As a recovering opioid addict, I know too well the misery of withdrawal from potent opioids. As a physician and scientist, I use my knowledge to help others avoid the misery that often– even usually– comes with use of opioid pain medications like oxycodone, Oxycontin, Vicodin, and methadone.
In the past, great efforts have been put forward to ‘dispel myths’ about opioid pain medications. Doctors, nurses, and patients were told that the risk of addiction is low for people with actual pain, and that more pain medication should be prescribed. We now know that much of that encouragement came from policy centers with significant connections to the very pharmaceutical companies that manufacture such medications, and that tens of millions of dollars were paid to these centers to do ‘research’ that would support the recommendation to prescribe more, more, and more pain pills.
I have great sympathy for those people who live with chronic pain. I recognize that pain has a cumulative effect on a person’s mood, energy level, and quality of life. I am NOT saying that people in pain do not need or deserve treatment. But as I will describe, current treatment approaches do little to reduce pain and improve quality of life. And worse, the use of opioids comes at very great costs. People taking pain pills become greatly focused on the number of pills remaining each month, knowing that running short will mean significant misery, to put it mildly. And even the people who stay on schedule must be careful to avoid theft or loss of medication. All people taking pain medications are familiar with the attitudes from health care practitioners and pharmacists, who treat patients on opioids as if they are guilty of some unstated crime, or as if they are drug addicts.
But the main problem wtih current methods for treating pain is the basic limitation on the use of opioids: tolerance. The body becomes ‘used to’ the person’s dose of pain medication over several weeks, so that any given dose soon becomes ineffective. The ONLY way to continue to get the same amount of pain relief is to escalate the dose. And dose escalation is not an option for most people. Yes, doctors do participate in dose escalation– but when they do, the outcome is ALWAYS a disaster. I rountinely see patients who have had their pain medication dose increased over time to ridiculous levels– 300, 400, 500, and more mg of oxycodone per day. The important fact is that no matter the dose, TOLERANCE will eventually remove the beneficial effects of the medication. So patients end up taking and paying for hundreds of milligrams of oxycodone per day, but getting the EXACT SAME PAIN RELIEF as they did at far lower doses.
Everything about my background– good and bad– has contributed to my ability to help people in this horrible situation. I initially earned a PhD in neurochemistry, learning and studying about actions of neurotransmitters, including opioids, at receptors in the brain and spinal cord. I then became a medical doctor, and completed a residency in anesthesiology. I worked for ten years in operating rooms and in pain treatment programs. Most pain treatment programs are run by anesthesiologists; I was once one of those people, and I understand the abilities and limitations of the medications and procedures used by these types of practices.
I became addicted to opioids after an initial period of legitimate use, and I went through treatment about ten years ago, in 2001. The treatment was successful and I’ve done well, but my addiction cost me my anesthesia career, since I cannot allow myself to work in an environment filled with potent opioids going forward. So I returned to residencey, in psychiatry. I completed residency in 2006, and I am Board Certified in Psychiatry as well as Anesthesiology. I also became certified to prescribe buprenorphine or Suboxone, a new approach to the treatment of opioid dependence.
There are new medications that use buprenorphine to treat pain. Buprenorphine is a unique medication with unique effects at the opioid receptor. There is a ceiling to the effects of the medication, for example. This property and others allows buprenorphine to activate the same receptors as oxycodone, but with different effects. The margin of safety is much higher with buprenorphine. And buprenorphine causes much less ‘craving’ for opioids. In fact, the medication is used to TREAT opioid dependence by eliminating cravings for opioids. So patients on buprenorphine typically report no desire to push the dose, or to take more than is prescribed.
Unfortunately, buprenorphine is subject to tolerance in the same way as other opioids. But through treating hundreds of patients with buprenorphine for the past five years, I have learned that buprenorhine can be used to treat pain in ways that avoid the ‘tolerance problem.’ My approach, in my opinion, will eventually be a standard method for treating chronic pain. But because my approach utilizes generic medications, there is limited motivation for pharmaceutical companies to invest in the research to develop the techniques used in my practice. But in the meantime, I am able to offer the approach for my patients.
Are You Getting Better?
For many conditions, pain medications make things worse. We now know about a phenomena called ‘opioid-induced hyperalgesia’ where taking potent opioids will cause the perception of pain to increase, rather than decrease. Of course, few patients will go through the horror of opioid withdrawal out of trust that things will get better. I can assure you, though– sometimes the pain DOES go away or improve when the pain pills are taken away– after the misery of withdrawal. There is no way of knowing if you are one of those people, though– so I understand your reluctance to sign on to stopping pain meds.
There are also people treated with narcotics who truly do not need them– people with lumbar strain for example, who would heal much more quickly through use of a heating pad, ibuprofen, and rest. Some people have been conditioned– by their DOCTORS– to take pain pills for every little problem. For those people, I can only strongly recommend that you consider finding new doctors, who will treat you without simply throwing pain pills at the problem. Or better yet, avoid the doctor entirely for minor aches and pains, or minor bumps and bruises. Your grandparents probably got through a tough life without those pills– you can too!!
But IF you are one of the many people who have true chronic pain– you have had a lumbar fusion, or you are getting steroid injections in the knee just to tolerate each day, for example- consider making an appointment. The goal would not be to eliminate the pain pills, but rather to use them in a way that is safer, that reduces or avoids dose escalation, and that allows the pain medications to work ‘chronically’ without the development of ever-increasing tolerance.
Criteria for Treatment
Consider making an appointment if you are:
- Currently taking potent opioid pain medications like oxycodone, hydrocodone, methadone, or dilaudid.
- Experiencing chronic pain from a serious condition that is not likely to improve.
- Struggling to avoid increasing the dose, or running short on pain medications some months and experiencing withdrawal.
- Always or often focused on the pain or on pain pills; counting pills often to make sure they will last the month, for example.
- No longer getting adequate pain relief from your pain medications.
- Sick and tired of the affects that taking pain pills has on relationships with people close to you.
- NOT drug seeking.
What do I mean by that? I do not provide pain medications when pain is not an issue, and when the person is instead seeking a ‘high.’ Suboxone and buprenorphine are potent pain medications, and like all opioids should only be used for significant pain. If you are unsure whether your pain disorder is ‘significant’, e-mail me and have that discussion, to avoid spending money on an appointment without benefitting in return.
If some or all of these conditions apply, consider making an appointment. I will not ‘shame you’, and I will not force you to go through detox. I will help you take the pain medication that you need, without the destructive impact that pain medications often have on a person’s life.
When you are done learning, make the call. I promise you, with all the nonsense claims out there about fixing pain, this is something that can truly make a difference in your life.