User:Ian Furst/sandbox2

I have a colleague, who is one of Canada's leading experts on toxicology, dependence, and addiction. Here is his CV page for reference. I explained the debate we are having and asked for both input, and open source references. Here is his response.

I coauthored a paper a few years ago on addiction and dependence. It's open source. The use of opioids for chronic noncancer pain has increased dramatically over the past 25 years in North America and has been accompanied by a major increase in opioid addiction and overdose deaths. The increase in opioid prescribing is multifactorial ... Dependence is absolutely a side effect. I discuss it here (although it likely won't meet your criteria for citation). Withdrawal is a side effect too, in that it DEFINES dependence in its pharmacologic sense. It's a weird side effect of course, in that one wouldn't experience it if they kept taking the drug. But because dependence is a drug-related harm, and because it's defined by withdrawal upon cessation, you're on safe ground calling it a harm I think. I think most people recognize addiction as a potential harm of opioids, even though we don't know the true incidence. Tolerance - this is also a side effect, in that it (that is, a rightward shift in the dose-response curve) only arises because of exposure to the drug. I'm sorry I don't have a lot of other open-source reviews. If I find one I will send it along. Hope this is of some use. dave.