Dependence Is Not Addiction. Chronic Pain Patients Deserve Better.

A storm that hit the wrong houses

When a hurricane barrels towards a coastline, we hear about it; warnings go out, shutters go up, and evacuations begin. Now, picture emergency crews sealing off entire neighborhoods in Tennessee as they board homes and cut power to families outside the surges.

That's an example of what blunt policy looks like when it can't tell the difference between danger and presence.

My last column compared dependence with addiction, and I was overwhelmed by the reaction.

I received emails from nurses, grandparents, and everyday people who've lived quietly with chronic pain for decades. Many wrote the same sentence, but in different ways.

I am not an addict.

The stories shared went far deeper than any terminology debate.

What science actually says

Medicine recognizes that physical dependence isn't an addiction. Tolerance and withdrawal happen to nearly everybody who takes opioids long-term: bodies adjust, and if the medication is stopped suddenly, symptoms follow. That's physiology, not moral failure.

Addiction, or opioid use disorder, needs behavioral markers such as loss of control, compulsive use, and continued use despite harm; diagnostic criteria specifically exclude tolerance and withdrawal when medication is taken under medical supervision for pain.

Here's more.

Addiction is not a predictable outcome of prescribing.
Among chronic pain patients prescribed opioids, estimates of opioid use disorder range from roughly 3% to 12%.
A 2024 meta-analysis found problematic pharmaceutical opioid use in around 9%.
More than 50 million American adults live with chronic pain. Around 7% to 8% live with high-impact chronic pain that limits daily life.
Most overdose deaths now involve illicit fentanyl, not stable pain patients taking prescribed medication.
Risk factors for opioid use disorder include prior substance use disorder, mental health conditions, and higher doses.
Surveys of misuse reveal that many report pain relief, not euphoria, as the primary motive.

Numbers matter because they separate myth from measurable risk.

Barbara and the hamster wheel

Barbara is a 75-year-old suffering from degenerative disc disease, spinal stenosis, and shoulder replacements, while receiving numerous knee injections. X-rays show the proof.

For 20 years, she took a low dose of hydrocodone; not enough to erase the pain, but just enough to function.

Every month, she drove to a pain clinic, providing urine samples, answering the same questions, enduring the same suspicions, picking up her prescription in person, while paying for her labs and appointment. Despite repeated requests, she was never given a chance for physical therapy.

She compared her appointments to reporting to a probation officer.

Eventually, she decided to walk away from the medication and the clinic, choosing to stay home more, declining invitations, and using a heating pad while watching movies.

Dependence let her function, but the policies treated her like a suspect.

The veteran who never built tolerance

One anonymous combat vet described 27 years of service, was shot twice, blown up three times, lived through two helicopter and one C-130 crash, suffering a broken neck and frostbite.

He's taken the same small opioid dose since 2005, with no increases in dose, no illicit drug use, tolerance spiral, or addiction.

Every new doctor treats him like a problem waiting for an opportunity. Like all of us prescribed opioids, Narcan is included with refills, with drug counseling referrals, and implied threats.

Screening exists for a reason, but blanket suspicion ignores nuance.

The system and the shift

There was a change in 2016, when federal guidance aimed to reduce harm and encourage careful prescribing. It wasn't intended as rigid law or forced tapering. Later clarification warned against abruptly discontinuing prescriptions and abandoning patients.

The 2022 update reinforced individualized care and shared decision-making.

Despite relationships between patients and doctors, many insurers, states, and clinics developed hard-coded limits. Doctors feared investigation, pain contracts multiplied, and monthly visits became mandatory. Meanwhile, forced tapers occurred.

Unsurprisingly, the prescribing rate for opioids dropped around 50% over the last decade.

Illicit fentanyl surged.

Meanwhile, millions like Barbara lost stability.

Dependence is not moral collapse.

Another reader described managing post-herpetic neuralgia for four years: three medications, one opioid, and monthly testing.

He decided to lower his dose to build a reserve in case pharmacies can't fill prescriptions: something I've done, too. And I agree with his fear of being labeled as drug-seeking.

When I call for my monthly refill, I honestly feel like the scum of the earth, ready for my next fix. It's a feeling I can't shake.

He knows his body is physically dependent, but he also knows he doesn't crave, escalate, or lose control; a distinction that defines his life.

Pain and addiction intersect, but they are not identical.

The cost of getting it wrong

It's a heavy burden living with chronic pain; we deal with depression, isolation, lost income, and the risk of suicide.

When pain is untreated or undertreated, some people are driven toward street drugs, where fentanyl contamination kills, while others retreat into beds, recliners, and our best friend, the heating pad.

A policy that can't distinguish between dependence and addiction hurts both groups, stigmatizing the stable and failing the unstable.

Back to the boarded windows

Hurricanes aren't stopped by a storm response that seals inland homes; it just traps families who were never in danger.

Drug policy aimed at addiction should target addiction, using tools such as risk screening, integrated mental health care, medication-assisted treatment, and fentanyl interdiction.

Chronic pain care requires a different approach: individual assessment, functional goals, shared decision-making, and, most importantly, respect.

Millions live in daily pain, most aren't addicts, and many are dependent in the same way a diabetic depends on insulin or a heart patient depends on beta blockers.

When policymakers forget that difference, they board up the wrong houses.

I Want to Hear From You

These chronic pain columns exist because people are willing to speak honestly in a system that often punishes honesty.

Read My Chronic Pain Series here.

If you're living with chronic pain and have had to learn to stay quiet just to survive care, your experience matters. Whether your story is long or short, clinical or personal, it helps expose what life inside the system actually looks like.

If you choose to share, you grant PJ Media permission to edit, publish, and use your submission without compensation. Any edits will be limited to grammar and clarity, never substance or meaning.

To submit, visit the Contact Us page and put “Dave Manney: Chronic Pain” in the subject line.

You may request anonymity or use a first name only. A few honest paragraphs about your condition, care, and how your life has been reshaped are more than enough.

Remember: Silence protects broken systems; your voice helps challenge them.

Support independent reporting that tells stories most outlets ignore. Chronic pain patients deserve honest coverage grounded in science and lived experience. Become a PJ Media VIP and help keep series such as The Chronic Pain Project alive and growing.