ABSTRACT
This chapter outlines the burdens of substance misuse to individuals and society and discusses the relevant neurobiology in order to explain why use of opioid drugs may lead to medical and legal problems. It discusses the definitions of addiction, dependence, and tolerance to opioid drugs in the context of pain management and presents data regarding risks of iatrogenic problem drug use. The medicinal use of such substances, particularly the opioids, is well established, but their nonmedical use is widespread with individuals using the drugs for the perceived benefit of the psychoactive experience. Addiction is a chronic relapsing brain disorder in which repeated exposure to certain substances induces plastic change in motivational and reward systems of the brain. The chapter describes the safe use of opioids for long-term pain control by giving guidance on identification and management of problem drug use, and shows principles of management of persistent pain in patients with addictive disease.
