Addiction, dependence and tolerance
ADDICTION, DEPENDENCE
AND TOLERANCE
It is a common myth that addiction, dependence and tolerance are the same thing. However, there are differences between the three and as a pharmacist, it is important to help your team and customers recognise these differences. This is particularly true as some customers may believe that OTC sleep aids can cause addiction, and therefore may be reluctant to use them.
Click the tabs to understand the difference between addiction, dependence and tolerance15
ADDICTION?
DEPENDENCE?
TOLERANCE?
Drug addiction is a chronic disorder characterised by drug seeking and misuse that is compulsive, despite its negative consequences and long-lasting effects in the brain. Addiction is considered to be a complex brain disorder and a medical illness that is caused by repeated misuse of substances.15
Physical dependence can occur with the regular (daily or almost daily) use of any substance; even drugs that are taken as prescribed. This is because the body naturally adapts to the regular exposure of a substance. When this substance is stopped, the body often needs to re-adjust to the loss of it, which can lead to cravings to relieve withdrawal symptoms.15
Tolerance is the need to take higher doses of a substance or drug to achieve the desired effect. This can be because the body becomes accustomed to it and often there is a significant diminished effect with continued use of the same amount of the substance. It often accompanies dependence.15
Note: It is important to remember that diphenhydramine hydrochloride (found in Nytol) is unlikely to cause addiction, but it can cause dependence and tolerance when used inappropriately or for long periods of time10
You and your pharmacy team play a crucial role in identifying patients at risk of misuse of diphenhydramine or other sleep medication. There are some red flags that can help you identify those who may be at risk:
Excessive/persistent requests for OTC Pharmacy-only sleeping aids
They report that the Pharmacy only OTC medication is no longer working
Unusual, aggressive or irritable behaviour or excessive anxiety or nervousness
Changes in appearance or mood, e.g. bloodshot eyes, slurred speech or unsteady movements
Frequently asking for a repeat prescription of their POM sleep aid before they are due or repeatedly asking for an ‘emergency supply’
HOW YOU CAN HELP
It is important to assist these customers without judgement or prejudice. There are many ways you can still support them, particularly if you must deny an OTC sale.
Raise awareness of the risks and consequences of not using medications appropriately
Offer ongoing guidance and support
Recommend non-pharmacological interventions, e.g. healthy sleep habits, good sleep hygiene and managing stress
Natural and herbal options have a lower risk of dependence and tolerance and may be more appropriate for some customers
Collaborate with other HCPs to establish referral systems for specialist advice
Ensure you are checking PMRs when prescription sleep aids are routinely being prescribed to ensure they are being used safely, and intervene where necessary