CAN RECOVERING ADDICTS TAKE NARCOTICS FOR PAIN MANAGEMENT?
IS HONESTY THE BEST POLICY?
This is a topic near and dear to my heart as I am a recovering addict and alcoholic myself. I have been clean and sober for over 17 years, by the grace of God, with the help of AA and a lot of hard work. The first hurdle to get over is whether to be honest and upfront with your treating doctors about your past. Although I cannot recount the number of times I regretted my honesty, the answer has to be a resounding YES, you must be totally honest with all of your treating doctors about your addiction history. Even though both my primary care doctor and my oral surgeon treated me as though I was a drug-seeking junkie, I still believe total honest is essential. My primary care doctor was awful to me when my TMJ pain started. He knew about my addiction history and I had always gotten the feeling from him that he was looking down his nose at me. When the pain started, it got much worse, and he acted as if I was scamming him for drugs. His nurse got downright nasty with me as she told me "He's not going to prescribe you any more narcotics". He had only given me one prescription for vicodin. When he started making negative insinuations about my parenting, I fired him. My oral surgeon was only slightly better in his prescribing of narcotics for my pain. I was allotted two 5mg vicodin a day for my pain. I was in pain around the clock, so I had to decide which six hours I was going to a little relief, and which of the rest of my remaining awake time I would spend in pain. My pain was bad enough for four surgeries on my joint, but did not warrant enough pain medication to keep me comfortable for more than six hours a day. So why, in light of this less than stellar treatment, do I think honesty is essential? For one, honesty is deeply ingrained in me as part of my recovery in AA; two, and more importantly, there is a reasonable chance that this information would come to light and I would then look dishonest. When dealing with narcotic pain medication, dishonesty is tantamount to the kiss of death. Any chance of having any ongoing, long-term treatment with narcotics will be next to impossible. This instance of dishonesty can follow you around like a black cloud. Lastly, I think all relevant medical history should be disclosed to treating physicians. I want my pain doctor looking out for me, another set of eyes watching for me to possibly slide down that slippery slope. Anytime an addict takes a mind altering drug the potential to slip is but a pill away. It may take longer to find a pain doctor willing to treat you, but when you finally do, chances are excellent you will be in very good hands, with a caring, compassionate and empathetic doctor. Thankfully this is exactly what I finally found. On the very first appointment I has with my current pain doctor, I was upfront with him about my addiction history and with how I had been treated up until this point by other doctors. His response to me was “Suffering is not an option”. I knew I had found a keeper.
Follow up since this was written:
My doctor has since closed his practice due to the DEA investigating him. He did nothing wrong except help people in pain. I weaned off all the narcotics I was on myself. My primary care doctor manages my pain now. I only take muscle relaxers and an anti-depressant. I am far from pain free but it is manageable. I think he too is afraid to give me narcotics, but not because of my addiction, but fear from the government. It is a sad state of affairs when doctors cannot properly treat their patients because of fear. No pain clinic where I live would even let me in the door. I could not even get an appointment. I have accepted pain is going to be part of my life. No doctor can promise you will be pain free, in fact that is not generally shoot for. They shoot for a level of manageability. Life is not fair and some of us get more than our fair share of suffering. I applaud your sobriety, keep that up. Don’t let these doctors and the pain make you lose that.
MAINTAINING SOBRIETY WITH CHRONIC PAIN
It is possible to sober and take narcotics for pain on a daily basis. Sobriety is more than what is running through one's bloodstream, or more to the point what is not. Sobriety is a state of mind, a way of life, a spiritual centeredness that cannot be altered by drugs, narcotic or otherwise. One big difference between maintaining sobriety and not, while taking narcotic pain medication, is the type of pain one is trying to kill.. If it is for physical pain one is aiming to ease, then one is still sober. But if someone is trying to kill emotional pain, then the line has been crossed. Here is where a deep sense of self-honesty and self-assessment is needed. The problem is, once one is back in the throws of active addiction, denial can be very difficult see through. To deal with chronic pain and management of it, particularly with newly sober people (anyone with under 5 years), there are some suggestions I would make. First, definitely be honest with the prescribing physician. He/she can closely monitor you, making sure you are not calling in for early refills, mysteriously losing prescriptions or pills, or doing anything that is not strictly by the book. Second suggestion, and I have done this myself, when I was in early in sobriety and had surgery that required pain medication for a short time, is to have a trusted person hold onto your medication and to give you only what you need for that day. Having access to an entire bottle of pills can be too big a temptation. Thirdly, have frequent contact with others in recovery. You need to keep talking about this openly and honestly with others. It helps to keep you honest when others know what is going on.
I do not think it is an easy thing to do and definitely not to be taken lightly. I have had friends of mine in AA relapse because of the use of pain medication for legitimate uses. I personally was scared to death to go down this road when the pain started for me. The thought of a life of horrendous pain was scarier though. I sometimes feel angry for being put in this position. It is bad enough that I am an addict, but now I’m an addict that has to walk this tightrope every day. It’s a high wire act with no net. The only thing I have to fall into is that abysmal life of addiction and despair. I am lucky enough to have a wonderful husband who has 24 years in recovery. He helps keep me balanced on that high wire and would not hesitate to confront me if he saw any behavior in me that indicated I was slipping. I am also fortunate that I had 14 very solid years of sobriety under my belt before I developed chronic pain. I must remain ever vigilant, totally compliant with my medication, and totally honest with my doctors. It can be done, and doctors should not shy away from treating recovering addicts with chronic pain. We do not deserve to suffer in pain simply because we suffer from another disease too. Don’t penalize us twice.
I am very impressed with your post. You touch on several different important subjects and you have explained the disease of addiction and dealing with chronic pain very well.
Your correct that just because one suffers from addiction have chronic pain they should not be treated any differently. Unfortunately there are those doctors that will not treat a person who has addiction issues for chronic pain.
There are doctors that specialize in both areas, addiction and chronic pain management.
In fact the past few PM doctors I have had did specialize in both areas.
This would be a wise choice for anyone who does suffer from both disease's.
The DEA is closing down PM doctors/clinics left and right and it is an injustice as most of them only do want to help those who suffer from chronic pain. Here in Florida there have been several articles written by the media telling people that there are strip mall doctors prescribing narcotics to anyone with money. While a few have been closed for prescribing liberally most are legitimate but these articles leaves the practice of pain managment in the worst light possible. The families of those who suffer from chronic pain see articles such as these and assume there loved ones are hooked on narcotics and are in need of an intervention when they only really suffer from chronic pain that is a disease and needs medical treatment.
Honesty is always the best policy. As you explained if it were to come out ( and it will eventually) that one has addiction issues then Pt is left with a horrible black mark on their record and will not be able to find the help they need for pain at that point.
I appreciate your post and know others here will also. As I said you touched on several different subjects that chronic pain Pt's deal with.
I applaud your efforts to stay sober and clean and you have done an awesome job of doing so. As you also realize though you need treatment for your pain too as it is also a disease that needs treatment.
Have you found a new doctor yet to help you?
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