Does use of just one dose of an opioid lead to addiction, or does addiction only occur after establishment of physical dependence? Physicians put a lot of effort into avoiding prescribing opioids at all or to those deemed at risk for addiction, but do they really have the tools they need to tell one from the other?
Maybe the risk of addiction stems from the experience of use the first time. Maybe some of us like the effect -- the so-called "high," and some dislike the effect. Those who dislike the effect still develop physiological dependence if they take the drugs long enough, but they might not progress to addiction. Those who feel a euphoric effect with their first use ever might try to find ways to use opioids again even after a single dose and progress to addiction.
Maybe a characteristic of our brains makes some of us like the effects of opioids while others do not. If we could identify those most at risk before prescribing that first dose, we might try harder to avoid prescribing to those individuals even once, and if we must prescribe once, we might exercise more caution in helping them deal with that risk.
Ultimately, we may want to treat with opioids even those at highest risk for addiction, but we could inform and educate them. Perhaps, too, opioids might differ in that initial high. Maybe buprenorphine, for example, produces less of a high with first use than, say, hydrocodone.