8.3 Addiction
Addiction is defined as craving for more of a drug for reasons other than analgesia and also by ongoing use of the drug despite clear evidence of harm. The presence of behaviour suggestive of addiction may require referral to a Drug and Alcohol team and either cessation of opioid therapy or maintenance under tighter supervision. Aberrant drug-related behaviours predictive of developing addiction have been classified by Portenoy41:
Major aberrant behaviours (more predictive)
i. Selling prescription drugs
ii. Prescription forgery
iii. Stealing or borrowing drugs from others
iv. Injecting oral formulations
v. Obtaining prescription drugs from non-medical sources
vi. Concurrent abuse of alcohol or illicit drugs
vii. Multiple non-sanctioned dose escalations
viii. Multiple episodes of prescription loss
ix. Repeatedly seeking prescriptions from other sources
x. Deterioration in function at work, in family or socially
xi. Repeated resistance to change in therapy despite evidence of adverse drug effects
Minor aberrant behaviours (less predictive)
i. Aggressive complaining about the need for more drug
ii. Drug hoarding during periods of reduced symptoms
iii. Requesting specific drugs
iv. Openly acquiring similar drugs from other medical sources
v. Unsanctioned dose escalation
vi. Unapproved use of the drug to treat other symptoms