How Do Former Opioid Addicts Safely Get Pain Relief After Surgery?

[cduggles]

NPR
shots

TREATMENTS
How Do Former Opioid Addicts Safely Get Pain Relief After Surgery?

April 20, 2017 5:00 AM ET
Heard on Morning Edition
CRAIG LEMOULT
(Audio available at linked site)

Nearly 1.5 million Americans were treated for addiction to prescription opioids or heroin in 2015, according to federal estimates, and when those people get seriously hurt or need surgery, it's often not clear, even to many doctors, how to safely manage their pain. For some former addicts, what begins as pain relief ends in tragedy.

Max Baker is one such case. He started using prescription pain pills as a teenager in New England and quickly moved on to heroin. His father, Dr. James Baker, is a physician in the Worcester, Mass., area, and says he saw signs that his son was high on opioids — in Max's pupils and skin tone. He begged Max to stop.

"He would have slurred speech, and be nodding off at the dinner table, and we'd go to a concert together and he would disappear and come back acting differently," James Baker says.

It was a long, painful slog, but Max eventually sought help. When he was 22, he was prescribed an opioid called suboxone, a standard relapse prevention drug that helps wean people off opioids. After a year, he'd worked his way off that medication, too.

He earned his high school equivalency degree, and a two-year associate of arts degree. Things were starting to get back on track, his family and friends thought.

"He called me just a few days before Christmas in 2014," Max's father remembers. James Baker still has the voicemail message.

"I just wanted to touch base with you," Max said in the message. "And also I wanted to let you know that I got a job."

"It didn't matter to him if he was washing dishes or delivering pizza," James Baker says. "He was working."

Max signed up at the University of Massachusetts in Lowell to continue his education — he'd decided he wanted to be a doctor, like his father.

By all accounts, the young man's recovery was a success story. Then, as he drove home from a class one day in late 2016, a single moment derailed everything.

"A young teenage girl didn't see him and just pulled out in front of him, and they had a major accident," says James Baker.

Max's injuries included a broken bone in his hand that required surgery. He told his surgeon — Dr. James Shenko — right away about his addiction, and that he was scared that medication used for anesthesia and pain might cause a relapse...

Source: http://www.npr.org/sections/health-...-addicts-safely-get-pain-relief-after-surgery

 

[cduggles]

I posted this because addicts and former addicts are often stigmatized when in physical pain by clinicians, and this was not the case in this piece.

This article raises realistic and unique challenges posed when former addicts need opioids after surgery or due to a physical injury. What questions should a clinician reasonably consider if a patient needs pain relief but is afraid of relapsing?

In this case, the care team tried to be thoughtful when taking into consideration that the patient was a former addict and trust that he was in enough pain to warrant pain medication. What else could or should they have done?

The picture is also complex when opiate/opioid addicts present with a need for pain medication and tolerance is an issue.

Sadly, the fear of malpractice suits might make clinicians reluctant to be anything but very conservative with a known addict/former addict and leaving a patient in pain. Looking beyond that practical issue, however, some difficult and interesting questions are raised here.