Active Addiction Versus Recovery
Active addiction can pose clinical problems distinct from those encountered with patients in drug-free recovery and those in methadone maintenance programs. Attempts to provide compassionate treatment to these challenging individuals may be skillfully subverted by patients seeking to obtain narcotics for purposes other than pain relief.16 Addicts, especially opioid addicts, often require larger opioid doses and more frequent dosing intervals than nonaddicted patients to adequately control their pain. Ben’s need for what seemed to his physician to be excessive pain medication may have been due to a similar increased opioid requirement to relieve his pain.
Narcotic withdrawal symptoms can interfere with attempts to control pain. The time for detoxification is not when pain management is needed but rather when opioids are no longer medically indicated. For acute pain situations, opioids should be administered in doses adequate to prevent withdrawal and afford effective pain relief. The best analgesia is achieved when withdrawal states and anxiety related to inadequate pain relief are prevented. One way of controlling opioid withdrawal symptoms while maintaining effective pain control is the use of methadone, 1520 mg/day, to control withdrawal symptoms, while additional opioids can be given for control of pain at their usual therapeutic doses.3
Using Pain Medication In Recovery
There are times in recovery in which an individual finds himself in a position to be in need of pain medication. These times include serious injuries and surgical/dental procedures. There can be times when pain medications are medically necessary. Relapse occurs when the medication is used outside of the parameters of the health care providers instruction or prescription. Knowing that pain medication can trigger the phenomenon of craving, especially if it is the drug of the choice of the person in question, it is important that the individual take precautions. If the pain medication is not the drug of choice, it can still trigger back to the individuals original drug of choice and the same precautions apply.
In the event of medical or dental conditions that require pain medication, the following is recommended:
If it becomes apparent that a narcotic pain reliever is needed such as hydrocodone, codeine, or other similar medications, the following actions are recommended:
Recovery is Possible
Treating Pain After Opioid Addiction: A Personal Story
- By Peter Grinspoon, MD, Contributor
Follow me on Twitter @Peter_Grinspoon
As a primary care physician at Massachusetts General Hospital , I am profoundly grateful for my 10 years in recovery from opiate addiction. As detailed in my memoir Free Refills, I fell into an all too common trap for physicians, succumbing to stress and ready access to medications, and became utterly and completely addicted to the painkillers Percocet and Vicodin. After an unspeakably stressful visit in my office by the State Police and the DEA, three felony charges, being fingerprinted, two years of probation, 90 days in rehab, and losing my medical license for three years, I finally clawed my way back into the land of the living. I was also able to return, humbled, to a life of caring for patients.
There is one question that I invariably get asked, by my doctors, colleagues, friends, family members, and at lectures and book talks: now that you are in recovery from opiates, what are you going to do when you are in a situation such as an accident or surgery, when you might need to take opiates again? I have blithely answered this question with platitudes about how strong my recovery is these days, and how I will thoughtfully cross that bridge when I come to it. In other words, I punted consideration of this difficult issue into some unknown future time.
Unfortunately, that future is now, and that bridge is awaiting my passage.
About the Author
Peter Grinspoon, MD, Contributor
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What Are Some Alternatives To Opioids
There are many non-opioid pain medications that are available over the counter or by prescription, such as ibuprofen , acetaminophen , aspirin , and steroids, and some patients find that these are all they need. Other people find relief with nondrug therapies that can be used alone or in combination with medications. These include:
- Physical therapy â A physical therapist or physician who specializes in physical medicine and rehabilitation may be able to create an exercise program that helps you improve your ability to function and decreases your pain. Whirlpools, ultrasound, and deep-muscle massage may also help.
- Acupuncture â You may find relief from acupuncture, in which very thin needles are inserted at different places in your skin to interrupt pain signals.
- Surgery â When other treatments arenât effective, surgery can be performed to correct abnormalities in your body that may be responsible for your pain.
- Injections or nerve blocks â If you are having a muscle spasm or nerve pain, injections with local anesthetics or other medications can help short-circuit your pain.
Many patients also find relief from massages and other relaxation techniques, as well as biofeedback, where you learn to control involuntary functions such as your heart rate.
What Is The Difference Between Drug Tolerance Dependence And Addiction
Drug tolerance and dependence are a normal part of taking any opioid drug for a long time. You can be tolerant to, or dependent on, a drug and not yet be addicted to it.
Addiction, however, is not normal. It is a disease. You are addicted to a drug when it seems that neither your body nor your mind can function without the drug. Addiction causes you to obsessively seek out the drug, even when the drug use causes behavior, health, or relationship problems.
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Your Successful Recovery Is Up To You
Ultimately, successful recovery is up to you. Your goal of recovery should be to live a healthy and clean life. Even if you have friends who take medications a few times a week and seem to live a normal, healthy life, doesnt mean you can do the same.
Non-addicts dont have the same chemistry as you do. It doesnt matter if your substance abuse created this chemistry or if you were born with it, you need to realize you possess it. This doesnt mean you have to live in pain or with allergies. It just means you have to make wise decisions about the medications you take for these conditions.
It is absolutely possible to live a clean life and reach your goals of happiness. But, you do have to work hard and stay away from anything that will cause you to relapse, and that includes refraining from certain medications. Your body is still learning how to function off your substance of choice and you are healing from emotional challenges as well.
So, before you reach for those pills, even if they are natural remedies, make sure you read the labels and ask about their ingredients. If for some reason, you absolutely have to take a specific medication that could threaten your recovery, you and your doctor can work out a plan on how youll take the medication and youll be watched carefully by your addiction specialist and your medical doctor.
If you are in recovery for an addiction and have additional questions about medications, contact us here at JourneyPure At The River.
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How Addictive Are Pain Relievers
There are different medications that can ease short-term or chronic pain. Many of these drugs fall into the opioid category. These drugs are also known as narcotic pain relievers and include morphine and codeine, as well as several synthetic modifications of these drugs.
It is important to be cautious when taking medication for pain. In some cases, the treatment can pose more risk than the underlying cause of the pain. While you can’t remove all risk, you are less likely to become addicted to pain-relieving drugs when you take them exactly as prescribed.
Still, many of these medications produce a high that can become addictive for some patients. Some people become psychologically dependent on this feeling of euphoria. There is also the risk of physical dependence on highly addictive pain relievers.
Dependence is most likely to happen if a person takes a higher dose of an addictive pain medication than they were prescribed or if the medication was improperly prescribed.
Pain medication overuse is one of the most prevalent forms of drug misuse in the United States.
One of the reasons is that addictive pain medications are sometimes over-prescribed. For example, a person might not need such strong pain relief, or a pain medication might be prescribed for longer than a person needs it.
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Has Your Treatment Failed If You Relapse
Because of the chronic nature of substance abuse, relapsing is possible. The good news is there are medications, such as Naltrexone, Subutex, Campral, and others that you can take that will help you manage cravings. Your doctor can direct you to some pharmacologic interventions too. You might have to get some blood work done before you start using any of these medications. Youll need to use them under counseling medical supervision as part of your ongoing recovery.
Can I Take Narcotic Pain Medicine In Recovery
For most people in recovery, avoiding narcotic pain medicine is a part of staying sober. Using these drugs without being directed to do so by a doctor is considered a relapse. Even using them when they are prescribed is considered a bad idea by many people in recovery, because there are usually other options for treating pain, and taking these medications can lead to addictive behavior and drug use.
Some people who undergo serious surgeries in their sobriety may not be able to avoid taking narcotic pain medicine. In these cases, the best course of action has to be decided upon by the individual patient, their doctor, their sponsor, and their sober support network. For some major surgeries, these medications may be necessary. In these cases, many recovering individuals may give the medication to their sponsor to hold or may decide to take it only as prescribed while in the hospital and not fill any other prescriptions once they are home. Some others may decide not to take narcotic pain medicine at all in order to avoid the potential risk of relapse. This decision must always be made based on what is best for the individual and their sobriety.
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Avoiding Narcotic Pain Medicine At The Hospital
In my personal experience, I have had multiple occasions in which doctors have tried to give me narcotic pain medicine while I was hospitalized. I suffer from chronic kidney stones, an extremely painful condition. However, in my experience, taking narcotic pain medicine is too much of a risk to my sobriety, even if its offered to me in the hospital. In order to stay sober, protect myself, and treat my pain, I avoid narcotic pain medicine and opt for treatment methods that have less of a risk of causing a relapse. It can be tempting to accept narcotic pain medicine at the hospital, especially when dealing with severe pain. After multiple hospitalizations, Ive picked up some tips for avoiding using narcotic pain medicine:
- Bring a sober friend to the hospital who can hold you accountable
- Tell hospital staff and doctors that you are in recovery or that you cannot take any narcotics
- Ask for non-narcotic pain medicine options
- Dont accept take-home prescriptions for narcotic pain medicine
In my experience, communicating with my doctor and the nurses has always helped me to get non-narcotic medication and treatment that relieves my pain and doesnt put me at risk of relapsing. This decision is always up to the individual, but for me, avoiding narcotic pain medicine at the hospital is the best choice for protecting my sobriety.
Can Alcoholics Take Prescription Pain Medication In Recovery
Is it okay to take prescription pain medication when you’re a recovering alcoholic or addict? Does getting sober mean you can never take a drug of any kind for the rest of your life?
Some recovering addicts are so dedicated to living clean and sober that they eliminate all mood-altering drugs or substances from their lives — including caffeine and psychological medications. These men and women are cognizant that their addiction can manifest in a dozen different ways.
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What Sedatives Are Used
Several non-opioid drugs can be used as sedatives when following the MAC approach:
- Midazolam
Midazolam belongs to an anti-anxiety group of drugs known as benzodiazepines. It induces sedation and amnesia during MAC and pain relief after surgery.
- Propofol
Propofol is a less-sedating and frequently used drug. Propofol also reduces nausea and vomiting symptoms that often require additional treatment and are worsened by opioids and pain itself.
- Dexmedetomidine
Dexmedetomidine and Clonidine belong to the same class of sedative painkillers that act on the brain and blood vessels. Dexmedetomidine is newer, also relieves anxiety, and has fewer side-effects.
Recovery is slow and it may not be safe for elderly patients, as drops in blood pressure and heart rate can occur with its use.
- Non-Steroidal Anti-Inflammatory Drugs
NSAIDS such as Ketorolac are another safe option.
- Ketamine with Propofol
Ketofol offers an almost ideal combination for sedation that tackles both pain and nausea. Propofol is given first to induce rapid sedation, followed by Ketamine to block pain pathways.
Newport Beach, Californias Dr. Barry L. Friedberg reviewed 80 clinical trials and found that Ketofol increases patient satisfaction, shortens recovery time, and eliminates the need for opioids.
How Pain Pills Work
Prescription opioids interact with opioid receptors in the brain, intercepting and warding off pain sensations. They also slow down heart rate, blood pressure, and breathing rates, inducing a sense of relaxation. Most prescription opioid drugs are classified as Schedule II controlled substances by the Drug Enforcement Administration . Even though they do have accepted medical use, they also have a high potential for diversion, misuse, and dependence.
The National Institute on Drug Abuse reports that about 54 million Americans have misused a prescription drug at least once in their lives. At the time of the 2014 National Survey on Drug Use and Health , approximately 4.3 million American adults were considered to be currently abusing prescription painkillers.
Taking these drugs, even as directed, can lead to physical and psychological dependence, as the brain gets used to the chemical changes incurred by their interference. When an opioid drug enters the brain, fills an opioid receptor, and depresses the central nervous system, it also increases the presence of dopamine and endorphins. Dopamine is one of the brains chemical messengers, or neurotransmitters, that signals feelings of pleasure. With repeated chemical interference, the brain may stop making and absorbing dopamine naturally, and brain chemistry may be negatively impacted. This is called drug dependence. When an opioid drug wears off, dopamine levels dip and both physical and emotional discomfort can occur.
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Barriers To Pain Management
On the prescriber side, there are:
- Regulatory fears
- Fears of being lied to by substance abusers
- Fears of creating addiction or causing a relapse
- Lack of training on pain assessment and pain management in general, and specifically in the recovering substance abuser
On the consumer side, there are:
- Fears that taking any opioid will mean Ive lost my sobriety
- Failure to take pain medication as prescribed
- Fears of getting addicted
- Lack of knowledge about how to report ones pain in a way that is useful
Of course there are cultural and language barriers that may also serve to impede effective pain management.
Pain Pill Addiction Symptoms And Causes
Pain pill addiction occurs when an individual develops an addiction to medication including opioids that is intended to treat pain and other symptoms. Some opioids, like heroin, are illegal. Others, like Oxycontin and Vicodin, may be prescribed to individuals who are facing severe pain. According to the American Society of Anesthesiologists, opioids are used by people with chronic headaches and backaches, by patients recovering from surgery or experiencing severe pain associated with cancer, and by adults and children who have gotten hurt playing sports or who have been seriously injured in falls, auto accidents or other incidents.
One major factor contributing to pain pill addiction is prescription drug abuse. The Mayo Clinic states that prescription drug abuse is the use of prescription medication in a way not intended by the prescribing doctor. Examples can include a patient taking a higher dose or higher frequency of their prescribed medication than what their physician recommended, or requesting unnecessary refills for pain medication.
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The Dangers Of Having Surgery While In Recovery
While no one is expected to be a martyr and forgo healing medical care, it is essential that anyone in recovery understand the risks associated with pain management in addiction recovery. In fact, one recent study found that millions of Americans stumbled into drug addiction as they recovered from a common surgery. Still, others got their hands on the billions of unused pain pills that are doled out each year for post-surgical care.
It would be a shame to break free from addiction and then end up right back in that terrible place because of a standard medical procedure. Whether you need to have a prescription painkiller prescribed or not, there are ways that you can prevent substance abuse from taking charge of your life once again.
Chronic Pain And Health Conditions
The causes of both chronic pain and addiction can be complex and very difficult to treat. Chronic pain often calls for several medications, some with side effects that can be disruptive to daily activities. For example, conditions like fibromyalgia that cause chronic fatigue, tenderness, and bone pain not only cause chronic pain but can also be emotionally frustrating to deal with. Additionally, chronic pain can be caused by health conditions like:
- Endometriosis or uterine fibroids
Chronic pain may also have lifestyle causes like:
- Long-term poor posture or bending
- Sleeping on a poor mattress
- Years of improper lifting or carrying heavy objects
- Wearing high heels
Other traits of chronic pain include an inability to move around, muscle tension, changes in appetite, and emotional frustrations due to ongoing pain. Lastly, women, tobacco smokers, obese people, and individuals who have had an injury are most at risk of battling chronic pain.
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