While numbers can tell a story, they are never the whole story. Instead of giving you statistics about the ongoing crisis of opiate and heroin addiction, let me tell you about Jodie*.
I met Jodie while I was interning and transitioning from being a medical student to becoming a doctor. She was a pleasant woman who I was paged to admit to the psychiatric unit. Earlier that evening she had come to the hospital saying she wanted to kill herself and thought if she was alone, she might actually go through with it. Jodie was a heroin addict, but she was not the image you probably have in mind when reading those words — heroin addict.
Two years before we met, Jodie was a practicing nurse in a busy endocrinology practice. She was a mother of four children under the age of 18, married to an electrician and a weekly churchgoer.
When she went for a tooth extraction, her dentist gave her two weeks’ worth of Percocet for pain and she said, “I just finally in my life felt like everything was under control, I felt happy, relaxed, in control … Those pills were magic.” She continued for months to go to her dentist complaining of pain and getting prescriptions and even further dental procedures to “correct” what went wrong with the first extraction. Ultimately her dentist stopped treating her and refused to continue to refill her narcotics.
Unfortunately for Jodie, she was now addicted — and quickly found physicians who would prescribe her more Percocet. When one doctor would stop prescribing, the relationship would end and Jodie would find a new one. It was a cycle that repeated itself until she could no longer find a new doctor.
Jodie was convinced that everything was under control as long as she could get the pills she desired. She decided to quit seeing doctors and started to write her own prescriptions using her employer’s prescription pad.
A suspicious pharmacist was surprised when Jodie presented a prescription for a 30-day supply of Percocet one day and another prescription for 30 days only two days later, and called the doctor writing these prescriptions — and that was the end for Jodie.
Fired from her job, Jodie lost her license to practice nursing weeks later. She couldn’t recall the exact details of the next step in her fall, but it involved neighborhood college-aged kids who were in the business of selling pills. At $20 per pill, though, Jodie quickly stopped being able to afford the luxury of a pharmaceutical-grade fix.
When pills became too expensive, she took another step that felt “wrong” but also kept her going amid the surprisingly quick end to her career: She began to use heroin. She started out snorting the drug, but quickly advanced to using needles.
“I just couldn’t believe I was sticking myself with a needle — but it seemed like the right choice at the time, if I could get my fix, I would feel normal and if I felt normal maybe I could get my nursing license back, and if I got my job back, I wouldn’t need to inject myself because I could afford pills.”
Jodie didn’t get her job back. All she got were divorce papers, a court order barring her from seeing her children, Hepatitis C and a strong urge to end her life.
Occasionally when I think about Jodie and the step-wise descent into the hell her life had become, I ask myself: Couldn’t she see how each step was going to bring her further and further away from the life she had worked decades to build? Couldn’t she have just stopped when the first dentist said, “I won’t prescribe these anymore?”
It is important to recognize that doctors are under an immense amount of pressure to respond immediately when a patient complains of pain. Part of this pressure comes from the ethos that defines the practice of medicine, reified in the words of the Hippocratic Oath, “I will take care that they suffer no hurt.” A portion of the pressure comes from the federal government, whose hospital regulations require patients’ pain levels be monitored at least three times daily and then responded to with a treatment, intervention and a note stating the success of the intervention. By far the most pressure, though, comes from patients themselves who look to their doctors to relieve them from suffering and pain fully and quickly.
Sam Quniones is considered the nation’s leading expert on the opiate addiction crisis and sees it as a co-created American disaster with many contributors. “We were a country that was willing to endure any pain to move forward. We crossed the plains in Conestoga wagons. Now Americans feel they are entitled to a life of no pain and to have every minor complaint immediately addressed.” In addition to changes in the American tolerance for discomfort, he criticizes the regulatory regime that measures hospitals and doctors on their response to patient surveys. “These scores and surveys of hospitals may have been a good idea, but now they have been completely twisted and why doctors feel so much pressure to prescribe opiates even when their clinical knowledge tells them differently.” He also places blame on doctors who “allowed their enthusiasm for relieving suffering through prescribing to outpace the science supporting these practices.” According to Mr. Quinones, “Americans make up 4.6 percent of the world population but consume 99 percent of its Hydrocodone [the opiate ingredient in Vicodin].”
Although Jodie was the first, I have seen many patients fall from lives of relative success and fulfillment because of the treatment of pain with powerful and addictive medications.
What can you do to prevent becoming another Jodie or to prevent that fate from befalling someone you love? Do your homework on the medications that are being prescribed. Ask the doctor these questions:
— Are these medications addictive?
— Without pain medications, how bad will the pain be and for how long?
— Is there anything non-addictive or non-pharmacologic for the pain?
Also, be aware of your risk of prescription drug addiction. Mental illness, family history and childhood trauma can all raise the likelihood of developing an addiction.
Finally, if you find yourself becoming too reliant on prescribed pain medicine, seek help immediately to avoid the unfortunate downward spiral Jodie experienced. The old adage that an addicted individual needs to hit “rock-bottom” is not true at all. At every step of recovery from addiction, there are options available to help, as you will read in my next blog about my patient Miranda* who availed herself of many of these and is certainly living a fulfilling and happy life to this very day.
*Names and identifying details of patients have been changed to protect their confidentiality.
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Prescription for Disaster: Developing an Opiate Dependence originally appeared on usnews.com