The course of opioid dependence is affected by multiple interacting conditions in the person and in the environment. The combined conditions create thresholds for the onset, continuation, and relapse after remission of opioid dependence. Different methods of investigation (for example, pharmacological, psychological, sociological, psychiatric) have led to different theoretical conceptions of the causal conditions and processes in opioid dependence. These conceptions, however, tend to be compatible and supplementary rather than contradictory. In the following description of the course of opioid dependence, the principal conditions thought to affect its onset and course will be identified.
In the United States, legal and medical conditions affecting opioid use and dependence have changed since the nineteenth century. In the nineteenth century many persons regularly used laudanum or morphine that they obtained legally from physicians, retail drug stores, or other sources. Physicians often prescribed or recommended these drugs for treatment of chronic physical PAIN or psychological distress. Although daily use of an opioid drug with consequent dependence on it probably impaired the social performance of many persons, reports exist of persons—including some with distinguished careers—who acceptably filled social roles during years of opioid drug dependence. Though some antisocial persons used opioid drugs, such use itself did not lead to criminal behavior.
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