This morning’s news that Prince died of an opioid overdose made me livid. Why? Because it was preventable! It also demonstrates — yet again — the complete ineptitude of how the American medical industry deals with pain management and the epidemic levels of addiction which have become a serious issue over the past decade.
I recently experienced first hand how easy it can be to become addicted to opioids. This latest celebrity death, was the proverbial straw and hit me closer to home than in the past.
This is the story of how simple and easy it is to become addicted. You too are just an injury away from potential addiction.
About 8 weeks ago I broke my leg and ankle in a horseback riding accident. At the ER I was given pain meds as they reset the bone and to help me through the next 8 days while I waited for the swelling to reduce before they could operate. I was given a prescription and precise instructions on how often to take the meds and told that I should stay on ‘top of the pain’, since waiting till you feel pain means you have waited a bit too long. It’s worth noting that up until that point, I had survived a good two hours without a single pill, and was told that I have a surprisingly high pain tolerance. But the instructions kinda scare you, so being a good patient, I listened and stuck to the schedule.
Following surgery I was given stronger pain meds, my surgeon even joked that I had been on wimpy pain meds. I was again directed to take my meds every 4 hours or so. I complied and even set an alarm every 3.5 hours to comply with my instructions. At around 72 hours after surgery [the traditional peak of post surgical pain], I was feeling some real pain — the first time it actually made me uncomfortable. I got nervous I would not have enough pills to last through the weekend so I proactively called the doctors office and after some perfunctory questions, was mailed a prescription for more meds [if needed].
By day 5 after surgery I was feeling a bit better and realized a) I probably didn’t need to be taking as many meds and b) I only had a few pills left anyway. By this point, I was kinda out of it and not thinking too clearly. I pride myself on being strong and I had never been on opioids before, so I just stopped taking them. I should not have made this decision on my own but no one had counseled me or warned me on tapering. At this point I had been on two different types of pain meds for about two weeks.
Needless to say, the next four days were hell. I lived through some really heavy withdrawal symptoms.
I had the shakes, I was lightheaded and had absolutely no appetite. It took me two days and a bad fall to even realize that I was going through withdrawal [thanks to a smart friend]. I just chalked all of this up to post surgery recuperation. Even if I had wanted to taper off appropriately at that point, I did not have enough pills and had already been through the worst of it — so I sucked it up.
Why am I sharing all this?
Nowhere in my conversations with ANY of the medical professionals I came in contact with did anyone communicate or counsel me on getting off pain medication.
My entire care was about managing the pain — god forbid I should feel any pain. The only side effect I was told about was to increase my fiber intake as opioids do a number on your bowels. Now, I am not advocating that we do not need pain medication for major surgery. We most definitely do and it is an important and helpful part of recovery and modern medicine. The medical profession is so very careful to explain to patients before surgery how to take medications, aren’t they also under an obligation to patients to communicate how and when to stop taking these medications?
Why do we not include simple directions and counseling on how to taper off your medication with every prescription?!
These directions should be communicated verbally, and ideally printed. This is a simple solution that would go a long way. It has two major areas of impact:
- Educational: A medical professional talking to you about tapering off sets a tone and alerts you that this is a two step process — you will take meds and you will stop taking meds. It is important to know this before surgery and the meds take hold. It must be communicated when you are discussing managing pain with your medical professional — doctor, nurse, anesthesiologist or surgeon. Once you are post surgery, these kinds of decisions are foggy at best. You are just too out of it and busy dealing with recovery.
- Physiological: If the pain meds are working, your body has gotten used to them — therefore, you can become addicted. It can happen in as little as 4 -5 days [as it did with me]. Physicians need to communicate the physical and emotional impact of these drugs and the importance of tapering off. You need to be given equally specific directions on how to taper off as you are on how to manage your pain. I was told explicitly to take a pill every four hours. Why could I not be told explicitly how to taper off? These directions should be printed out with every prescription, alongside the directions for taking the medication.
This is an appropriately hot topic in our society and in the medical profession. As the industry debates the big issues and starts to set new guidelines and procedures, I think the simple approach outlined above would go a long way in helping to prevent the unintended consequences and unexpected addiction that can accompany surgery. I know it would have helped me.
If not for a smart friend jumping in at a critical moment, I too could have become one of the nameless, faceless statistical opioid dependents we read about in the news.
Note: Chronic post surgical pain management is a much more complex issue. The medical industry has woken up to the need to better address this issue, but IMHO it is taking too long to integrate throughout the profession.
