This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Anesthesia  • Substance Abuse/ Alcoholism  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: I am concerned about the use of the concept and term "dependence" in the Editorial regarding methods of detoxification by Dr O’Connor.¹ In the context of the discussion related to the article by Dr Collins and colleagues,² this use is misleading and is one of the reasons the medical community at large, along with patients, continue to have misconceptions that perpetuate a barrier to rational and effective pain management.

Physical dependence and addiction are not equal; they are clearly distinct entities according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.³ O’Connor refers to opioid dependence in the same context as opioid addiction. Although chronic opioid therapy will inevitably involve some degree of opioid physical dependence, it will not necessarily lead to addiction. Tolerance and physical dependence are pharmacological properties of a drug and are not synonymous with addiction. For several years, . . . [Full Text of this Article]

Jose A. Contreras, MD
jcontreras@humed.com
Department of Pain and Palliative Care
Hackensack University Medical Center
Hackensack, NJ

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Detoxification and Treating Opioid Dependence
Catherine J. de Jong
JAMA. 2006;295(8):887.
EXTRACT | FULL TEXT  

Detoxification and Treating Opioid Dependence—Reply
Patrick G. O’Connor
JAMA. 2006;295(8):887-888.
EXTRACT | FULL TEXT  

Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction: A Randomized Trial
Eric D. Collins, Herbert D. Kleber, Robert A. Whittington, and Nicole E. Heitler
JAMA. 2005;294(8):903-913.
ABSTRACT | FULL TEXT  

Methods of Detoxification and Their Role in Treating Patients With Opioid Dependence
Patrick G. O’Connor
JAMA. 2005;294(8):961-963.
EXTRACT | FULL TEXT