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!