What Is Opioid Pseudoaddiction?

Opioids (also called opiates) are highly addictive pain medications. Since the 1990s, the United States has been battling an opioid crisis, with numerous cases of opioid addiction (also called opioid use disorder) and opioid overdoses occurring every year.

During this crisis, some people have expressed concern about opioid pseudoaddiction. Here’s what you should know about this phenomenon. 

What Is Opioid Pseudoaddiction? 

First coined in 1989, the term pseudoaddiction refers to the idea that many patients struggle with under-treated pain. Proponents of this idea consider pseudoaddiction an iatrogenic syndrome, which means it’s a syndrome caused by medical treatment.

According to proponents, many healthcare professionals underestimate their patients’ pain and misinterpret their drug-seeking behavior as a symptom of drug addiction (also called substance use disorder). 

Proponents also claim that people with pseudoaddiction may display various symptoms of addiction, including:

• strong cravings for prescription opioids
• tolerance (needing increasingly higher or more frequent opioid doses over time)
• doctor shopping (visiting multiple doctors to get multiple opioid prescriptions)
• loss of motivation
• loss of interest in activities once enjoyed
• avoidance of family and friends
• irritability
• mood swings
• trouble concentrating

However, unlike people with true addiction, people with pseudoaddiction are said to stop seeking opioids once they experience adequate pain relief.

Phases Of Pseudoaddiction

Proponents of the concept of pseudoaddiction claim it involves three phases: stimulus, escalation, and crisis. 

Stimulus Phase

In the stimulus phase, a prescribing clinician starts treating a patient’s pain with opioid analgesics (painkillers). However, the prescribed dosage fails to provide adequate pain management. The patient then requests stronger treatment. 

For example, they might ask for a higher dose or a more powerful opioid medication.

Escalation Phase

In the escalation phase, the patient realizes they must convince their clinician that their pain is real and requires more opioids. 

Crisis Phase

In the crisis phase, the clinician refuses to prescribe more opioids, and the patient’s pain worsens. The patient’s drug-seeking behavior then becomes more intense. 

For instance, they may constantly worry about their access to opioids or always have opioids on hand, even when they don’t need them. 

This behavior worsens the clinician’s fear that the patient has an opioid addiction. As a result, the clinician continues to deny the patient opioids. 

This creates a cycle of mistrust between the patient and clinician. Proponents of pseudoaddiction argue that clinicians must break this cycle by believing the patient’s reports of pain and providing stronger opioid therapy. 

Is Pseudoaddiction Real?

There are very few studies on pseudoaddiction. None of them have proven the concept as a real condition. In fact, some people believe the term has only worsened the opioid epidemic by encouraging doctors to overprescribe opioids. 

These critics often point to the marketing efforts by Purdue Pharma, the manufacturer of OxyContin (oxycodone). At the start of the epidemic, Purdue Pharma claimed that doctors should prescribe opioids more freely because they are not as addictive as people think.

However, since then, researchers have determined that opioids indeed pose a high risk of drug abuse and addiction. They’re also very deadly. 

According to the Centers for Disease Control and Prevention (CDC), most overdose deaths in the United States involve opioids. In 2021, the nation’s annual overdose death toll reached a record-breaking 100,306, with 75,673 of those deaths involving opioids. 

Opioid Risks Vs. Undertreated Pain

Critics of pseudoaddiction claim that the risks associated with the use of opioids are worse than the potential undertreatment of pain. 

They argue that healthcare providers should retire the term and focus on finding safer pain treatments that enhance a patient’s quality of life without posing serious side effects. 

Indeed, studies suggest that many people with acute pain and chronic pain don’t need opioids. Instead, they experience adequate pain relief from physical therapy and over-the-counter pain medications such as ibuprofen. 

People with terminal pain, such as cancer pain, may require opioids for adequate pain control. However, even in these cases, doctors must watch for signs of addiction. Also, before prescribing opioids, they should consider whether the patient has any risk factors for addiction, such as:

• a family history of addiction
• early exposure to drug use
• mental health conditions

If you or someone you love struggles with illicit or prescription drug use, please reach out to an Ark Behavioral Health specialist. Our substance abuse treatment programs offer medical detox, mental health counseling, and other evidence-based services to help you stay sober.