Opioid dependence vs. addiction: what Veterans should know

Before your appointment

For a Veteran managing persistent pain, a useful next step is an honest medication review. You can ask about dependence, pain relief, side effects, and concerns about control in the same appointment. You don't need to decide on a label before asking for help.

How are dependence, tolerance, and opioid use disorder different?

Physical dependence concerns the body's adaptation and withdrawal. Tolerance means the same dose may have less effect over time. Neither is permission to increase a dose yourself. CDC patient guidance.

Opioid use disorder, or OUD, is a clinical diagnosis based on a pattern of symptoms, such as difficulty controlling use, craving, and continued use despite harm. The diagnostic criteria require at least two symptoms within a year. Tolerance and withdrawal do not count toward those criteria when opioids are taken solely under appropriate medical supervision. This exception does not mean that prescribed medication can never be associated with OUD. CDC diagnostic criteria.

In a 2016 Stanford Health Care Q&A, Anna Lembke, MD, makes the distinction between physiological dependence and addiction. Her point helps explain why withdrawal alone is not enough to make that diagnosis. Watch around 49:03.

What should I tell my VA care team?

Describe what is happening in plain terms. For example: “I'm taking it as prescribed, but I feel unwell when a dose is late,” or “I'm taking more than the plan says, and I'm worried.” These are suggested ways to start a conversation, not patient testimonials.

Bring your medication list and ask to review prescriptions from both VA and community clinicians. Include sleep medicines, other sedating medicines, and alcohol use. Combinations can increase overdose risk. CDC guidance on medication risks.

You could also ask:

• What might explain the symptoms I'm having?
• Do I need an assessment for OUD, a review of pain treatment, or both?
• Who will coordinate recommendations across my clinicians?
• How will we keep treating my pain if my medication plan changes?
• What should I do if I run short before we meet again?

Ask for a specific contact and a follow-up date. If you would like a trusted person to attend, tell the team what role you want them to have. You can also ask to speak privately for part of the visit.

If I have OUD, what treatment can help?

OUD is treatable. FDA-approved medicines include buprenorphine, methadone, and naltrexone. A qualified clinician should discuss which option fits and how to start it safely. Detoxification alone is not recommended treatment for OUD because of the risk of returning to use and overdose. Counseling can be part of care, but lack of access to counseling should not delay medication treatment. CDC treatment guidance.

If you have a VA primary care provider, ask about assessment and treatment. If you don't, VA directs Veterans to a local VA medical center or substance use disorder program for help finding care. Availability and the right care setting depend on your circumstances. Find VA substance use treatment options.

Should I stop my medicine to find out?

No. Don't use an abrupt stop as a test for addiction. Discuss any change with your prescriber. Pain treatment, physical dependence, and OUD require different decisions, and those decisions deserve clinical support. CDC guidance on continuing opioid therapy.

Ask about naloxone and an overdose-response plan. If someone cannot be awakened or has slow, difficult breathing and overdose is suspected, give naloxone if available and call 911. Stay with them and follow emergency instructions. CDC overdose response.

For broader pain-care planning, see the Veteran chronic pain care guide. Valor's inquiry options below are for questions about its chronic pain program. They do not replace OUD assessment, withdrawal care, or medication treatment; contact your clinical team for those needs.

About this guide

Based on the complete available automatic captions and selected visuals from Doctors and the Opioid Addiction Crisis, published by Stanford Health Care on November 23, 2016, with current CDC and VA sources. Veteran appointment suggestions are editorial additions. This educational guide has not received clinical sign-off.