What Is Pseudoaddiction?
Key Takeaways
- Pseudoaddiction resembles addiction symptoms, often linked to painkillers - Jump to Section
- Signs include escalating need and risky behaviors to obtain pain medication - Jump to Section
- Differentiating requires doctors' judgment; prolonged drug craving can be a red flag - Jump to Section
- Treatment involves trust, alternative pain management, and careful patient evaluation - Jump to Section
- Recognizing pseudoaddiction is vital due to its potential link to the opioid crisis - Jump to Section
What is Pseudoaddiction?
Pseudoaddiction refers to a condition that mimics addiction symptoms, often among those using prescription painkillers. The term "pseudo" comes from Latin, meaning "fake" or "not real."
It can be challenging for medical professionals to distinguish between genuine undertreatment of pain and addiction. If those with pain don't receive adequate opioid therapy, they may exhibit drug-seeking behaviors.
Healthcare providers could mistake this for addiction and classify as pseudoaddiction. Although certain people may be at higher risk of developing opioid addiction, it can potentially affect anyone.
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What are the Signs of Pseudoaddiction?
The signs of pseudoaddiction are similar to the symptoms of drug addiction, including:
- Feeling a need to take the pain medication
- Asking for more and more of the pain medicine
- Taking larger amounts of the pain treatment
- Maintaining a 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
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How to Differentiate Pseudoaddiction from Addiction
Differentiating between pseudoaddiction and addiction can be challenging as they exhibit similar symptoms. Some may display a craving for painkillers, which can stem from either a genuine need for pain relief or a desire to satisfy addiction.
To navigate this challenge, healthcare professionals look for specific signs. One red flag is a person's persistent request for painkillers long after a surgical procedure or injury, which typically shouldn't require prolonged medication.
In these situations, medical professionals use their clinical expertise and judgment. They evaluate your medical history, current condition, and risk factors for addiction to determine if your requests stem from unmanaged pain (pseudoaddiction) or addictive behaviors.
Can Pseudoaddiction Turn into Addiction?
Yes, as opioids are highly addictive. If you keep using painkillers to treat pain, you can become dependent even long after your pain has subsided.
Around the world, millions of people have experienced or are currently dealing with opioid use disorder (OUD).1 In the United States alone, there are over 3 million affected people, with more than half a million dependent on heroin.1
Opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019.2 However, there were 68,630 in 2020, which increased to 80,411 increase in 2021.2
How to Treat Pseudoaddiction
Pseudoaddiction treatment involves building trust between doctors and patients. People should believe their caregivers are committed to recognizing and treating their pain, reducing the need for unsafe methods.
Treatment for pseudoaddiction is similar to addiction management. The focus is on gradually reducing medication dependence and introducing alternative pain management methods.
In terms of alternative pain management:
- For terminal patients: Palliative care can address physical, emotional, and psychological pain instead of relying solely on opioids.
- For chronic pain sufferers: A structured physical therapy can provide significant relief.
- For post-surgical pain: After surgeries like wisdom tooth extractions, over-the-counter pain relievers like aspirin or ibuprofen may suffice, avoiding the risks of stronger medications.
Possible Consequences of Neglecting Treatment for Pseudoaddiction
Neglecting treatment for pseudoaddiction can lead to consequences:
- Worsening pain: Someone's untreated pain may intensify, potentially escalating into chronic pain that's harder to manage and treat.
- Health complications: Chronic pain can contribute to a range of other health issues, including significant physical and mental stress.
- Risk of addiction: Failing to address pseudoaddiction can lead to the development of a true addiction. People might start self-medicating and taking unsupervised higher doses of painkillers, leading to uncontrolled drug use.
- Loss of trust in healthcare: People may disengage from seeking professional medical advice, creating detachment that makes them more vulnerable to addiction.
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Why is it Important to Acknowledge Pseudoaddiction?
It’s essential to talk about the concept of pseudoaddiction because it plays a role in the opioid crisis. Between 21 and 29 percent of people who are prescribed opioids for chronic pain misuse them.3
Opioid-related deaths are currently the deadliest drug epidemic in the U.S. In 2015, the Centers for Disease Control and Prevention reported an increase to 7.0 deaths per 100,000 people due to opioid analgesics.4
Substance abuse also affects over 20 million people.4 Substance use disorders involve opioids, methamphetamines, and alcohol.
The History of Pseudoaddiction
Weissman and Haddox coined the term pseudoaddiction in 1989. It was a reference for those who had under-treated pain.
They described pseudoaddiction as an iatrogenic syndrome that's an illness that medical treatment or intervention caused. In the case of pseudoaddiction, harm is due to withholding treatment or a lack of intervention.
Researchers first suggested that people with pseudoaddictions go through three phases:
- Stimulus: They receive inadequate treatment for their pain, so they ask for more.
- Escalation: They realize that they have to convince their doctor that their pain is legitimate to receive more medication.
- Crisis: Their pain persists without treatment, and they engage in drug-seeking behaviors. This creates distrust between the clinicians and them.
Is Pseudoaddiction Fact or Fiction?
There's plenty of research on pseudoaddiction, and more is underway. However, there's no evidence to support that a pseudoaddiction is clinically diagnosable.5 There isn't any evidence of objective signs or specific pseudoaddiction treatment plans.
It’s still hard to say whether someone's dealing with undertreatment of their pain or opiate abuse. Either way, doctors need to take pseudoaddiction and addiction seriously.
Summary
Pseudoaddiction is a controversial concept that describes behavior that resembles addiction but stems from untreated pain. It's crucial to acknowledge it as part of the opioid epidemic and find ways to treat it effectively.
By understanding pseudoaddiction, we can help prevent the worsening of chronic pain, health complications, and potential addiction. Despite its controversy, seek professional help if you or a loved one is struggling with untreated pain and potential pseudoaddiction.
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- Azadfard et al. "Opioid Addiction." StatPearls Publishing, 2023.
- "Drug Overdose Death Rates." National Institute on Drug Abuse, 2023.
- Oelhaf et al. "Opioid Toxicity." StatPearls Publishing, 2023.
- Dydyk et al. "Opioid Use Disorder." StatPearls Publishing, 2023.
- Greene et al. "Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature." Current Addiction Reports, 2015.
- “Opioid Crisis Statistics.” U.S. Department of Health and Human Services, 2022.
- “Drug addiction (substance use sisorder).” Mayo Clinic, 2022.
- Passik et al. “Pseudoaddiction Revisited: a Commentary on Clinical and Historical Considerations.” Pain Management, 2011.
- Weissman et al. “Pseudoaddiction.” Palliative Care Network of Wisconsin.
- Vowles et al. “Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.” Pain, 2015).
- "Prescription opioid use is a risk factor for heroin use." National Institute on Drug Abuse, 2015.
