Anyone in recovery who has broken a limb, been in a car accident or had surgery or some incredibly painful dental work has had to face the pain meds question. And it’s one that usually draws the loudest responses from the people who are going to give you the worst possible answers. There’s the one school of thought that is totally opposed to taking any kind of pain medication, and then there’s the other extreme position that as long as a doctor is prescribing it, there’s absolutely no problem. The truth, as usual, lies somewhere in the middle. And it really does depend on where you are in your recovery.
The first group is made up of those that will tell you that taking pain meds (mostly opiates, BTW) will almost certainly guarantee a relapse, and even if you’ve just had your leg amputated with a rusty saw, you should suck it up, bite on a bullet and wait until it passes. Oh, and pray. If you take the meds, they contend, you will surely relapse and die, and even if you don’t, you’ll certainly lose their cherished respect. While these people are well intentioned (and unfortunately, actually right in some cases), anyone who looks at an issue with such a black-and-white attitude is usually operating off a bias that isn’t very strongly rooted in demonstrated addiction recovery. But even though those folks can come across as controlling dickheads at times, at least their hearts are (generally) in the right place. Sometimes people do relapse on pain meds.
The other extreme faction is actually more dangerous to listen to, because they don’t fully respect the true nature of addiction. They’re usually the ones that start this discussion with, “If you don’t have an MD next to your name, then shut up,” forgetting that in 2010 alone, opioids prescribed by people who did have MD next to their names led to 92,000 overdoses. And my guess is that most of those people who died had addiction problems, because you don’t tend to OD when you take meds as prescribed.
The medical model isn’t always a good recovery model. Most doctors don’t really understand how an addict’s brain works—that if we put something in our system, we’re automatically going to want some more, and some “unintended” consequences can result. For instance, we can easily read “one every four hours” as “four every one hour” and it’s not because we’re dyslexic.
And it’s not because the doctors are bad people, it’s because most aren’t trained in addiction. This isn’t just my opinion; it’s backed up by a report from the National Institute of Health, which states, “The overall emphasis among various levels of training remains disproportionately low compared with other chronic medical disorders.” I’m lucky because my PCP is trained in addiction recovery (I met him while I was in detox). Some of the other doctors and dentists I’ve seen have just methodically written up prescriptions for pain meds that I probably don’t really need even after I told them I was a cross addicted alcoholic.
Addicts and alcoholics (even the ones that don’t understand that alcoholics are addicts) don’t react to pain medications the way that normal people do, because that’s what makes us addicts. And because of that fact, we really can’t take pain meds even if we can find a doctor to prescribe them, so we’d better have a good reason (like extreme pain) if we really want to be sober.
One of the things that I’ve found by listening to people in recovery is that many alcoholics and addicts—particularly alcoholics—tend to think of having to take pain meds like Vicodin, Percocet and Oxycontin as a kind of get-out-of-jail free card, a way to get high without changing your sobriety date. I know I have, and even after a number of challenging experiences, still do to some extent. For instance, the unpleasantness of a colonoscopy/endoscopy every few years is more than balanced by the knowledge that I won’t feel a thing and will wake up still jammed out of my gourd on Fentanyl and Versed (basically heroin and Valium) and stay that way for a few hours. But since there are no more meds coming after that, it’s a one shot deal and I just go back to reality again without consequences.
But it’s a little different when you get a prescription, because that’s where the potential for abuse really presents itself. I have taken pain meds a handful of times in my 11 years of sobriety, with varying levels of consequence—none ending in relapse but a few experiences that gave me a firsthand education on how opiates work on a sober addict’s mind.
When I was about five months sober, I had hand surgery to straighten out my trigger finger (I’m not a hit man, it’s really called Dupuytren’s contracture), which was a complicated procedure with a lot of post-op pain. Before the surgery I told my recovering heroin addict friend that I wasn’t worried about taking meds (Percocet) because I didn’t really like opiates.
“Don’t worry kid, you will,” was his reply, and I found out what he meant. Although I took them as prescribed, I found myself eagerly waiting my next prescribed dose, regardless of how much pain I felt. And when I went to a party one night, I convinced myself that I was in a lot of pain, so I took an extra one, just like the prescription said—“as needed.” In hindsight, what I “needed” was to catch a buzz before the party. After that I gave them to my nurse wife to dole out on schedule. I also resorted to another addict behavior. After I stopped feeling pain, and mindful of my growing fondness for the pills, I sold the rest of the prescription to my old drinking buddies to remove the temptation. Not good sober behavior. But the obsession to drink or drug didn’t return with that round of meds.
But it did with the next one. My next encounter came as a result of a root canal at about 15 months sober. The dentist gave me a Vicodin prescription that I didn’t fill, but then the pain went through the roof as soon as the anesthesia wore off. I ran to the pharmacy, and when I got home, my wife (the nurse) told me to take two, given the pain I was in. If she weren’t there, I would have crushed them and snorted them, like I did with Xanax when I was drinking and had the shakes. The two kicked in about 20 minutes later and I was fucking jammed. It was awesome. I know I was taking it for the pain, but I loved every second of it.
The next day I had no dental pain, but I still had 10 Vicodin. Despite knowing the potential consequences, I almost immediately rationalized that it would be a shame to waste the pills that I paid for, and besides, my arthritic hands were bothering me. I picked up the bottle, unscrewed the cap, and then (luckily) the thought came to me, “This is what they told you would happen.”
I ran into the kitchen and dumped the Vikes down the disposal. But it didn’t end there, because the obsession to drink and take drugs returned, in a very subtle form. I became really angry and irritable, and when I went to meetings, everyone sounded like an asshole. About a week later I was watching a TV commercial where a guy was sipping Bailey’s Irish Cream, and I became furious and screamed at the television, “Put some booze in that, you pussy!” That’s how I found out for myself that I was dying to drink. Most alcoholics really are addicts, and the Vicodin had set off the urge to drink again. Apparently, both alcohol and heroin stimulate a receptor in the brain called the opiate receptor. But I didn’t drink or drug and it passed because I continued doing the usual intensive recovery drill.
My third experience showed me why being a hero and not taking meds is a really bad idea when you’re in massive pain, and also that you can be in recovery and take opiates without consequence if your recovery is on the beam. When I was seven years sober, I shattered the top of my shin bone jumping off a fence (it’s not as traumatic an injury as it sounds). When they sent me home from the emergency ward, they offered me pain meds, and I refused because I wasn’t in unbearable pain. That changed a few hours later, when the screaming agony set in and I would have pimped myself out just for a couple of Percs to stop it. The next day I got a much needed prescription and was okay in a few days.
A few months later, I had surgery and they sent me home with a lot of really good drugs, including 100 Percs and a bunch of really powerful Dilaudid. I took them for about three days, but didn’t like being that fucked up. When I was relatively pain free for a 12-hour stretch, I poured them down the disposal before I started liking them. The obsession didn’t return this time, but I had been going to meetings, talking to people and had been sober long enough to not want to be fucked up anymore.
It has been my experience that alcoholics who relapse on pain meds are usually (though certainly not always) either in early recovery or have a less than enthusiastic program. Based on relapse stories I have heard firsthand, it generally means not going to enough meetings or working any kind of a program, and basically getting caught off guard. Even when I’m on the beam it’s a challenge but it can be done without relapse. Yes, I’m powerless over drugs and booze, but I’m not powerless over what I can do about it.
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