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Detoxification and Treating Opioid Dependence
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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
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