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Psychological dependence is a condition characterised by abnormal behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis to experience its psychic effects.

Drug dependence is a pathological psychological response and not physiological. For patients with advanced cancer, concerns about psychological dependence are largely irrelevant as many will require continuing therapy with opioids until they die. Even if it is anticipated that their pain will be relieved by other means, opioid analgesics should not be withheld because of any concerns related to psychological dependence. Several large studies have shown that, with the exception of a few patients with a past history of psychiatric disturbance or drug dependence, patients with cancer do not become psychologically dependent or addicted to opioid analgesics.

• The risk of addiction in cancer patients with pain is extremely low.

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