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November 2019

​The Real Dangers of Equating

Opioid Dependence with Addiction

The National Prevention Science Coalition to Improve Lives (NPSC) and the Congressional Addiction, Treatment and Recovery Caucus (ATRco-hosted a briefing with internationally recognized experts to discuss the dual challenges of addiction and dependence in developing policy responses to the opioid epidemic.  Although many people conflate addiction and dependence, they are not the same, and the distinction has important implications for the millions of people who rely on opioid medications for pain management.

Addiction refers to compulsive drug use, despite harmful consequences, such as an ability to meet work, social and family obligations. Dependence, on the other hand, reflects the body’s adaptation to drug use over time—the development of tolerance to its effects and withdrawal in its absence. There are millions of patients in the US who rely on opioids for pain management and, over the years, have become dependent on them, including veterans, ex-athletes, accident victims, people with disabilities, and cancer patients. Most of these people are not addicted to these medications, and proper screening, appropriate prescribing and careful monitoring can prevent the escalation from dependence to addiction. As policy makers continue to explore solutions to addressing the nation’s opioid crisis, it is imperative to ensure that pain patients who could benefit from opioid analgesics do not suffer unintended consequences of well-intentioned policies aimed at restricting access to these medications when their use is appropriate.

This briefing brought together lawmakers, regulators, physicians and other scientists, and the public into this critical conversation. Speakers addressed the science of addiction and dependence, how the distinction between them affects clinical practice and policy, and specific strategies suggested by the medical and prevention sciences for ensuring that patients’ differential needs are met. The latter includes: (1) a public health campaign to educate the public, lawmakers, industry leaders and community organizations about the distinction between dependence and addiction and its policy implications; (2) destigmatizing appropriate medical use of opioids to ensure patients receive needed treatments; (3) routinely implementing assessments to distinguish patients with addiction from those with dependence to appropriately guide remedies; and (4) scaling up evidence-based individual, family, school and community-level preventive interventions and policies to reduce exposure to the detrimental conditions that lead to addiction (Prevention and Intervention).  Although prescribing and monitoring are largely a physician-based undertaking, state and federal governments play a role in providing regulatory oversight and legislative guidance that support the evidence-based initiatives needed.



This briefing was in collaboration with the Congressional Addiction, Treatment and Recovery Caucus (ATR)

Thank you Congressman Bobby Scott (VA-3) for making remarks! The NPSC appreciates your continued support (see video here).

Overview: Dr. Diana Fishbein

University of North Carolina

Briefing Presentation

Keynote Speaker: Dr. Nora Volkow

Director of the National Institute on Drug Abuse

Briefing Presentation

Pain Specialist: Dr. Susan Glod

Penn State College of Medicine

The Other Victims of the Opioid Epidemic,  Published in NEJM

Pain Patient: Dr. Patrick Byrne

University of Texas

Policy Researcher: Dr. Brendan Saloner

Johns Hopkins Bloomberg School of Public Health

Briefing Presentation

A Public Health Strategy for the Opioid Crisis

Prevention Scientist: Dr. Phillip Graham

RTI International

Briefing Presentation

Additional Resources


Compton WM, Jones CM, Baldwin GT, Harding FM, Blanco C, and Wargo EM (2019). Targeting youth to prevent later substance use disorder: An underutilized response to the US opioid crisis. AJPH Perspectives, 109(S3), S185–S189. [PMC free article] [PubMed]

Hahn KL. Strategies to prevent opioid misuse, abuse, and diversion that may also reduce the associated costs. Am Health Drug Benefits 2011;4:107–14. [PMC free article] [PubMed]

Koh HK. Community-Based Prevention and Strategies for the Opioid Crisis. JAMA. 2017;318(11):993–994. doi:10.1001/jama.2017.13767 [Full Text]

Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA. Reframing the prevention strategies of the opioid crisis: focusing on prescription opioids, fentanyl, and heroin epidemic. Pain Physician. 2018;21:309–326. [Full Text] [PubMed]

O’Brien CP, Volkow N, Li TK (2006) What’s in a word? Addiction versus dependence in DSM-V. Am J Psychiat 163:764–765. [Full Text] [PubMed]



The Hill: National leadership needed to fight the opioid crisis [Link]

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