A quick view into the understanding of how alluring opiates can be

Good morning everyone, I trust that everyone is doing well since the forum has been so quiet lately. While reading the news online this morning I came across another blog post from Jana Burson. Recently she had a bad fall and was required to have surgery. Her story is posted below:

In Praise of Opioids

Yes. That’s an odd title for a blog about opioid addiction, but my recent experience with a broken leg gave me some new insights into opioids
While walking my dog four weeks ago, I fell and broke my tibia and fibula (both bones of the lower leg). The break was obvious; I had to hold my foot to keep it from moving to an odd and painful angle. I sat on the ground, thinking, “Oh shit. This is going to hurt, and I’m going to have to go to the hospital emergency room on a Friday night to get a cast.”
And of course it did hurt. It was the worst pain I’ve ever had. I couldn’t get into a car to go to the hospital, since both hands were busy holding my foot. If I let go, my foot drooped to a sad angle. I wasn’t going anywhere under my own steam. So my fiancé called 911.
First to arrive was a huge fire truck, with ladders, hoses, etc. One of three or four firemen took my blood pressure, asked me a few questions, and said EMS would be there soon. When EMS arrived, three or so more young men sprang from their vehicle. They asked the same questions all over again. At one point there were five or six burly young men who all responded to the 911 call, standing around me in a semi-circle. It felt like a bit of overkill, but I didn’t mind.
The worst part of my whole ordeal was when EMS workers tried to splint my leg with a device obviously meant for a much taller person. Putting the splint on caused my foot to move to an angle that God did not intend. The grinding of my bones made me sick to my stomach, to the dismay of EMS personnel. I’m told my screaming and cursing, punctuated by intermittent vomiting, gave neighbors quite a show.
Once I finally got inside the ambulance, the EMS worker easily slid an IV into my arm and gave me a dose of fentanyl.
I have never taken any IV opioids, to my knowledge. Immediately, I felt hot all over, and then started weeping with relief. I wouldn’t say I felt euphoria, so much as a profound relief that the pain no longer hurt. That also sounds odd; I still had pain… but it didn’t bother me, and I felt like everything was going to be OK. In that moment, I had a better idea what my opioid-addicted patients describe when they tell me of the allure of opioids. Under the influence, I felt like nothing would bother me, physically or emotionally. Then my eyes felt like they were spinning around in my head like pinballs, but I didn’t care about that, either. Then I got very chatty and talked nonstop to the hospital.
The emergency room doctor ordered X-rays that showed the tib/fib fracture. I thought I would get a cast, and then go home. Wrong. The nurse told me I was being admitted for surgery on my broken leg. I wasn’t happy about this, especially since I hadn’t even talked to the orthopedic surgeon who would operate. I had questions. Why couldn’t I go home with a cast? What was he going to do at surgery, and why was it better than a cast?
So I stayed in the hospital that night, edgy about what surgery was proposed and full of questions. My leg hurt, but the emergency room staff had placed a plaster-type splint, or partial cast, on my leg, which kept the bones from moving around. As long as I kept it still and elevated, the pain wasn’t too bad. I had several shots of morphine through the night. I didn’t feel high from the morphine, but the shots put me to sleep, a good thing.
The surgeon came into my hospital room mid-morning, and talked to me about the advantages of having an intramedullary rod place through the center of my tibia to hold the broken sections together. This sounded extreme, but the surgeon said in “someone your age,” with simple casting the bones would take longer to heal. At my age, there was a relatively high rate of non-union, which would result in surgery at a later date anyway.
It took me longer to process the information than it should; I was stuck on that “someone your age” comment. I’m a young-looking 52, and finally realized I had to be much older than this young surgeon. Maaaaaybe the comment fit.
Anyway, I agreed to the surgery. Pre-op, the anesthesiologist gave me fentanyl, and again I had the feeling my eyeballs were spinning in circles and I got chatty. Then he must have given me something else that put me out completely, because the next thing I remember I was waking up back in my hospital room. I was upset when I didn’t see a cast, because I thought that meant I didn’t have the surgery. I didn’t know that an intramedullary rod takes the place of a cast…kind of like having a cast on the inside.
Since that surgery, I haven’t had much pain. I took my last morphine injection the night after surgery.
I’m no martyr. If I have pain, I want pain medication. The surgeon, knowing what I do for a living, asked me if I wanted to go home with any opioids. I said yes. I told him please prescribe what you would for anyone else. He prescribed twenty-five Percocet. I took two the morning after I got home, and they relieved the pain, but left me a little groggy and sleepy. I’d had enough of that in the hospital, and was eager to do some reading and writing, so that was the last dose of opioids that I have taken for my broken leg. After making it a week with no opioids, I flushed the remaining twenty-three pills.
I had one bad spell after falling on my crutches, twisting the broken leg a little. The rod held my tibia in place, but the fibula hurt intensely for about twenty minutes before I was able to calm the pain with elevation, ice, and ibuprofen.
I think I’ve done well during my recovery from the broken leg. This surgery allowed me to heal much faster. It’s now almost six weeks since my surgery, and the above x-ray was taken today. My leg hurts only when I walk around. Ibuprofen and Tylenol have worked fine. I’ve been careful, especially during the first few weeks, to keep my leg elevated and use ice for swelling. I’m convinced elevation and ice helped a great deal.
This week I can walk with the help of a cane. It does hurt to walk, but it’s the kind of hurt that’s necessary to build back my muscles. If the pain gets too bad, I sit down and elevate my leg again.
I know I’m very lucky. The fracture happened in a place where help was readily available. It was less than thirty minutes from the time I broke my leg until I got a shot of a powerful opioid, fentanyl. This medication was a godsend to me.
I have health insurance, and could afford to get the surgery to help my leg heal quickly. My surgeon did a wonderful job, even if I do have underwear older than he is. I was able to take several weeks off work to keep my leg elevated for better healing and less pain. I have a loving fiancé who didn’t mind being my legs for a few weeks. Some people don’t have any of those things, so I’m very grateful.
What is the point of this blog, other than to blather on about my surgery and broken leg? It’s this: opioids are great when used the in the right situation. For acute pain, they are truly a blessing to mankind. But these drugs produce pleasure, and anyone can get addicted to that intensely good feeling.
Doctors have to find a balance between empathy and caution. Let’s not be stingy with opioids during acute medical situations with intense pain. Even in a patient with known addiction, opioids shouldn’t be withheld for an acutely painful medical situation, because that would be unethical. But we can’t ignore the dangers of addiction, particularly if opioids are used for more than a few weeks. Even if we feel uncomfortable talking about addiction, we have to have those conversations with our patients. And please, fellow doctors, see patients with addictions as people with a treatable disease, who deserve the same respect as patients with any other disease. You don’t need to kick them out of your practice; you do need to refer them for help.

 

Wow.
Interesting.
First, I guess i will always cringe when I read someone flushed pills down the toilet.  

Second, I do appreciate her comments about treating patients with addictions the same as anyone other patient. BUT we can't ignore the danger OF addiction.

Now, reflecting on her story. What if that were any of us ? Minus the fact we are on an opioid blocker right now, how will we handle an emergency situation like this ?
Maybe one of us has already ?
I know, for me, I would not be in charge of my own medication, that's for sure.
But after that. How will I feel stopping.

Unfortunately these are issues we will deal with for the rest of our lives.


Be well fellow addicts.

Blue

Good questions blue, how would someone handle a situation. I've had to take opiates a couple of times since going into recovery but each time I was in the ER. I was given Dilaudid each time and never wanted anything to take home. If there came a time and I hope it doesn't happen but if it did. I would have one of my family members help me out on this part. I would also stay on a low dose of Suboxone at the same time. But in truth Suboxone has helped my pain immensely so far so I would hope it wouldn't come to that.