Refusing Prescription Opioids in Recovery

prescription pad rx

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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    July 25, 2018 at 6:48 PM

    The “Opioid Epidemic” pendulum, in my opinion has swept too far. I appreciate that there has been decades of over prescribing, misuse, abuse and addiction.
    But there are people that legitimately need these opioid medications and the to the point that chronic pain patients are being denied access to medication for which they may be “dependent” to be at a threshold to control their pain but not “addicted”.
    I truly believe that there is a distinction. Rarely does the medical community acknowledge or subtract this group from their statistics.

    Opioid Dependent Patients have never sought to manipulate their doctors, ER’s, doctor shop, increase dosages or but have used their medication as prescribed, have been educated as to the side effects, attended pain management specialist/clinics and are med compliant.
    Currently, in our Province, EVERY death in which there is a trace of Fentanyl, even should the cause of death not be Fentanyl related (i.e. died as a passenger on a train) will be listed as a Fentanyl/Opioid death statistic. I think this skews the statistics somewhat. At least in the province I live in (Alberta).
    The College of Physicians & Surgeons has mandated that an application must be approved for any treating physician to prescribe Fentanyl, Oxycodone etc. They are strictly monitored in quantity, dosage, triplicate copies.
    Most family physicians, and some specialists will not apply as there is too much bureaucracy and they can’t be bothered.
    Pain specialists are difficult to find and defer prescribing to the family physicals.
    Now where????
    Yes, I agree that over prescribing has happened in the past and has lead to a huge addiction problem and every alternative should be considered as a treatment plan. There has to be some ground floor training as to the nature of pain, treatment of immediate pain, alternatives, use of anti inflammatories and good use of paramedical treatment. Education on addiction follow up.
    But, be cautious, that you may cross the boundary of “Do no harm” while your intentions are very honorable.

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    John Byrom

    July 25, 2018 at 2:18 PM

    I am in recovery and many years ago I had my nose broken in an operation to fix my air passages. I was prescribed an opiate. I was very carful and extended the time before taking one dose. I ended up only taking three pills. My addiction was woken up though, and a couple weeks later my disease worked on me telling me I’m worthless and no one cares about me. I knew what was happening and got closer to my recovering friends and in a week or so it passed. Be very vigilant with secondary withdrawals.

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    Alan A. Wartenberg MD, FACP, DFASAM

    July 25, 2018 at 2:10 PM

    Fully understand and agree with Dr. Muench’s concerns, and am pleased that he was assertive enough to get a good outcome. There are, however, procedures where the pain will be more than mild-to-moderate, and opioids may be required, or cases where alternatives (like the combination of Ibuprofen 400 mg and Acetaminophen 1000 mg – 2 OTC Advil and 2 OTC Extra-Strength Tylenol) are contraindicated. Developing strategies with one’s sponsor and/or significant other, as well as informing the prescriber and having him/her as part of the plan, is critical in these cases. Having a second party have custody of the meds, or having no more than one or two doses in hand (with the rest in the hand of the sponsor or SO), having frequent checks and very short-term prescriptions, can prevent relapse. Increasing one’s supports in such times, more visits from sponsors, or attending more meetings, working on alternative pain management techniques (meditation, relaxation exercises, yoga, TENS units and/or whatever works) is also an important strategy.

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