The potential for ADDICTION or ABUSE influences the licit medical use of many drugs, including OPIOIDS, BENZODIAZEPINES, BARBITURATES, and others. This influence can be evaluated from two perspectives—(1) the risk that addiction or abuse will result from medical treatment of patients with no such prior history, and (2) the possibility that overconcern about this risk leads to inappropriate undertreatment of certain medical conditions. Although these issues can be discussed with reference to any of these drug classes, the opioids are most illuminating and are emphasized below.

The Risk of Addiction or Abuse

Like any other potential adverse outcome of drug therapy, the prevalence of iatrogenic addiction (drug addiction or abuse during medical treatment) must be determined so that the risk can be assessed by both the practitioner and the patient. An accurate understanding of prevalence, in turn, requires the application of clinically relevant definitions of these phenomena...