Terminology in Illicit Use of Opioids

Reward is a stimulus that the brain interprets as intrinsically positive or as something to be attained [8].

Craving is an intense desire to re-experience the effects of a psychoactive substance; it is the cause of relapse after long periods of abstinence [8].

Relapse is a resumption of drug-seeking or drug-taking behavior after a period of abstinence. Priming (new exposure to a formerly abused substance), environmental cues (people, places, or things associated with past drug use), and stress can trigger intense craving and cause a relapse [8].

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Contrary, physical dependence is a state of adaptation that is manifested by a drug-class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Lastly, tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

There are several misconceptions of chronic opioid therapy that routinely can cause later addiction:

1. Opioids lead to significant cognitive impairment

2. Absolutely contraindicated in persons with addictive disorders

3. Opioid doses will require continual escalation

4. Adequate pain control with opioids now will lead to poor response later.

Physicians can help minimize the potential for abuse of opioid pain medications by considering the agents' delivery route, bioavailability, and pharmacokinetics. In this respect, a little caution is able to minimize opioid abuse.

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