Addiction versus Dependence

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Regular Member

Date Joined Mar 2007
Total Posts : 161
   Posted 8/23/2009 3:23 PM (GMT -6)   
Hello all.  I hope you all are doing well.  I had been running out of my meds early for about 4 months and had to keep calling the PM docs office to get in early.  I was on Oxycontin and b/t oxycodone.  I was embarrased.  The people at the docs office were kind of upset.  I dont blame them.  My PM doc was upset to.  I thought I had become addicted to the medicine and was abusing them.  I went in to my appointment this last month and told my doc everything.  I told him I thought I was addicted to my medicine and maybe abusing them because I kept running out.  I thought maybe I should check myself in somewhere.  He said we could get me off of the oxycontin and try methadone.  The reason for this is I was soooooooooooo concerned about the pain.  What do I do?  When I am not on the meds I am in constant pain.  I have been on the methadone now for about a week and have realized after alot of reading online and observing my ownbehavior and actions that I was never addicted to oxycontin.  I was dependent on it.  It was my body that had developed this.  I never took my medicine to get a buzz or get high.  I kept telling myself that I was becoming addicted because I ran out early for several months.  I was dosed the oxycontin 3 times a day.  When I started taking oxycontin 4 yrs ago I would take them and they would last 12hrs.  I was changed 2 yrs in to every 8 hrs.  Recently I take one and about 4-5 hours in my body would start to go through withdrawals.  I did not want the meds to get high I wanted them to avoid withdrawals.  I think I was telling myself I was becoming addicted because of what we PM patients go through daily with what society has labeled us.  I have another appointment this week and am going to let my doc know what I have discovered about myself.  As far as the pain goes and my new medicine,,,, I would have to say the oxcontin is better for controlling the pain.  The methadone lasts longer.  I do not find myself going through withdrawals like I did with the oxycontin.  A problem I am having is the methadone does not take care of the pain as the oxycontin did.  I think I would be fine if I could continue taking oxycodone for b/t.  The only problem there is my PM doc says you dont need any b/t meds with the methadone as he thinks you dont need them.  So my issue is this:  The methadone last longer but does not cover the pain like the oxycontin.  Like I said I think I could manage with a b/t med with the methadone but the doc said I dont need it.  Please, any of you give me some pointers or opinions on what I should do.  Keep in mind I can talk to my doc openly and honestly, he listens.  Hes not the nicest guy in the world but I can talk and he will listen.  What should I do.   I hate that fact that I have found exactly what controls my pain but in is in 2 different medications. 
THank you all

Veteran Member

Date Joined Nov 2007
Total Posts : 6795
   Posted 8/23/2009 4:01 PM (GMT -6)   
Hi, Shaw,
First, there's so much misinformation about the difference between addiction, dependence and tolerance it's mind-boggling. That being said, your body was obviously developing a tolerance - which means you need more and more of a medication to achieve the same result. Not everyone will develop a tolerance, but most all of us who take narcotics (and many other medications) will become physically dependent on them.

When you start taking more than was prescribed, that's a sign that you need to consider addiction. Mind you, I said consider. One important factor is genetics. If there is any family history of addiction to any type of substance - be it alcohol, drugs or similar substances - you may have a genetic predisposition. That's something none of us can control, and is one of the main factors that can lead to addiction, even in a person who has never before taken any of these medications or had a drink of alcohol. It's not something you can control. So if that happens to be the case there are some choices; one is to work closely with your doctor to find whatever combinations of medications work to manage your pain - and stick religiously to the dose as prescribed. The other is to switch to something such as methadone, which is increasingly being used for pain, and can be beneficial for many. But it needs to be started at very small doses, and increased slowly because of the way methadone operates (there are some old threads here with some good information, and maybe you can try to search for some - but some have inaccurate info, too!). So the methadone may not yet be covering your pain because your doctor may be doing what is needed - a slow start and increase.

Since you have a good relationship with your doctor, I would suggest an honest discussion about how you were taking your oxycontin and oxycodone, the development of tolerance (and how rapidly or slowly that occurred in your case), and what he/she thinks about options. My hunch is you were switched to methadone because the doctor saw you increasing your doses too fast (in other words, your body's tolerance increasing too rapidly).

There is a reason why BT meds are generally not prescribed with methadone and that has to do with the way methadone works in the body. Ask your doctor to explain it, and if you're going to stay on methadone, you need to learn a lot about it. It has a long half life, and therefore stays in your body a long time, and sometimes people end up taking other medications when they still have more methadone than they realize in their system, and an accidental overdose can happen.

You may not have been formally addicted yet, but your doctor may have seen the signs that you were headed in that direction. You have really picked them up for yourself, and it's better to catch it early and change course, then let it worsen over time so that you are abusing your medications.

Have a good discussion with your doctor. List your questions and take them in with you.

Hope this helps a bit!

Good luck!


Regular Member

Date Joined May 2008
Total Posts : 177
   Posted 8/23/2009 5:53 PM (GMT -6)   
PAlady summed it up pretty neatly. I won't wory too much about it, whatever you call it, you nipped it in the bud.

Personnaly, I use the following criteria for myself to determine whether or not I'm on the path tp addiction. If I take more medication than I need to perform a certain task, I'm on the path to addiction. Of course the amount of medication depends on the task. For example, if I need to take out the trash (a round trip of some 750 feet), I need to take additional medication or I'm physically not able to wheel the trashcan out. Afterwards I still feel like hell o.f course. If I take some more medication once the trash is out to deal with the additional pain, though the task is done, I consider that to be on the wrong path. This is of course a very personal interpretation but it kept me from serious intoxication. In the old days I took whatever my doctors prescribed and that was usually too much. Of course, extreme situations might require extreme measures. During the 2001 War, I had to walk an a crushed ankle for three months (my cast came off on Friday, September 7th and I should have remained in a wheelchair for three more months). Wednesday the 12th my ankle tossed in the towel. War situations being what they are, I continued but was heavily medicated of course. Apart from such extremes I'd stick to simple rules you have to decide for your self, in accordance with your doctor if you feel that's better.

And don't worry about having to take two different meds to combat the pain most effectively. Better to take two different ones with good results than one with mediocre results. I think most of us here take more than one.

Take care.
To stand and be still at the Birkenhead Drill is a mighty bullet to shew.

Regular Member

Date Joined Mar 2007
Total Posts : 161
   Posted 8/23/2009 7:12 PM (GMT -6)   
Thanks for all feedback.  I would like to say that I really do not think I had an addiction issue as I first thought.  I had been on these meds for 4 yrs and no problems.  I really think I was having tolerence and dependence issues because my body seemed to start going through withdrawals 4-5 hrs after my long acting dose.  I am not saying it was not addiction but I am thinking it had more to do with tolerence.  I really do appreciate all of your feed back.  It is hard because I know i need these meds to control my pain.  Also, PALady said methadone maybe should be taken alone.  What then should I do if I have breakthrough pain or if the methadone does not cover the pain and I know that the oxycodone works well.  You can understand why I am in a bit of a pickle.  The methadone does not cover the pain as well but last long and the oxycontin covers the pain better and does not last as long.  I have found that taking the methadone with the oxycodone works very well but from what I understand they cannot be taken together.  Anyway, thanks for all of your feed back and please give opinions on how I should approach this with my PM doc.

Veteran Member

Date Joined Nov 2008
Total Posts : 1037
   Posted 8/23/2009 7:41 PM (GMT -6)   
Hello Shaw,
I admit that I haven't read all of the replies to your post....bad me.  But, I will say that this issue comes up about once every three months.  We all have had issues about our meds.  Whether it's that they're not working as well, maybe we're taking too many and running out, maybe they're too strong, not strong enough...are we addicted or just dependent...the list goes on and on and on.... First let me tell you that I have NEVER taken Oxycontin...only because the Dr. that I saw said she would NEVER put her name on a prescription that had so many issues...I wanted to but never did.  I do however take Methadone 120 mg. daily and Oxycodone 30 mg. Immediate release 4 times a day.  I know that Methadone works for me better then any other narcotic I have ever taken..and I have been through a lot of them.  I tried to change from the Methadone to Morphine once a few months ago and it didn't work. I changed back within a week.
Methadone is its own animal with its own problems.  I think it gets a bad rap.  People only think of it something that heroine users take to get off the "Junk"...that's far from the truth.  Why it works for some and not others is a mystery to works for me. 
I know that I have thought in the past that I was an totally affected the way I thought about my medical problems and how I could help myself.  I just thought that I was worthless and deserved to be in pain...then I read the replies on here when I posted about the addiction vs. dependence thing...I realized that I was dependent. Then I could move forward in my treatment.  Maybe I'll be on Pain Meds for the rest of my life, but that doesn't make me a bad person.  Luckily, most Pain Dr.'s know about this and treat us with that knowledge...not making us feel bad when we ask for something stronger or for something that lasts longer.  They know what we are dealing with.  CP is Horrible...and I wouldn't wish it on my worst enemy.
I don't know if anything I wrote helped you, I hope so.  just don't be so hard on yourself...No matter what, we deserve to have pain control like anyone else...
Me. smilewinkgrin

I have been a spectator for so long..Now it's time to participate.......
Post Lamenectomy Syndrome, Spinal Stenosis, DDD....
1999 Hemi Lamenectomy/2005 Spinal Fusion(L4-S1)
Methadone 120 mg. a day/  30 mg. Oxycodone as needed(up to 4 x a day)
High Blood Pressure: Lisinopril HCTZ 10 mg. daily
Type 2 Diabetes: (March 16, 2009)
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Veteran Member

Date Joined Nov 2007
Total Posts : 6795
   Posted 8/23/2009 7:58 PM (GMT -6)   
You said you can talk openly and honestly with your doctor, and that's exactly what you should do. I would tell him just what you're telling us, and ask about all your pain management options. That's really the best thing. You may get some BT medication with the methadone, but it may be too early to know if you're just starting on the methadone if you'll need anything if the dose is slowly increased.

Try to relax, and talk to you doctor. You're lucky you have a good relationship - a lot of us struggle to find that, so trust in it!


Regular Member

Date Joined Aug 2009
Total Posts : 64
   Posted 8/23/2009 9:11 PM (GMT -6)   

That blows mate. Its so hard aint it? Ive get a pack of 20 5mg oxy for B/T, and require about 3 for releif and it is IMPOSSIBLE not to sit there and be in any kind of pain and not take em. I get embarrased going back tot he doc a week or 2 later and asking again feeling as if he thinks i may be abusing them...theres such a stigma attached to it and junkies make it sooo much harder for people in real pain.

I think we all suffer this type of problem at some stage when it comes to narcotics eh? try to think of it as a side effect of the disease - If you didnt have the disease you wouldnt be taking em in the first place....SIDE EFFECT

Veteran Member

Date Joined Jun 2005
Total Posts : 610
   Posted 8/23/2009 9:41 PM (GMT -6)   
I remember when I was a kid, my parents use to talk about how much of an addict my grandmother was (my dad's mother) cause she was always needing pain meds. Well now that I'm older and have pain myself, I've noticed that my grandmother was/is far from being an addict. She's had many surgeries on her back and other types of surgeries. She now has a pain pump, which took care of her pain for a while, but now that she's at the end of life,she's taking oral pain meds too. SO I guess it's misinformed people like my parents that think if someone is dependent, they must really just be addicted, and it makes me angry. But we do have addicts in the family for sure, but most of them are hiding from dealers cause they got themselves in some big trouble, and I do a good job of staying away from them as much as possible.
But it does seem to me that your doctor doesnt beleive you are an addict, cause he would of just tapered you off of your meds and booted you. And the fact that they're trying other pain meds on you, say right there that they dont beleive your addicted. Maybe they already knew about your tolerence issue and thats why you didnt get tapered or cut off. So that to me says that you've got a good doctor there.

Chronic Pain Moderator

-Stress is when you wake up screaming....and realize you haven't fallen asleep yet.

-What if the Hokey Pokey really IS what it's all about.

-Is it time for your medication or mine?

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Veteran Member

Date Joined Jul 2008
Total Posts : 2268
   Posted 8/23/2009 10:25 PM (GMT -6)   
Roughly I would say the difference is that addicts are willing to lie, cheat or steal in order to get more of a [prescription] drug. People who are just dependent on a drug will still go through all the misery of withdrawal, but they are willing to be honest with their family/friends/doctors, play by the rules even when the rules are not in their favor, and do not take medicine that does not belong to them.

But that is just my understanding, in layman's terms. For a more detailed description, you can this manual produced by The American Chronic Pain Association

Hope that helps. Feel better!

Moderator -- Depression Forum

Veteran Member

Date Joined Jan 2005
Total Posts : 9090
   Posted 8/23/2009 11:02 PM (GMT -6)   
Hi Shaw!

Pain control is a miserable way to live but living with uncontrolled pain is even worse! A couple of thoughts came to mind reading through this thread..... first, for those of us with chronic pain who take medications, we will never be totally, 100% pain free. We should be given an opportunity to try pain medications and use them if we can handle them~ side effects, proper usage, stigma and all. I believe that if a doctor doesn't offer compassionate options for pain control then he/she should get out of the business. But for those who will live with pain the rest of their lives we are mostly happy if we can get 80%-90% pain relief. Heck, I would take 50% most days!!

Second, the other thought that struck me when reading your posts is the fear and anxiety that seems to be there between the lines. Correct me if I'm wrong but you seem very uneasy and fretful over taking pain medications and possible withdrawal symptoms. Is it possible you are taking medication early, before your next dose is due, out of 'fear' of withdrawal? Or maybe fear of more pain returning? Please don't take this as an insult or critical remark....just an observation on my part. It's bad enough that we live in pain but it hurts my heart to watch as people struggle with basic pain management and most often it is at the hands of a doctor who isn't doing a good job. (This is my opinion here and feel free to totally disagree with me)

If you, or anyone else reading this post, is living with anxiety over their pain, the management of their medications or concerns of withdrawal there is alternate help for that. There are pain counselors who can work with you as part of your medical team. Most often those who take advantage of these counselors actually reduce their medication doses and learn how to better manage the pain. Also by lowering anxiety and stress it is easier for your medical team to treat your pain and be more successful.

Just some thoughts and I do hope something someone says will help you find something that is more successful for you and the treatment of your pain. No, it's not fair that we have to live this way but we have options and help like never before in history. Plus we have groups like this who, for me, are the best medication of all. Without the people on this forum I wouldn't do near as well as I do. Something about talking to people who truly understand what I'm saying helps me through each hour of the day.

Play fair. Don't hit people. Say you're sorry when you hurt somebody.
~Robert Fulghum

(\o/)Co-Moderator Fibromyalgia & Chronic Pain Forums

Regular Member

Date Joined Aug 2009
Total Posts : 64
   Posted 8/23/2009 11:11 PM (GMT -6)   
Im booked for my first Pain management clinic appt of the things i intend to address is the problem i have about asking for pain meds, either stronger or just through need due to more severe pain...I just cant help but perceive that the drs would think im a junky and all that from past experiences with cold hearted doctors (my current gp is a legend though lol)...I have a real problem with it and realise it is detrimental to my treatment as Im probably not getting the doses that I need to control the pain.

White Beard
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Date Joined Feb 2009
Total Posts : 3602
   Posted 8/23/2009 11:25 PM (GMT -6)   
Shaw 31
You have gotten allot of good advice! You don't have to worry about what to say to your Doctor, just be yourself and tell him the truth, tell him of your concerns about the how the methadone is not taking care of your pain as well as the oxycontin. Explain it to him the way you have to us!
I personally don't wory about addiction or dependence, I know my body is physically dependent on Oxycontin pain meds, just like it is on the Baclofen I take for my muscle spasms, and my Metoprolol I take for my Blood Pressure. Heck I am physically dependent on my VPAP ASV machine to sleep with! There are allot of medications that your body becomes dependent on. I think of some one that is addicted as someone who wants and will do anything to get the medication to feel "good"! My pain meds do not make me feel "good"  they just take the pain and hurt away and let me feel "normal"!! Nothing more, and sometimes they don't quite take all  the pain  away, so I have to take more for Break  through, just to feel "normal". ( to me feeling "normal" is to be without Pain, because "normal" people do not have pain!) Feeling normal is not feeling "good" but it is good to feel normal! I hope this all  makes sense to you! Because it really is true! Do you take the meds to feel "good" or do you take the meds to take away the pain so you can feel normal? If you have to take them to feel or be normal, you are probably  physically dependent on them. And that is OK, at least for me it is, and I dare say most people suffering with CP, it is the trade off we make to feel normal!
White Beard
Moderator Chronic Pain
I'm Retired USAF, went back to school and became an RN, and now am on full disalbility!--Degenerative Disc (affecting mostly the thorasic disc but all levels involved), C6/7 laminectomy/diskectomy& fusion, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications: Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV

Veteran Member

Date Joined Mar 2009
Total Posts : 1158
   Posted 8/24/2009 8:38 PM (GMT -6)   
Whitebeard well put!

I know I'm not addicted I just plain ole hurt all the time. I can just imagine if I run out of meds I would go through withdrawls. I have only been short one month due to more pain then normal. Just take note that some of us have to have pain meds or else we would crawl in a hole and want to die.

I'm so happy your doctor didn't jump to the conclusion that you were an addict, any pain management doctor would see signs much earlier so he must be pretty observant with his patients. Plus most addicts would never come forward and state those concerns as you did.

I hope you find a good mix of medications so that you can have a more functionable life

Kidney Diseases and Disorders
39 yr young female with,
Chronic Kidney Stones, PKD (Polycystic Kidney Disease), Chronic Kidney Failure, Severe Hypertension, Urological RSD

Also CHF (Congestive Heart Failure) and Sleep Apnea

Hopefully NO MORE........

Veteran Member

Date Joined Jul 2008
Total Posts : 2268
   Posted 8/24/2009 9:11 PM (GMT -6)   
I do want to point out that a pain psychologist can help you either way. When I first started going to see a PM, I was completely terrified of taking narcotic pain meds. So I was undermedicated & was miserable for it. I refused to take anywhere close to the amount of meds prescribed to me. After working with the pain psych, I actually started taking more meds, much earlier than I had been. After a while, the pain was much better controlled (b/c I wasn't waiting until it was horrific to take the first dose of medication) and I was actually able to take the same quantity of medication as before, but got much better pain relief.

Chutzie does make a really good point, though. Pain meds are not designed to make us pain-free & they certainly are not appropriate for preventing withdrawals. There are medications that help with that. One med that I use when I go off pain meds periodically is Catapres patches. The generic name is clonidine. It is on-label for high blood pressure, but helps a LOT with withdrawal symptoms -- well, for me at least & a number of people I know. I would encourage you to talk with your doctor about how miserable the withdrawal symptoms are. That is completely normal to struggle so much with withdrawal that you want to just keep taking the narcs to make them stop. Still, you really do need to find a healthier way to handle them.

I'm trying to remember which member it was just a little while ago that I recommended asking their doctor about clonidine & she just wouldn't consider it. Eventually she landed in the ER when she ran out of her pain meds early & there they gave her clonidine tablets, which she said really helped. I think it's awful to have to suffer through withdrawal & nobody should have to suffer through that, but narcs just aren't the best meds to help with that. A short time on clonidine (every person's different, but it usually takes me 2 weeks) & the withdrawal symptoms should go away -- assuming you aren't actually addicted.

In any case, please do talk with your doc about what's going on. S/he really should be able to help you. :)

Moderator -- Depression Forum

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Date Joined Feb 2003
Total Posts : 13366
   Posted 8/24/2009 9:34 PM (GMT -6)   
Shaw you have been given some great info as usual. The only thing I will add is all medication should be taken as prescribed by the drs. Otherwise a person can end up booted out if they constantly are running short every month because of self medicating, not to mention over dosing. You are lucky that you have a good dr you can talk to, not everyone has that luxury. When a person has to take more medication than what was prescribed thats the red flag your medication is not working effectively any longer, which means get into your dr ASAP.

Good luck with your dr.
Moderator Chronic Pain
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.

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