I’d like to take this opportunity to discuss something important to me. An assumption, more along the lines of an uneducated opinion, has turned into a war of sorts that is tearing apart my country right now. That something being: not all people who use opioids are drug addicts.
The problem with those who doesn’t understand this fairly easy concept comes down to observation bias. Those who label anyone who uses an opioid for any reason as a drug addict are refusing to see the distinction between people who abuse opioids and those who take them responsibly.You mean there are people out there who can use opioids and not become drug addicts? Indeed, there are. Case in point? Me.
The Cyst
The first time I took opioids, it was May 2003 and I was 17. I had a pilonidal cyst (basically an abscess on top of my tailbone) and the pain was unbelievable. It left me unable to stand up straight or put on anything tighter than sweatpants. I missed four days of school and almost missed my junior prom. An on-call doctor initially prescribed me Tylenol #3 (Tylenol with codeine). I must be a rapid metabolizer, because within minutes of taking it, the room started spinning. I was immediately drenched in sweat, and I puked everywhere.It took my mom hours to get me off the bathroom floor and to my pediatrician’s office. He instead prescribed Percocet, which thankfully helped the pain, but in a weird way. I remember when I came downstairs the next morning after taking one, my mom asked how I was feeling. I said, “I’m in the worst pain of my life. But I don’t care.” And I plopped down on the couch. Later that day, after we were able to drain the cyst, I remember trying to do my precalculus homework with Percocet in my system and it didn’t go very well. I felt spaced out and couldn’t focus. At some point, I said to my mom, “Why would people want to feel like this?”
And guess what? I didn’t get addicted.
The Wisdom Teeth
Two years later, in May 2005, I had my wisdom teeth removed. My oral surgeon prescribed Dilaudid for post-op pain. That may seem like overkill, but he did this to avoid prescribing a combination Tylenol product, such as Percocet or Vicodin. This was actually a smart move on the surgeon’s part. Since many people don’t realize those medications contain Tylenol, they might take additional Tylenol for pain and end up acutely overdosing themselves, which can cause liver damage pretty quickly. As for the Dilaudid, the surgeon prescribed 8 or 10 pills and I used 2 or 3.
And guess what? I didn’t get addicted.
The Grand Canyon Sucks
My body remained free of opioids until March 2013. Then a 30-mile hike through the Grand Canyon bummed out my already bummed left knee. I was airlifted to a medical clinic on the South Rim. (This earned me the “privilege” of being 1 of 350 people medevac-ed from the Grand Canyon annually. I think I should have at least gotten a t-shirt for that or something.) The doctor gave me a bottle of maybe 30 Vicodin. I didn’t think I was going to need them, but once the swelling in my knee started to reduce, the pain from the actual injury made itself known.Three weeks later, I had knee surgery to repair a torn meniscus. (The original knee injury actually occurred in February 2002 during a dance rehearsal, but I was too stubborn to do anything about it.) My recovery was to be more challenging because my surgeon sewed the tear closed instead of cutting most of the meniscus out. He decided on this approach due to my young age, 27 at the time. This should hopefully prevent early-onset #Arthritis. I was given a prescription for maybe 40 Lortab. I only used them for about 4-5 days after the surgery.
And guess what? I didn’t get addicted.
#Endometriosis is a Bitch
One morning in April 2014, I was struck out of the blue with unbearable right-sided abdominal and pelvic pain. In the ER later that night, I received IV morphine for the first time. And I hated it. Yes, it was helpful for the pain I was in. (For those who are “in the know,” little me was given 8 mg. That’s how bad the pain was.) But what I now know to be the “rush” that people experience when the drug is administered was not even remotely pleasurable to me. Every time I’ve received IV morphine since then, I’ve had to steel myself to ride out the rush because I hate the feeling so much. Eventually, I was diagnosed with endometriosis. This is an extremely painful condition in which tissue that is similar to the tissue which lines the uterus is found growing elsewhere in the body. endometriosis lesions respond to hormones and break down and bleed, which is part of what makes it so painful. Long story short, my first surgery, an ineffective procedure known as ablation, ribbonrx.com/2018/03/23/life-after-endometriosis-surgery-ablation.
I was completely bedbound when I wasn’t at work. The pain could only be somewhat managed by Percocet. When I got home from work each morning (I worked night-shift at the time), my husband would hold my hand as I lay in bed crying, waiting 45 minutes or so for the drug to kick in.I was in such horrible pain I sought a second opinion. In October 2014, I had excision surgery, the gold standard in endometriosis treatment, in Atlanta at the centerforendo.com. Within a few months of the surgery, my body had healed and my pain was virtually gone. I no longer needed the Percocet, and I was glad to come off of it after having been on it for six months.
And guess what? I didn’t get addicted.
The #BrainTumor and the Torsion
Brain tumors hurt, y’all. Don’t let any stupid doctor tell you #PituitaryTumors don’t cause headaches, because ribbonrx.com/2016/07/09/zero-to-migraine, which eventually evolved into severe tension headaches. The only thing that helped those headaches was Percocet.
At the same time in the spring of 2016 that I was being ribbonrx.com/2016/07/08/i-have-what-now, I was also experiencing severe right-sided pelvic pain that felt very different from endometriosis. Yet the source couldn’t be identified. Between the two extremely painful conditions, I was taking 10-12 Percocet a day and still my pain was uncontrolled.At the end of April 2016, my PCP called me in for an emergency appointment. I really thought for a bit that she was going to cut me off due to my frequently escalating doses of Percocet. But she said, “What we’re doing isn’t working. We need to consider a long-acting opioid.” After some trial and error and titration, I was taking MSContin 30 mg three times a day, but still needing 6-7 Percocet a day for breakthrough pain. My pain was such that taking all those opioids didn’t make me feel euphoric, tired, or even free of pain. They simply reduced my pain to a level at which I could function reasonably well.
In July 2016, I finally had ribbonrx.com/2016/07/14/always-a-zebra (back at the CEC) to determine the source of my pelvic pain. It turns out I had a hernia in the broad ligament that was causing intermittent ovarian torsion and bowel obstruction. Within three weeks after the surgery, I had completely weaned myself off the MSContin of my own accord because I no longer needed it.Two months later, I had ribbonrx.com/2016/09/11/the-eviction-of-mini. I was in the hospital for 48 hours and given loads of fentanyl and Percocet. (Having your skull cut open through your nose causes some pretty intense headaches). Six weeks after the surgery, my constant tension headaches finally went away.
And guess what? I didn’t get addicted.
My Pelvis Is Still Mean
I still have chronic pelvic pain that I need opioids to control. Per my OB/GYN, I have two options remaining. One, I can have another exploratory surgery. Or two, in his words, “You need to decide how much pain you’re willing to tolerate.”
Aren’t those fantastic options?
I’m currently working on ways to control my pain, from acupuncture to seeing a chiropractor to eventually seeing a functional medicine doctor. I use certain creams and lotions, heating pads and PEMF technology, all in an effort to get me to the point where my pain is controlled enough that I don’t need the opioids to allow me to be functional. I’m hopeful that that day isn’t too far off.
Currently, if my pain gets really bad and I need 15 mg of oxycodone, it doesn’t make me feel high or even tired. If it makes me feel anything at all other than some, but not complete, pain relief, it’s nausea. I can’t imagine wanting to take any higher dose.
All in all, I’ve been on opioids almost continuously for just over four years. Am I physiologically dependent on opioids? Yes. That simply means that if my pain is ever under enough control that I don’t need the opioids anymore, I’ll need to wean down my dose to prevent withdrawal. But physiological dependence and #Addiction are not even remotely the same thing.
And guess what? After all this, I’m not addicted.
Why Not Me?
It’s taken me time to realize something about myself that might be helping to keep me away from the path of addiction: the feeling of being impaired is something I absolutely despise. I also very rarely drink alcohol for the same reason; I don’t like my inhibitions being reduced even the tiniest bit. The number of times I’ve been drunk I can count on one hand, and I’ve never been hungover even once. I feel the need to be 100% in control of my mind at all times.
Another thought I had involves genetic makeup. Since research has shown that addiction certainly has some genetic component, perhaps the opposite is also true; maybe some individuals have a genetic makeup that makes them less likely to become addicted.
Or perhaps my training as a pharmacist has something to do with it. During my second year (out of six years) of pharmacy school, I took an elective in Chemical Dependency. A pharmacy graduate of the university who became an addict taught the class. I remember him saying that pharmacists are six times more likely than the general population to abuse drugs, not only due to access, but to our education as well.
But I also remember the day his wife came to class to tell the story of her husband’s addiction to opioids from her perspective, from his lies to her to his multiple arrests and jail time. She went around to every single student, took our hand, looked into our eyes, and said, “Please, don’t let it be you.”
And I promised her: it wouldn’t ever be me.
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