Tolerance, physical dependence, and psychological dependence are related—but still distinct—conditions that are often confused with one another. Understanding the difference between these conditions is important because the treatment considerations can vary widely. Pain patients, in particular, may be interested to learn that the likelihood of their becoming opioid-dependent is relatively slim, even when opioid use leads to tolerance or physical dependence.

Opioid Tolerance 
Physical Dependence on Opioids
Psychological Dependence on Opioids
Common Characteristics of Opioid Dependence

Opioid Tolerance
Over time, repeated use of an opioid causes certain receptors in the brain to become tolerant (ie, less responsive) to opioids—in other words, more of an opioid is needed to produce the same effect.^1,2 The neurological changes that cause opioid tolerance are predictable and well understood. These changes appear to correct themselves within a period of weeks after opioid use stops.² Although tolerance is one of the traits often seen in opioid-dependent patients (see Common Characteristics of Opioid Dependence), in the absence of other symptoms, tolerance is not evidence of opioid dependence or misuse.¹

Physical Dependence on Opioids
A physical dependence on opioids means that the brain has made so many changes in response to repeated opioid stimulation that it now actually needs opioids to function "normally."²

Pain medicine and addiction medicine specialists agree that most patients treated with opioids for long periods of time become physically dependent on them.¹

If opioid use suddenly stops, patients who are physically dependent will experience withdrawal symptoms. Avoiding this withdrawal is the main reason behind the drug seeking and drug use of someone who is physically dependent on opioids.

(NOTE: SUBOXONE is not indicated for pain management. Patients with a clinical need for pain management should not be transferred to a SUBOXONE regimen, even if they are physically dependent on opioids.)

The neurological changes associated with physical dependence on opioids are predictable and well understood. These changes appear to correct themselves within a period of weeks after opioid use stops.²

Physical dependence on opioids almost always precedes opioid dependence (see Common Characteristics of Opioid Dependence). However, unless other symptoms of opioid dependence are present, physical dependence should not be viewed as "proof" of opioid misuse.

Psychological Dependence on Opioids^3-5
Psychological dependence involves continued drug use for reasons other than tolerance and withdrawal, such as a desire to experience a drug's pleasurable effects. The hallmark of psychological dependence—compulsive drug seeking and use—stems in large part from intense opioid cravings caused by complex neurological changes.⁶

An individual is generally considered psychologically dependent when his or her opioid use continues in spite of its negative effect on the individual's life. For example, people who are opioid-dependent feel a need to keep using opioids even if it hurts their health, job, finances, or family.⁷

• Opioid tolerance
• Withdrawal symptoms occur when opioids are not used
• Taking other drugs to help relieve the withdrawal symptoms
• Taking larger amounts of opioids than planned and for longer periods of time
• Persistent desire to or unsuccessful attempts to quit
• Spending a lot of time and effort to obtain, use, and recover from opioid use
• Giving up or reducing social or recreational activities; missing work
• Continued use of opioids, regardless of negative consequences

SUBOXONE is appropriate for the treatment of people who have become physically dependent or psychologically dependent on opioids AND who are not in need of opioids for pain management. SUBOXONE is not indicated for treating pain.

See the Dependence Identifier for a list of questions that can help identify possible opioid dependence, in yourself or someone you are close to.