Patients looking for pain management worry about opioid addiction
The stately, gray-haired woman in the colorful suit sat quietly as a nurse explained to a conference room of joint replacement candidates what exactly lies in store for them.
Models of new hips and knees were passed around, manipulated and examined. There was talk of preoperative tests to screen for infection. Physical therapy regimens were outlined in meticulous detail.
Oh, yes. And there will be pain. Lots of pain.
When the talk on Tuesday night turned to the medication to defeat that pain, the elderly woman finally spoke up. “How soon can I get off the pain meds?’’ she asked. “I don’t want to become an addict.’’
The room dissolved briefly in laughter. But there was an edge to it – chuckles etched more with anxiety than humor.
Little wonder. Around every corner, it seems, there’s another tragedy. The beautiful young kid from your child’s high school class dead from an overdose. Police logs cluttered with calls for paramedics who rush to resuscitate those caught in heroin’s deadly grip.
“It’s been in the news almost every day,’’ said Robert Jamison, chief psychologist at the Brigham and Women’s Hospital Pain Management Center. “It is on the consciousness of everybody, and there are some people who are just so worried — maybe not rationally — that they don’t want to take anything.’’
Since 1999, the amount of prescription pain meds sold in the US has skyrocketed. It’s up nearly fourfold. In Massachusetts, Attorney General Maura Healey has noted, there are enough opioid prescriptions out there to supply every adult in the state with a bottle of pills. Overdose deaths? Up 300 percent.
“The opioid epidemic is the direct result of years of overprescribing painkillers to everyday people, who get hooked on an extremely addictive substance, then turn to heroin when they can no longer afford to sustain an expensive pill habit,’’ Healey wrote in a piece for the Globe last month.
And so everyday people – and not-so-everyday people — are worried. Actually, they’re freaked out.
One of them was Charlie Baker, whose son broke his arm playing college football three days before Baker was elected governor in 2014. The boy was prescribed Percocet. Baker said he was “scared out my mind,’’ and advised his son to switch to over-the-counter meds as soon as possible.
Janet Gorman of Dedham, too, knows that worry. Two years ago, she lost a child after an overdose of anti-anxiety medication. So when she had her knee replaced recently, she was pleased to receive formal notification that she would get only a limited amount of medication.
“I took barely half of what was prescribed,’’ Gorman told me. “And the only time I took it was right before physical therapy, which is pain beyond belief. Otherwise, I controlled it with Tylenol.’’
State lawmakers this week voted to help curb the opioid epidemic by, in part, limiting doctors’ initial prescription to a week’s worth of pills.
Some of the applause you’re hearing for that action is coming from specialists who have been studying the problem for more than a decade – people like Dr. Daniel Alford, who directs the Clinical Addiction Research and Education Unit at Boston Medical Center.
“There’s no question that we’ve become overly opioid-centric in our management of chronic pain,’’ he said. “And that means there are too many opioids in medicine cabinets that are available to people.’’
Alford said patient anxiety is shared by doctors. “They’re worried about causing addiction,’’ he said. “They’re worried about finding the right balance to maximize benefit and minimize harm.’’
When opioids are used properly to treat acute severe pain, the risk of addiction is low. “Let’s not let the pendulum swing too far so that we stop using what can be a helpful medication for some patients,’’ Alford said.
But for some patients any risk is too much.
On Thursday, a former patient of Milton Hospital paid a visit to the medical safety deposit box at his local police station.
He approached the green metal box with a nearly full bottle of Vicodin, which he avoided in the days after a recent surgery, choosing postoperative pain over any chance of addictive entanglement.
He dropped in a pill container as if it were a loaded gun — a grenade, its pin only precariously in place.
Considering the carnage enabled by those pills — one portal to addiction’s scourge — who could blame him?
Thomas Farragher is a Globe columnist. He can be reached at email@example.com.