Addiction is a substance use disorder; a health issue requiring proper prevention and care, not moral judgment.  Addiction is a misunderstood illness involving an individual’s repeated and uncontrollable harmful actions, often incorrectly thought of with stigmatizing connotations.  The human body and mind are naturally regulated by many intricate mechanisms; prescription opioids increase the risk of addiction by replacing the brain’s own natural endorphins in vital areas such as the limbic system, which controls emotions including pleasure and reward while reducing pain perception.  Over time the effect of this is to alter control of these functions from the normal mechanisms to those of the drug, leading to addiction. Similar effects upon the brain center which controls breathing during sleep can increase the risk of overdose and death from prescription opioids, especially if combined with other drugs which depress brain function.

For an addicted individual, therefore, normal neurobiological function is compromised. The continued use of opioid narcotics inhibits the body’s ability to produce essential naturally occurring chemicals, and conditions the body to rely on the use of opioids. This physiologic reliance is known as chemical dependence, but because emotional centers of the brain are also affected, there is a strong psychological aspect to the process as well.  Opioids may initially provide pain relief, but over time dosage increases are required to maintain a given level of pain relief, a condition known as tolerance.  In addition, patients treated long-term with opioids may develop opioid-induced pain hypersensitivity, i.e., whatever the actual source of their pain, it is felt more rather than felt less. Although defined somewhat differently, dependence, tolerance, and addiction are thus all inter-related.

The stigma and bias surrounding addiction is due to substantial and pervasive misinformation about its true nature, much of which has been fueled by the opioid industry as an important part of their marketing practices. It is erroneously believed by many that an individual who is addicted has a choice and can stop at any time, and that they like doing what they’re doing.  This is absolutely not the case.  As noted above, an addicted individual’s body is incapable of producing and regulating essential chemicals in the usual manner, and without opioids will experience withdrawal symptoms which are quite severe and unpleasant, compel him/her to often negative behaviors in order to avoid them and continue taking the drugs, and usually require medical support to assist with tapering, overcoming withdrawal, and becoming drug free. There is thus much more to addiction than will-power; because of the documented chemical and emotional devastation, those addicted frequently cannot cease using opioids even when they desperately want to stop.

It seems clear that it is counterproductive to endorse or perpetuate stigma and bias toward those addicted.  Often the term “abuse” is used to imply that someone is deliberately and repeatedly taking a drug non-medically; the reality is that once addicted, the ability to “choose” is severely compromised. People may begin taking opioid narcotics for many different and often legitimate reasons, but with sustained use the risk of addiction increases even if the drugs are medically indicated and taken as prescribed.

ARPO encourages education and better understanding of the dangers and highly addictive potential of legally prescribed opioid narcotics.  Thorough knowledge about addiction and careful use of language will help prevent stigmatization of those suffering from addiction and promote its prevention as well as compassionate and safe care for those afflicted.


Dr. Nora Volkow Explains the Science of Addiction 

The Face of Addiction