# A 60-year-old client receiving long-term morphine for metastatic bone pain confides to the nurse, "I am scared I am becoming addicted because I now need a higher dose for the same relief and I felt awful for a day when I missed a dose." Which response by the nurse demonstrates accurate education?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375150&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 60-year-old client receiving long-term morphine for metastatic bone pain confides to the nurse, "I am scared I am becoming addicted because I now need a higher dose for the same relief and I felt awful for a day when I missed a dose." Which response by the nurse demonstrates accurate education?

## Option

1. You are right; this is addiction and we should taper you off as soon as possible.
2. What you describe is tolerance (needing a higher dose for the same effect) and physical dependence (withdrawal when stopped abruptly), which are predictable physiologic responses to long-term opioid use and are different from addiction (compulsive use despite harm); your team will adjust the dose and avoid abrupt stops. **✔ Correct answer**
3. Stop the morphine today and switch to over-the-counter ibuprofen.
4. You should not need any more medication; chronic pain is psychological.

**Correct answer: 2**

## Explanation

Three terms must be distinguished in opioid education: (1) tolerance — a predictable pharmacologic adaptation in which higher doses are needed for the same analgesic effect; treated by careful dose titration or rotation, not viewed as addiction, (2) physical dependence — predictable physiologic state in which abrupt cessation or antagonist administration causes withdrawal (anxiety, sweating, lacrimation, rhinorrhea, GI upset, gooseflesh, dilated pupils, tachycardia, hypertension); managed by gradual taper (10 to 25 percent per week or per institution protocol), (3) opioid use disorder/addiction — compulsive use despite harm, loss of control, craving, life dysfunction; treated with comprehensive substance use treatment, not by withholding pain relief in a patient with cancer pain. Pseudoaddiction can mimic addiction in undertreated pain — drug-seeking behavior resolves when pain is adequately treated. Teaching: cancer pain patients are not creating addiction by needing dose escalation; the comprehensive plan is multimodal (NSAID/APAP/coanalgesic gabapentinoid plus opioid), bowel regimen, monitoring, and clear taper plan if therapy ends. Tapering immediately because of fear, telling the patient pain is psychological, or stopping all opioids are unsafe in cancer pain.

## In-depth explanation

Tolerance plus dependence is not addiction. Cancer pain patients escalating doses or experiencing withdrawal need correct labeling, not stigma. Addiction = compulsive use despite harm.

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