More than one-third of Americans experience acute or chronic pain. For older adults, the number is closer to 40 percent, according to the New England Journal of Medicine. In order to manage their symptoms, many people turn to medicine for help.
Unfortunately, one of the most commonly utilized classes of medication to treat pain is also highly addictive. Prescription opioids, provided legally by doctors, played a huge part in starting today’s opioid drug epidemic. For a number of years, opioid drugs were prescribed in higher dosages and for longer periods of time than would be permitted today. While opioids have been found to be an effective treatment for acute pain, utilizing them for longer durations and in higher dosages led many people to develop addictions. A decade ago, prescription opioids were the cause of more overdose deaths (37 percent) than heroin (19 percent).
Sadly, after patients developed addictions to opioids, their doctors were often minimally trained about how to spot addiction or help their patients stop misusing the drugs they had been prescribed. Even pain management fellowships often did not include rotations in addiction medicine. This, on top of findings that patients with co-existing chronic pain and addiction have decreased pain tolerance and increased difficulty with sleep, depression and anxiety, which can all increase chronic pain, has been a recipe for disaster.
Undermining the Doctor/Patient Relationship
As it has become clear that prescription opioids and chronic pain are driving forces behind the opioid epidemic, doctors have become less comfortable with prescribing opioids, but they are often still lacking training on how to work with a patient who has a history of addiction or talk to them about their addiction concerns. All of these factors combined can lead to doctors labeling patients as “drug-seeking” and viewing reports of pain with suspicion rather than attempting to find other ways to treat the problem. Patients are often turned away without being given tools to manage their chronic pain. These responses can lead to patients seeing the medical profession in an adversarial light.
What Can Be Done?
Screeners have been developed to help doctors recognize which patients could be at risk for developing addictions or relapsing if given opioids. More rigorous guidelines are also in place now for how much of an opioid medication a person can be prescribed and for how long. In addition, tools like the Chronic Pain Journey Map can help doctors to better understand the needs of their patients who experience chronic pain and steps that they can take to help them without involving opioids.
Sharing About Your Substance Use
In order for doctors to provide the best care for patients, it is important that they know the patient’s history and current use of substances. While it might be uncomfortable to share if you are in active addiction or in recovery from it, doctors need to have this information so they can:
- Avoid drug interactions between what they are giving you are whatever else you might be using
- Refer you to substance use treatment, if needed
- Watch for signs of relapse
- Prescribe medications that will not increase your risk of relapse
- Watch for issues in bodily systems that may have been impacted by your substance use
- Help you to address nutritional deficiencies that may arise as a result of past or current drug use
If your doctor treats you differently after you disclose substance use or you get the impression that they are unsure of how to work with people who have a history of addiction, you can try to help them do better–but you also have the right to change doctors and find someone who is more helpful to you. If you do choose to switch doctors, you do not have to disclose your substance use history immediately. It is understandable that you might first need time to build trust and rapport with your new doctor.
If it seems like your doctor is overly fixated on your current or past substance use, you can redirect the conversation in a number of ways:
- Acknowledge their concern, but tell them that you are currently more concerned about a different issue
- Ask them to explain how your use relates to the concern you wish to discuss
- Tell them how you are addressing your substance use, that you do not need additional support, and that you would like to focus on another health-related concern
- Ask for other things you can do right now to address the concerns you have, separately from focusing on your substance use or history
Safe Harbor Recovery Center supports whole-person approaches to recovery, including the best possible medical care for people who have struggled with addiction and chronic pain.