Refusing Prescription Opioids in Recovery

    I have not taken an opioid in 20 years.

    A few years ago, after a significant dental procedure, my dentist said, “We’ll get you a couple of pain pills to put you at ease for the next couple of days.” It was the first time I was offered an opioid since I’d been in recovery. I immediately declined, saying “No thank you, I will be okay with some over-the-counter medication.” He said, “Oh, don’t be silly, give yourself a break.” I responded, “It might be more than a break – I am in recovery from heroin addiction.” His face dropped. He apologized that he didn’t know. He gave me extra-strength ibuprofen and that was that.

    I knew that something like this would happen and was prepared to say no, but the nonchalant offer still startled me. Several thoughts rushed through my head:

    Maybe it would be fine.

    I shouldn’t have to feel any pain, so why am I denying myself comfort?

    The pain may be too great to handle, and maybe I should just be prepared.

    Nothing my doctor did was out of malice. He was simply doing what most dentists and physicians do. They want to make sure their patients are satisfied, and opioids are an easy fix to a patient feeling discomfort. Many don’t know the recent research on even short-term opioid prescriptions increasing the risk for dependence later on, nor the cascade of emotions that come from being offered a prescription when you are in recovery. There was no pre-interview about my history or risk factors for addiction, no discussion of the addiction potential of opioids, and no “stepped” approach to prescribing non-opioid alternatives as a first line of treatment. Unfortunately, physicians have not been trained to say, “You will feel some pain, and that is okay. Come back if you need something stronger.”

    What is most telling to me is that there was no discussion with my dentist about a pain management plan that excluded opioids. I didn’t hear, “This is going to be very difficult. By me not giving you this medication, you are going to have to take off work or get additional help. Be prepared — here are a set of procedures if you can’t make it through the day.” All the dentist provided was a simple recommendation for an alternative, stronger over-the-counter pain reliever. And you know what? It worked. I felt some mild pain, but that was a good thing. I was alert, and my overall functioning was better without opioids.

    I tell my doctor upfront that I do not take opioids. I won’t let my expectations of what pain may be like later trick me into feeling that I need a strong opioid pain reliever. I don’t, and if I do, I will make a pain management plan with my doctor or dentist before any procedure. However, at no point will I ever let someone convince me to take an opioid until all other alternatives are exhausted.

    For our children and loved ones in recovery, assessing another’s pain can be a harder task. If you’re in the position to advocate, don’t back down and speak with their healthcare provider prior to any visit and let them know opioids are not an option. If you don’t want to disclose that your child is in recovery, you can simply say that they are allergic to opioids, and make sure this information is included in their chart so that if someone else is covering for your dentist or doctor, they won’t inadvertently prescribe opioids. Empower your loved one with research to show that opioids are no better than over-the-counter medications in many cases. Empower yourself to know that the potential consequences of your child taking an opioid alternative may be a slight increase in pain in the short-term, but that the potential consequences of taking an opioid could be much worse. It’s so important to be an informed parent and advocate.

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    By Fred Muench, PhD
    July 2018
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