A client with metastatic bone pain has taken prescribed morphine for several months. The client now needs a higher dose for the same relief and develops sweating and abdominal cramps if a dose is missed, but reports no compulsive use or loss of control. Which response by the nurse is best?
1These findings prove opioid addiction, so the morphine should be stopped and replaced with nonopioid therapy.
2These are tolerance and physical dependence, not proof of addiction; reassess analgesia and avoid abrupt discontinuation.✓ Correct answer
3These findings indicate opioid-induced hyperalgesia, so each dose should be doubled until the pain is controlled.
4These are psychological symptoms rather than medication effects, so counseling should replace the current analgesic plan.
Explanation
Needing a larger dose for the same effect describes tolerance, while withdrawal symptoms after a missed dose describe physical dependence. Both can occur during long-term prescribed opioid therapy and do not alone establish addiction, which involves compulsive use despite harm. The nurse should support reassessment of pain control and prevent abrupt discontinuation rather than label the client or change therapy independently.
Clinical reasoning Tolerance is reduced response after repeated exposure. Physical dependence is physiologic adaptation that can produce withdrawal when the drug is stopped. Neither finding alone proves addiction.
Decision rule Separate expected physiologic adaptation from compulsive use despite harm. Reassess analgesia and safety, and taper only through an individualized prescribed plan.