Ten days ago I came face to face with a problem that most of us in recovery eventually have to reconcile: pain management. In my case, the situation involved post-op pain from emergency gallbladder surgery that was thankfully short-lived, but even so I knew enough to be aware that prescription pain medication can be extremely dangerous for people in recovery.
When I quit drinking nearly five years ago, my only concern was to avoid alcohol. For years, I had started each morning with two extra-strength Tylenol (for aches and pains, I’d tell myself, because I certainly wouldn’t acknowledge I was hungover every morning). I had no worries about prescription painkiller addiction because I did not use them, and the need for morning Tylenol mysteriously (*wink*) disappeared within a few months of living alcohol-free.
I’ve since listened to enough Dr. Drew podcasts to know that prescription pain medication is a gateway to opiate addiction, and interviewed enough people on The Bubble Hour to be aware that kicking a pill habit is a serious bitch. I’ve learned so much about addiction basics – the hijacked pleasure-reward circuitry, the genetics, and the personality traits – to know that I am in a higher risk category, and respect that good protocol for me includes avoiding anything potentially harmfully addictive.
So when I found myself in the local emergency room, exhausted and weak from painful Choledocholithiasis (a big word I had to Google meaning gallstones in the bile duct), I mustered both courage and strength to appraise the attending doctor that as a person in recovery, I have to be careful with pain medication.
Whew. I get flutters just thinking about it! It was hard to utter those words because:
a) I had never seen that doctor before and had no idea how he would respond
b) I actually really wanted to escape from the pain
c) I was not 100% certain how to self-advocate.
The doctor was very positive, beginning with a slightly patronizing “Alright, high-five! Good for you!” Then, in a more serious tone, he said,”There’s some misinformation about that. When you have pain, the meds treat the pain and you don’t get high. It’s when people take more than they need or take them without pain that a euphoria occurs. But we have something that should work well for you and you don’t need to worry.”
I’d like to tell you that I sat up and asked a dozen insightful questions, but the truth is I just cried with relief and trusted. Sometimes that’s the best we can do.
Following my surgery, I was given a drug called Tramadol for pain. It was mixed with acetaminophen, like a T3 but without the opiate. Tramadol is said to behave opioid-like for pain relief but without the euphoric side effects, and is sometimes used to treat depression. (A quick internet search shows, however, that addiction to Tramadol is, in fact, a concern for many.) My experience was that it did relieve my pain and made me sleepy. I took it every 4 hours in hospital, and once I went home I took it only at night for the first two nights. After that I found that regular strength Tylenol was effective for my pain around the clock, and within a few days I needed nothing at all. I am not giving a recommendation or endorsement for any medication, but simply relating my experience for information.
In the days since, I have reflected on what I did to help me successfully navigate the dangerous waters of pain management in recovery. I was fortune that my situation was resolved within a matter of days, and recognize that this issue becomes much more complicated for chronic conditions and complex injuries.
Here are five things I did that contributed to my success:
- Be aware of the dangers. Simply understanding that some medications could pose a threat to my sobriety, especially narcotics for pain. Although the doctor I spoke with may have been correct in his assertions about pain negating euphoria, I’ve since discovered a recent study from McMaster University showed that 52% of female patients at Ontario methadone clinics indicated that their opioid dependence began with doctor-prescribed pain medication. It seems the problems begin after the pain begins to subside, and the patient is by then at home and left to figure out appropriate dosages without medical monitoring and guidance.
- Speak up. I told the doctor I was in recovery. I asked the nurses each time they brought me the meds to confirm that it was, in fact, Tramadol. I told my husband I was concerned about having pain medications in our home, even ones that the doctor had deemed to be a safe option. Yes, I felt vulnerable – especially with the nursing staff for some reason – but I also felt fiercely protective of my sobriety. I never EVER want to be dragged back into addiction and especially not into that death spiral of pills.
- Enlist an accountability partner. I kept the pills where my husband could see them and kept him posted when I used them. I have heard that some people even hand their meds over to someone else to administer them. I think the hole in the system is that patients are sent home with those little bastard pills to figure things out alone. No education, no written protocol, no follow up.
- Do not use them longer than absolutely necessary. Pain relief is proven to speed healing, but I made a conscious effort to get off of painkillers as soon as possible. Because much of my discomfort was from the gas that is put into the abdomen during surgery, often just a bit of gentle movement and walking around the house was enough to reduce pain. I rested more than I wanted to, whereas the old me would have tried to do too much too soon and then I would have medicated the resulting pain. Instead, I did relaxation exercises and short meditations which also alleiviated a surprising amount of pain.
- Get the leftovers out of the house. When I finished with the meds, there was more than half a bottle remaining. I knew those had to get out of the house, despite temptation to keep them around for the next migraine. Even though Tramadol is said to be less addictive and non-euphoric, I knew I might want to use them to escape a bad mood or feeling because they put me right to sleep. When I drank, it was to escape by falling asleep, and I did not want to have that possibility whispering to me from the medicine cabinet. It wouldn’t be a relapse or anything….Tricky thinking. Nope, get rid of it. I took them back to the pharmacy and asked my pharmacist to safely dispose of the remaining pills. He was somewhat taken aback, so I explained the situation and we had an interesting discussion about this very topic.
Although I am glad that I was granted what is considered a safer option than opiates, I see some flaws in the system. I wish I had been given more education on how to use and then discontinue use of pain meds when I was discharged from hospital. I wish I was given further information when the prescription was picked up. I wish someone touched base to follow up. I understand that there is no provision for these things in our current system, but imagine the lives that could be saved if those steps were taken.
The bottom line is, my sobriety is my priority and my responsibility. I guard it with the same passion and ferocity as I do my own children. Getting sober gave me whole new view on life, and I won’t let anything take that away from me!
Great advice. Like you I had gallbladder issues and was worried about the “we’ll give you some morphine for the pain in a while” comment. I mentioned to the nurse – they told me like you – with a normal dose I’d not feel high – true. I just felt cruddy on in. In the end they moved me to iv paracetamol which seemed better.
I also have to take codeine at times when I have bad migraines. Your advice point 3 is critical. The whole house knows I am on them – they are on the counter for everyone to count and they basically just “keep an eye” on me. It’s never been an issue I stick to the prescription guidelines regarding dose, frequency and how long I take them but I’m happy for my wife or daughter to check up on me.
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Thank you for your post, Jean.
I have had 3 surgeries since getting sober, and I never had any problems with the pain meds.
They don’t give me many, and I find I don’t want them as they make me feel yucky.
In fact after my cochlear implant, the pain meds made me throw up and it was awful!
Most of the time I use regular Tylenol.
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As a pharmacist in recovery I can assure that Tramadol is an opiate and addictive (I was in rehab with a few tramadol addicts) and that Lyrica can be a REAL problem for recovering addicts. Following open heart surgery, I limited my opiate pain medication to 48 hours post-op switching to maximum Motrin thereafter. This regimen worked well. CAUTION with a doctor who says he “understands” because he usually does not.
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Thank you for this, Mark. The words “opiate-like” came straight from my pharmacist’s mouth. I believe he was speaking sincerely, but your point illustrates that even the best intended individuals we trust can be wrong or at odds.
Even after many reassurances that he understood my concerns about pain meds, a doctor prescribed Lyrica for post surgery pain management. I went on a 24 hour high with one pill, and I liked it, a lot. Learned that this medication is the devil for anyone like me. I no longer see this doctor. Thanks Jean for a very insightful post, and illustrating that anything can become addictive including Tylenol…..
I have asked to only be given 3-5 pills as a full perscription with refills by doctor phone call only. I have also asked the pharmacy to give me only 3 at a time. The rest are left there for me to pick up if I want. Lori
I love the doc’s ‘high five!’ then the quick turn into seriousness. Great post.
I understand the guarding your sobriety with the same ferociousness as you would your children. I’m like that too. I’m going to carry this post through the coming years as, inevitably, health issues are bound to come up, if not for me, for someone else in the household.
Great post and so glad you are healing well! Xx
Very helpful post! Thanks so much and glad you are feeling better.
Thanks very much for sharing this story. Your comments and advice are very helpful. Over the years, I have had a couple of similar occasions, and when walked through with honesty and in recovery, the results were great. Here is one of my experiences on this:
I am glad you are recovering well.
I have always had Tylenol 3 (by prescription) for migraines. These migraines have come and gone since I was a teenager. I tried everything.
I have continued to use the T3 as needed. I don’t like them, as they make me sleepy, dull and constipated. But they are the only thing that helps when the headaches get severe.
I am very aware and conscious of them. I tell my husband when I am taking them. And I have never felt any draw to take them for any reason except pain relief.
If I had any other thoughts about them I would remove them from the house completely. But I expect I would end up in the hospital every couple months for pain relief. Which I would suck.
You did the smartest thing by being honest with your doctor. That is always the best idea.
Thanks for this post. I would say that in my experience tramadol is definitely addictive. I took care of my mother for a long time before she passed away. She was prescribed tramadol for her bad osteoarthritis. The doctor let her take higher doses and when it would run out she went through terrible withdrawal symptoms and would be begging me for relief and to get more. She had to quit it cold turkey eventually because it just got too bad. So, yes, I think tramadol should be taken carefully.
I am a recovering opiate addict and tramadol led me into my first relapse back in 2012
Thanks for this, I liked the part where the doctor said the bit about using them appropriately to treat pain you won’t get the euphoric high. My primary gave me tramadol last month for my reoccurring headaches. I’ve been doing the chiropractor thing, exercising, and will see a neurologist in a couple weeks. My doctor knows I’m in recovery from alcohol and was very cautious with giving me pills.
The addict in me was a bit excited that I got a script for tramadol, but I told myself I would use it responsibly for its purpose and be careful. I have been careful with them, and haven’t taken it much since I got it. Although the I will admit that I was exited to get a headache so I could try the pill. It did nothing for me but treat the headache. Meh, I guess my only ‘high’ will continue to be the gym:).