Pain Control After an Opioid Addiction

Don’t torture patients – treat their pain!

I am seventeen years in recovery from a vicious addiction to prescription painkillers. My cataclysmic downward spiral, as a heavily addicted doctor, and then my return to medical practice, is detailed in my memoir “Free Refills”. I walked into a common trap for physicians (and other healthcare providers), succumbing to stress and ready access to medications (the “Free Refills” doctors and nurses are continually exposed to…). I became hopelessly addicted to Percocet and Vicodin, which led me to such strong compulsions that I routinely broke the law and stole drugs (which I am not proud of but…this is pretty typically what addiction can do to even a nice, ethical person.). As with all addictions, it starts out fun, with bursts of euphoria, and quickly ends up utterly miserable and ruinous.

After a profoundly stressful visit to my primary care office by the State Police and the DEA, (“cut the crap doc – we know you’re writing bad scrips”), followed by three felony charges, being fingerprinted, two years of supervised probation, 90 mandatory days in a brain damagingly inane rehab, and losing my medical license for three years, as well a brutal divorce (from a very stressful person…), I finally clawed my way into a sustained recovery from addiction. I believe that, at heart, recovery involves getting one’s need met in healthy, sustainable ways so that the drugs don’t have any place to creep back into your life.

What if you need opioids after a surgery?

What if you need opioids after a surgery? This is one question that I was invariably asked by colleagues, friends, and family members: 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 used to blithely answer this question with platitudes about how strong my recovery is those days, and how I would thoughtfully cross that bridge when I came to it. I punted consideration of this difficult issue into some unknown future time. Unfortunately, that future has now come several times, with major surgeries requiring opioids. How did I cope? How did I avoid a return to the nihilistic emptiness of addiction?

                                                       

The most recent test was in August 2023 when I was mowed down by an elderly psychiatrist who was driving at night without her lights on. I was crossing the street with my family to get ice cream and she plowed right into me. I never saw her coming. My right leg was severely fractured. Lying in the road, I held my drooping foot onto my leg, to preserve the blood flow (and hopefully preserve my foot…) as the bones poked out of my leg.

You don’t need a radiologist to see how badly my leg was broken. Just looking at this photo causes a flash of PTSD for me.

Within minutes I was in an ambulance. They gave me 200ug of fentanyl – enough for 8 colonoscopies. It didn’t touch my pain at all, even in the slightest. It didn’t even make me sleepy which is amazing given that I hadn’t take opioids for years and had no tolerance.

I asked the medics for more, as the pain was all consuming, worse than I ever imagined was possible. They said, “you’re at the maximum dose, we give you more, you stop breathing.” At that moment, I was experiencing fentanyl-resistant pain.

The ambulance was headed to Man’s Greatest Hospital (MGH), the hospital where I work, and where I underwent a sequence of gruesome surgeries and painful procedures. Even on a good day, being in the hospital is excruciating, with procedures, blood draws, transfusions, I.V.’s, beeping machines that keep you up at night, moaning roommates, and pressing logistical issues like, ‘how am I going to get to the bathroom?”

What is a person who used to suffer from a substance use disorder (SUD) to do when they need pain meds?

There are tens of millions of us in this country alone who are in recovery from addiction, or who are suffering from an active addiction.