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Physical dependence on prescribed opioids isn’t the same as opioid use disorder.

Better pain care requires individualized treatment, accurate addiction diagnosis, and overdose prevention.

New research suggests estimates of opioid addiction risk and other harms depend on how addiction is defined.

Are patients with severe chronic pain being denied effective treatments because physicians fear prescribing opioids? Pain is one of the most common reasons adults seek medical care in the United States, with recent Centers for Disease Control and Prevention (CDC) National Health Interview Survey data indicating that the prevalence of chronic pain has risen to 24.3 percent of the adult population. Of those individuals, approximately 8.5 percent experience high-impact chronic pain, which severely limits daily life or work activities.

Severe chronic pain disrupts sleep, mobility, work, and family life. Yet some physicians fear causing addiction by prescribing opioids, even when other treatments have failed.

The opioid epidemic taught medicine painful lessons about indiscriminate prescribing. But have we gone too far in the opposite direction? Have we confused physical dependence with opioid use disorder (OUD), exaggerating addiction risks for patients taking prescribed medications appropriately? Patient complaints and new studies suggest we may have.

A 2026 study by Yarborough and colleagues examined 1,952 patients receiving long-term opioids through 10 U.S. health systems. Researchers followed participants for one year and assessed them using structured diagnostic interviews adapted for patients treated for pain.

Using pain-adjusted Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, 1.54 percent developed moderate-to-severe OUD over one year, compared with 4.46 percent using unadjusted criteria. That's nearly a threefold difference in estimated addiction risk, depending on how OUD is diagnosed.

I have described this many times here, but patients chronically taking opioids develop a tolerance. They show withdrawal symptoms when opioid medication is reduced. These pharmacological adaptations are not addictions since the DSM-5 specifically excludes tolerance and withdrawal during appropriate medical treatment.

Taking additional medication because of intense or chronic pain needs evaluation, keeping the clinical context in mind. It may reflect misdiagnosis and inadequate pain analgesia. It can also be a sign of misuse or developing addiction. These are very different diagnoses.

A 2018 systematic review by Higgins and colleagues examined 12 studies involving more than 310,000 patients, with a pooled opioid dependence or abuse incidence of 4.7 percent.

A 2024 review by Kyla H. Thomas and University of Bristol Medical School colleagues included 148 studies involving more than 4.3 million patients with chronic noncancer pain. It estimated 9.3 percent for dependence and OUD combined, 29.6 percent for related symptoms, and 22 percent for aberrant drug-related behaviors.

The prevalence of OUD among patients already receiving opioids differs from the incidence of newly diagnosed OUD. Neither establishes lifetime addiction risk when treatment begins.

These data are concerning. However, problematic medication-taking behavior does not necessarily establish........

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