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Editor's Correspondence |

Dependence Is Not Addiction and “Tolerance” Declares Addiction—Reply

Jane C. Ballantyne, MD, FRCA; Mark D. Sullivan, MD, PhD; Andrew Kolodny, MD
JAMA Intern Med. 2013;173(7):595-596. doi:10.1001/jamainternmed.2013.3207.
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It is true that the relationships between tolerance, dependence, and addiction are poorly understood, as they have been for decades. However, Dr Geller's portrayal does not help us to understand why opioid-treated pain patients dose escalate, lose control over their medication use, and die in alarming numbers.13

For example, he asserts that analgesic tolerance does not exist and that pain patients only dose escalate when they are addicted. If this were true we would have to conclude that all patients using high doses of opioids are addicted. He suggests that opioid dependence simply necessitates a taper and acceptance of withdrawal symptoms. Yet there are a lot of patients who find it very difficult to taper opioid use, even when they experience unsatisfactory analgesia. Finally, he asserts that work disability will remit for pain patients using opioids unless comorbid addiction is exposed. Pain patients treated with opioids are in fact less likely to be employed than those managing their pain by other means, and not because they are necessarily addicted.4,5

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Correspondence

April 8, 2013
Aaron S. Geller, MD
JAMA Intern Med. 2013;173(7):595-596. doi:10.1001/jamainternmed.2013.3045.
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