Chronic Pain and Addiction

Key takeaway

Chronic pain lasts more than three months, and CDC says about one in five U.S. adults had it in 2019. Nonopioid therapies are preferred. A plan should cover physical health and behavioral health together. If opioid use disorder is present, clinicians should offer medication treatment. Do not stop a prescribed opioid on your own.

Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)

The pain has lasted for months, the opioid is still in the bottle, and you are afraid that asking for help will get the medicine taken away. Pain that lasts more than three months is chronic pain, in CDC's definition. About one in five U.S. adults had chronic pain in 2019, and about one in 14 had high-impact chronic pain, meaning pain on most days or every day that limited life or work. NIDA describes chronic pain as affecting an estimated 100 million Americans and as a primary reason people are on disability. The two figures come from different sources and different years. Both support the same point: this is common medical care, not a rare edge case.

Some of those people also have a substance use disorder. NIDA lists chronic pain among the health conditions that commonly occur with substance use disorders, alongside HIV and hepatitis C. Having pain does not mean you have addiction. Taking a prescribed opioid does not mean you have addiction. Leaving either problem unnamed is how people get hurt.

If breathing has slowed, or you cannot wake someone, call 911. For a mental health crisis, call or text 988. Do not stop a prescribed opioid tonight because you read that another kind of care is preferred.

What CDC wants a pain plan to include

CDC's 2022 guideline says people with pain should receive appropriate treatment, with a careful look at benefits and risks. The recommendations are voluntary. They are meant to support individualized care, not replace it. They do not apply to sickle cell disease, cancer-related pain, palliative care, or end-of-life care.

One guiding principle is easy to miss if you only hear the cautions about opioids: acute, subacute, and chronic pain need to be assessed and treated whether or not an opioid is part of the plan. Another says a multimodal and multidisciplinary approach is critical. That means physical health, behavioral health, long-term services and supports, and the outcomes that matter for that person, considered together. A third warns against misapplying the guideline in ways that abandon patients, including rapid tapers and rigid dose caps that CDC says have caused harm.

For pain that has already lasted one to three months (subacute) or more than three months (chronic), CDC prefers nonopioid therapies. Clinicians should maximize nonpharmacologic care and nonopioid medicines that fit the condition, and they should start an opioid only if expected benefits for pain and function outweigh the risks. Before an opioid starts, CDC says the clinician and the patient should talk about realistic benefits and known risks, set goals for pain and function, and consider how the opioid will be stopped if benefits do not outweigh risks.

Nonopioid medicines CDC names include acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants. Non-drug care includes exercise, exercise therapy, mind-body practices, psychological therapy such as cognitive behavioral therapy, manual therapies, and other options matched to the condition. None of those is a suggestion to start, stop, or swap a medicine because it appeared on a government list. NSAIDs, for example, carry their own risks. The prescriber matches the option to the person.

NIDA notes that opioids have been the most common treatment for chronic pain since the late 1990s, despite sparse evidence that they work long term for pain that is not from cancer or palliative care. Some patients develop hyperalgesia, pain that worsens or a higher sensitivity to pain, during opioid treatment. A plan that only raises the dose can fail.

What long-term opioids do and do not deliver

CDC's evidence review found insufficient evidence to determine long-term benefits of opioids for chronic pain, and an increased risk of serious harms that appears to rise with the dose. Compared with no opioid use, opioid use was associated with higher risk of opioid use disorder, overdose, deaths from any cause, fractures, falls, and myocardial infarction. Compared with placebo over one to under six months, the average improvement in pain was small, and that improvement was smaller at three to six months than at one to three months. No placebo-controlled trial in the review showed that opioids were effective at a year or beyond.

A separate long-term trial CDC cites found no function advantage, and higher pain intensity, when stepped care started with opioids instead of nonopioid medicine. CDC also says there is no clear dose below which the risk of opioid use disorder or overdose is zero, and no instrument that predicts those harms with high accuracy. That is why the decision is revisited, not signed once and forgotten.

None of this is an order to discard a medicine that is currently helping you function. CDC says clinicians should not insist on a taper when benefits still outweigh risks. It also says that for people already on long-term opioids, stopping can itself be harmful. Discontinuation of long-term, high-dose therapy has been associated with mental health crisis, overdose, and overdose death. If benefits and risks are close, CDC says shared decision-making matters more, not less. That conversation belongs with the clinician who knows your dose and your pain.

When the concern is opioid use disorder

NIDA defines dependence as the body adapting to a drug. Stop suddenly and withdrawal follows. Addiction is compulsive use despite negative consequences, with other changes in brain circuits. Tolerance, needing more for the same effect, often travels with dependence. NIDA says physicians should screen for misuse when tolerance or dependence shows up, because a higher dose can mean a worsening pain problem or the start of a drug problem. The short-term version of that distinction is the postsurgical guide. Chronic pain is the version that lasts.

NIDA cites one study of chronic pain patients receiving opioids that applied then-current criteria and found mild opioid use disorder in 28.1 percent, moderate in 9.7 percent, and severe in 3.5 percent. That is one study, not a national rate, and NIDA notes that estimates vary with how long people have been treated and how the outcome is defined. Use it as evidence that the overlap is real. Do not use it to calculate your own odds.

CDC's recommendation on opioid use disorder is narrow and important. Clinicians should offer or arrange treatment with evidence-based medications. Detoxification on its own, without those medications, is not recommended, because the risks of returning to drug use, overdose, and overdose death go up. FDA-approved medicines for opioid use disorder are buprenorphine, methadone, and naltrexone. They are explained on the medication guide and the buprenorphine guide. CDC also says a pain-opioid rule should not be copied onto these medicines. A taper written for oxycodone is the wrong tool for methadone or buprenorphine.

NIDA's broader point about co-occurring conditions fits here. People do better when the substance use disorder and the other health condition are identified and treated together, rather than in sequence. Pain clinics that will not discuss addiction, and addiction programs that will not discuss pain, both leave half the problem in the hallway.

What not to do from a search result

Do not stop a prescribed opioid tonight because you read that nonopioid care is preferred. CDC says that unless there are signs of a life-threatening problem, such as impending overdose, opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce higher doses. Sudden stops can precipitate withdrawal. Rapid tapers have been tied to distress and to emergency visits. Ultrarapid detoxification under anesthesia is associated with substantial risks, including death, and CDC says it should not be used.

Warning signs CDC names for impending overdose include confusion, sedation, and slurred speech. Those need emergency help, not a taper you invent. Slowed breathing is the emergency described in the naloxone guide. CDC says clinicians should offer naloxone as part of managing overdose risk. Ask for it.

Do not borrow another person's pain medicine, and do not add alcohol or a benzodiazepine because the pain broke through. CDC says clinicians should use particular caution with that combination. NIDA says alcohol or sedatives with an opioid increase the chance that breathing slows or stops.

Substance use treatment locations are listed on FindTreatment.gov. That locator does not list a pain protocol, and it does not replace the clinician who prescribes your medicine.

Call or text (800) 653-9376 if you want help finding a program that will talk about both pain and substance use. Bring the names of your medicines. Do not stop them before the call.

Additional Resources

Sources cited on this page:

Common Questions

If I have chronic pain and take opioids, do I have addiction?

Not automatically. NIDA says dependence and tolerance can develop with prescribed opioids and are not the same as addiction. One study NIDA cites found a range of opioid use disorder severity among chronic pain patients on opioids, which shows the problem occurs and also that it is not universal. Only a clinician can apply the diagnosis. Do not stop the medicine to find out.

What does multimodal pain care mean?

CDC's guiding principles say a multimodal, multidisciplinary approach should attend to physical health, behavioral health, long-term supports, and the outcomes that matter for that person. Nonopioid medicines and therapies such as exercise, physical therapy, and cognitive behavioral therapy are part of what CDC says to maximize. The mix is clinical. A clinician matches it to you.

Can I taper my pain medicine with a chart from the internet?

No. CDC says opioid therapy should not be stopped abruptly, and a higher dose should not be cut rapidly, unless there are signs of a life-threatening problem such as impending overdose. The pace is individualized and done with the patient. There is no percent-per-week schedule here. Call the prescriber. Call 911 for slowed breathing.

What if I have both chronic pain and opioid use disorder?

CDC says clinicians should offer or arrange evidence-based medication for opioid use disorder. Detox alone, without those medicines, raises the risk of returning to use and of overdose death. NIDA says conditions that occur together, including chronic pain, are better addressed in an integrated way than one at a time. Pain still needs treatment. The disorder still needs treatment.

Do opioids stop working for long-term pain?

CDC found insufficient evidence for long-term benefits and an increased risk of serious harms, including opioid use disorder and overdose, that appears to rise with the dose. At short-term follow-up, pain improvement was small and got smaller as months passed. That is a reason to revisit the plan with a clinician. It is not a reason to quit overnight.