Taking Pain Medication in Recovery

I had surgery this past Friday to repair my rotator cuff that had me in chronic pain. I am sober five years in just a couple of weeks. I was concerned because this is where my journey began in the world of opiate addiction. I was also concerned that the chronic pain would set a relapse in motion by providing a nice case of the “fuck its”. What did I do? I talked it over with my doctor, sponsor and sober supports who guided me to take care of my medical necessity with a hitch. The hitch was that things needed to be different, and it would be the first time in my life that a prescription narcotic would not be in my possession. You see, the one absolute thing that I know about myself is that I can’t be trusted with a bottle of anything controlled. My girlfriend has assumed the role of the narcotics officer and dispensed medication to me, as needed and as directed. While it may seem weird to be cared for like a child, I assure you it is necessary if you are anything like me. I am excited for my physical recovery and proud of how far I’ve come in addiction recovery.

When it comes to pain, almost no one is immune. Whether it’s back problems, broken bones, a sprained ankle or recovery from surgery, nearly all of us have had (or will at some point) terrible pain. Naturally, anyone who’s in recovery from addiction isn’t exempt. So, the question isn’t whether you’ll hurt, it’s when. And if you’re sober, there’s another key question: How will you maintain your sobriety if a prescription opioid painkiller is needed or suggested? Will taking oxycodone, hydrocodone, fentanyl, morphine or another of the drugs that fall into this class compromise your recovery? The answers to these questions aren’t so clear-cut.

How to Balance Pain Relief and the Risk of Relapse

When talking to your doctor about the risk of taking prescription pain medication, the first thing she’ll consider is your personal and family history of addiction. This is crucial to factor in. If your physician hasn’t done so before, she should evaluate you, too, for psychiatric disorders such as depression, anxiety and stress. When a patient has a history of addiction, the physician needs to take note and be careful with the amount, type and refill frequency of pain medications. So someone with a long history of using heroin, which is an opioid, and a short sobriety would not be a good candidate for being prescribed, say, hydrocodone or oxycodone. If your doc doesn’t know about any mental health or addiction issues you’ve experienced, or that they have been part of your family’s history, this is the time to be open and honest with her.

Physicians follow these general guidelines when prescribing pain pills to patients with a history of substance use disorder:

For chronic pain (typically defined as pain lasting longer than six months), most patients can be treated without the use of opioids. An estimated 1 million people in the U.S. are suffering from substance use disorders related to prescription opioid pain relievers. The World Health Organization recommends three steps for treating pain, and opioids are the final of these. The first: Doctors should recommend over-the-counter (OTC) drugs like acetaminophen, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs); these are the least addictive pain relievers. If OTC pain pills don’t work, doctors are advised to try medications like gabapentin, lidocaine and tricyclic antidepressants. Only if those drugs fail to work should opioids be used for chronic pain, and then only if specific protocols are followed (more on those below).

For acute pain, such as pain following surgery, it’s appropriate to start with an opioid. After that the opioid painkiller should be discontinued under a doctor’s supervision.

Managing Pain and Maintaining Recovery

The recovering addict needs to let their sponsor, spouse or significant other and other people in their support system know the pain medication they are on, why they are on it and how they are supposed to take it. YOU cannot have secrets about medication. If you’re worried about these drugs jeopardizing your hard-won sobriety, you can ask someone else in your support system to be in charge of dispensing pain pills to you. The recovering user needs to give up all control of the medication. They need to take the medication as prescribed and no more often than is prescribed and get off the medication as soon as possible. Lastly, your goal is to get off a prescription pain medication ASAP, but to make sure your pain is addressed. This can be a relapse issue unto itself. Untreated pain makes patients very squirrelly and they will relapse if not treated appropriately.”

Many doctors also require patients to sign an opioid agreement stating that the patient will only receive opioids from that doctor and from one pharmacy and/or that he or she will submit to urine drug screening samples periodically. These agreements indicate that the prescribing physician will administer urine drug screens, count pills, decline early refills and/or keep the patient accountable with weekly or monthly office visits to be sure the individual is taking these powerful painkillers in the way they were prescribed, without changing dosage or frequency.

Safe Haven Recovery is a boutique Florida Drug & Alcohol Treatment Center located in Miami, FL. We specialize in Suboxone Maintenance & Detox, along with, Couples Addiction Treatment. Call us today at 866-447-4650.

About the Author

Matthew Koenig is a freelance writer and principal of Last Call Marketing which devotes their efforts to Digital Marketing, SEO and Social Engagement. Concentrated in addiction recovery, Mr. Koenig is based out of South Florida. His sober date is June 10, 2013.

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