As the nation struggles with an epidemic of opioid abuse, KPCC is launching an occasional series in which we’ll share your stories of dealing with pain, and offer experts’ advice on how best to manage it. Share your story and insights through the Public Insight Network.
"Mary" knew opioid painkillers were highly addictive and, as a former heroin addict, she knew she was at an elevated risk for a relapse. So even though she had been sober for decades, she pushed back when her doctor prescribed Vicodin for an injured rotator cuff and a couple of cracked ribs.
"I said, 'I'm really leery of taking Vicodin because I used to be a junky,'" says Mary, a 65-year-old who spent most of her life in California and now lives in Florida. She asked that we not use her real name due to the sensitive nature of her story.
Mary's doctor said the drugs were necessary; the broken ribs were making it hard for her to breathe and he said she risked developing a collapsed lung. He soothed her fears by promising to monitor her to ensure she didn't abuse the pills.
"What really shocked me was how quickly it escalated into a gigantic addiction," she says. "I started taking two a day, it went to four an hour, it went to eight an hour. I was buying them from a friend of mine … and I was buying extra from him, and I was taking, all of a sudden, 40 Vicodin a day."
Once she was on Vicodin, she says she just wanted more.
"The mentality of the addict," says Mary, "is you're enjoying yourself, and so you don't really want to stop."
She might have continued to spiral deeper into addiction if it weren't for a serendipitous meeting at a Studio City supermarket. Two or three weeks after she started taking the drugs, she recalls standing in the market's checkout line, waiting to pay for a bottle of vodka to take with the Vicodin.
"There was a guy in line in front of me, and somehow we started talking about Vicodin," Mary says. "He and I had this weird conversation, and I said, 'Oh my god, I've gone from two a day to 40.'"
She remembers him responding, "They’re so addictive," and then telling her: "Stop. Stop now."
That random conversation spurred Mary to call her doctor. She told him she'd become addicted to the painkillers, as she'd feared she might. He cut off her prescription and she stopped buying extra pills. She says she's off opiates for good now.
Looking back, Mary acknowledges that she was in a lot of physical pain after her accident and did need medication. But since she was so concerned about slipping back into her addiction, she says it would've been helpful if she and her doctor had spoken by phone each day, to ensure she wasn't abusing the drugs.
For those with a history of addiction who need to manage pain, here are a few tips from Dr. Suzette Glasner, an associate professor at UCLA’s Semel Institute for Neuroscience and Human Behavior.
Have an honest conversation
Glasner recommends having an honest conversation with your doctor about your history of substance abuse. She says studies show that people with a history of substance abuse have nearly four times the risk for developing addiction compared to people who don't have addiction history, so your doctor should take your history into consideration when developing your treatment plan.
She acknowledges that conversation could be uncomfortable but she recommends saying something like, "I'm worried that if I start to take opiates for this particular condition, that I may fall back into a pattern that’s really unhealthy for me."
Of course, as we saw in Mary's case, that conversation alone may not always suffice.
If you do have that talk, Glasner suggests telling your doctor that you hope any opioid treatment is short-term and that you are interested in transitioning to other methods of pain management - therapy, meditation or acupuncture – as soon as possible.
If your doctor does prescribe opioids and you have a history of addiction, Glasner recommends enlisting the support of an addiction specialist. That practitioner would likely perform regular urine tests, which would "provide a certain kind of accountability for taking your medications as prescribed," she says. She adds that another concern for people with addiction history is that taking opioids can make them vulnerable to relapse to other drugs.
You could also ask a family member or loved one to be in charge of holding onto your medication, says Glasner. "Then that person essentially dispenses [the drug], so that they can't take more of it than is prescribed."
Another option, she says, is to enroll in an addiction outpatient treatment program while you're taking opioids, which would allow you to discuss any challenges you're facing while taking the medication.
What is your experience with using opioids or other treatments to manage pain? You can share your story and insights with us through the Public Insight Network.