary on Clinical and Historical Considerations.” Pain Management, 5 May 2011, www.futuremedicine.com/doi/abs/10.2217/pmt.11.12.

PDF, Pseudoaddiction David E Weissman MD Download. “Pseudoaddiction.” Palliative Care Network of Wisconsin, www.mypcnow.org/fast-fact/pseudoaddiction/.

Puget Sound Veterans Affairs Health Care System; Seattle. “Opiate Abuse or Undertreatment? : The Clinical Journal of Pain.” LWW, journals.lww.com/clinicalpain/Citation/1998/03000/Opiate_Abuse_or_Undertreatment_.20.aspx.

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