Opioid Use Disorder

What is addiction?

In 2013 the Diagnostic & Statistical Manual of Mental Disorders replaced the term for opioid addiction with opioid use disorder. It is defined as a psychological and behavioral dependence on drugs characterized by compulsive and continued drug use regardless of harmful consequences, even death. The key words in that definition are psychological and behavioral dependence.

Patients who are being treated in a palliative care program have a small risk of becoming addicted. Opioids are only one of the many medications and therapies available to treat and control pain. The palliative care physician is extremely knowledgeable regarding the medications, how they work on reducing pain and how they can effect the patient. Relieving pain reduces the possibility of addiction.

The addiction risk to opioids that are prescribed for pain relief is real but it is small and can be avoided. As a caregiver, you are in the best position to make certain that the risk to your loved one is minimal.

  • Be compliant. Follow the physician’s orders regarding prescription opioid medications. Take the prescribed dosage at the designated intervals. More medication does not mean greater pain relief.
  • Your loved one should share and discuss with the physician any personal or family history of substance abuse, including alcohol, tobacco (yes, smoking is considered an addictive behavior) and drugs.
  • Developing a tolerance to opioid medication is normal but you and your loved one should discuss any concerns with your physician if it becomes troubling to either one of you.

Tolerance and Physical Dependence


Tolerance is the reduced effectiveness of a given dose of medication over time. This occurs when the original dosage of a substance loses its effectiveness. Higher doses are then needed to achieve the same level of pain relief. Patients taking opioids for a long period of time for cancer or chronic pain may develop a tolerance to the opioid being taken and even develop a physical dependence. It does not mean that the patient is addicted.

Physical dependence

Taking opioids for an extended period of time may lead to a chronic physical need for the drug. If the opioid is suddenly stopped, withdrawal symptoms will occur.

  • nausea
  • sweating
  • chills
  • diarrhea
  • shaking

These symptoms are not life threatening. But your loved one should never abruptly stop taking an opioid medication. Always consult with the physician before stopping any medication.

Physical dependence on opioid medications may be compared to a diabetic patient’s need for insulin. Both are needed to function and maintain an improved quality of life.

Signs of addiction

Even with the minimal risk of addiction to palliative care patients, as a caregiver you should always be aware of the signs of possible addiction.

  • Taking prescription medications is having a negative effect on your loved one’s job, family life and daily activities.
  • Using a drug even if it is causing bodily harm or changing your loved one’s behavior.
  • Taking larger amounts of a drug than is prescribed. Non-compliance would signal a possible problem. If your loved one is taking more medication than is being prescribed and at more frequent intervals than recommended, you should contact your physician immediately. Your loved one may need an increase in dosage or different medication to achieve pain relief. But your physician needs to know in order to help.

Patients who are prescribed opioids by their palliative care physician rarely become addicted even with long-term therapy. Tolerance and physical dependence may develop but they are not signs of addiction. Through pain management in a palliative care program your loved one may experience pain relief and improved quality of life with manageable side effects and without addiction.