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It Couldn't Happen to Me, Could It?
Submitted by the USPS Employee Assistance Program
No one wakes up one morning thinking, “I want to be part of the opioid epidemic.” Yet there are thousands of susceptible people who find themselves or someone they love part of this epidemic. Unbeknownst to them and others, they are on the road to becoming dependent on one of the most addictive, highly prescribed substances known to man.
How does one unwittingly become a part of this group? It can begin as simply as scheduling a routine surgery, breaking a limb, spraining the back or having painful headaches, among others. People with one of these ailments may need the help of a prescribed opioid (OxyContin, morphine, codeine, fentanyl, oxycodone) to address the extreme pain associated with it.
These opioids are an appropriate and needed treatment to address pain. How, then, can their use turn into an addiction? Let’s take a look at one possible scenario that could happen to a person receiving a regular prescription for an opioid to help relieve the pain of a broken leg.
Charlie has been playing intramural soccer with his team for the past three years. He has had some injuries in the past from his rough play: a sprained ankle last year and a broken rib the year before. Each time he saw his doctor, he was prescribed 30 hydrocodone pills to help with the possible pain that could result.
Charlie got the prescriptions filled, but used just six pills out of each bottle before he could tolerate the pain with only acetaminophen. He left the bottles in the back of his medicine cabinet, forgetting they were there.
This year, Charlie’s broken leg was a serious break that needed surgery. The doctor explained that he needed to take his prescribed pain killers (30 oxycodone pills, with one refill) to help him heal appropriately. The prescription stated he could take one to two pills every four to six hours for pain relief.
On the first day after surgery, Charlie felt no pain. On the second day, he took the medicine as prescribed, taking two pills every four hours, even in the middle of the night, because the pain would wake him. His pain was real and he was following the prescription parameters. His wife supported his decision to take extra pills for a short time because she hated to see him in such agony.
The refill was made on the fourth day post-surgery because Charlie was afraid he might run out of the medication. He started to rationalize his need for the extra pills per day because, after all, he had just broken his leg and was in deep pain.
At this point, Charlie did not know he was becoming dependent on the medication; many do not. Each person’s pain threshold is different and each person’s susceptibility to addiction is different. As well, each person’s response to how the medicine makes them feel physically, emotionally and psychologically is different.
His follow-up appointment with his doctor a week later was routine. The doctor asked how he was doing. Charlie stated truthfully that the pain was continuing to persist and asked for another prescription for oxycodone. Without hesitating, the doctor wrote a prescription for 30 more Oxycodone pills and asked that he follow up with his primary care physician to have the sutures removed in another week.
Before Charlie completely ran out of pills, fear of the pain made him feel panicked. He knew he needed to try and cut back, to make the remaining few pills last until he could plead with his doctor for more. Before the week was up, he had taken all the pills in the prescription. The pain from the broken leg and surgery was there, but a new emotional/psychological agitation started to arise.
Charlie was short-tempered with his wife when she asked how he was feeling. He did not want to do anything but lay around and watch TV. He was skipping showers and not shaving.
He had prescheduled a week off from work. The second week into his surgery recovery, he asked for more time off due to lingering pain. He was complaining to his wife how bad he felt—physically and mentally—as a result of cutting back on the medication.
His wife wanted to help alleviate his pain and remembered there may be more meds tucked in the back of the medicine cabinet. Charlie could have kissed her; he didn’t remember the leftover pills from his previous injuries. She saw the instant change in his mood. How could a pill make you feel like that?
He painfully hobbled over to the bathroom and dug through the cabinet and found the leftover pills. He popped the lid and dry-swallowed two out of his shaking hand. He instantly knew he would feel better. But, deep down, he also knew this behavior was not normal.
Fast forward several weeks. Charlie is spending much of his time trying to find ways to get more opioids. He went to the home of his mother, who had survived cancer, to find her leftover opioid prescription pill bottles. He developed “splitting, painful headaches,” started seeing a specialist for them and was prescribed more opioids.
Charlie remembered a conversation with a friend who said he could not tolerate the hydrocodone prescription he was given. Charlie invited himself over, only to rummage through his friend’s medicine cabinet until he found what he was looking for. His need and rationalizations for more pills continued to grow.
He kept missing deadlines at work. His wife grew increasingly more concerned. Trying to cut back only created more pain and suffering—emotionally and physically. He became so distraught and sick and tired of himself, he started to think about overdosing just to get away from his internal and external misery. He asked himself, “How could this happen to me?”
There are several reasons why this could happen to anyone. The start of Charlie’s eventual problem was with the initial prescribing of opiates. If a thorough physical and mental history had been taken by the surgical team, it may have shown that Charlie has a fairly high pain tolerance. He had used only six out of 30 pills on two different prior occasions for fairly painful traumas to his body.
The doctor could have explained how to increase the pain meds, starting with a lower amount with additional Ibuprofen to control the pain. Instead, he was given the choice to take up to 12 pills per day from the start. When he had a follow-up appointment, the doctor could have:
It is not all the doctor’s responsibility to monitor the use of opiates. The public needs to be educated, as well. The opioid epidemic currently is receiving a lot of attention; an educated population is an informed one. With information, people can make wiser decisions for themselves.
Charlie may have not paid much attention to all the easily accessible information because “it couldn’t happen to him.” Why care more than necessary? Once he thought his behavior was not normal, he could have searched on the internet with the phrases “warning signs of opioid abuse” and “how to tell if someone is addicted to opiates.” Charlie’s wife also could have researched similar topics when her concerns arose, using the phrases “how do I know if someone is addicted to opiates” and “addiction to pain pills.”
One great source of information is the Substance Abuse Mental Health Services Administration (SAMHSA). Doing research on a possible problem early is one way to avoid serious problems later. Catching the opioid abuse early can lead to much better outcomes than waiting for dependence to settle in.
To review Charlie’s case scenario, there were several warning signs he may have been developing an addiction to his prescribed opiates:
1. He started taking the most he could take at first, as prescribed. This took away his pain, but also may have given him some euphoria and lack of concern for the pain.
2. If he took an extra pill, he felt even better. This led to higher tolerance for the medication, which meant he had to take more to get the same effect.
3. He began to fear running out of the medication well before he was out.
4. He started to rationalize his need for pain relief, yet had not tried to back off the medicine to see how much pain he would experience.
5. He went to his first follow-up appointment knowing he would plead his case for pain relief.
6. He became panicky at the thought of running out.
7. He stopped taking care of regular hygiene.
8. He had little to no motivation.
9. He was short-tempered much of the time, especially with his wife who was concerned.
10. His work product suffered.
11. He took extra pills left over from previous injuries.
12. He searched for a supply, taking other people’s meds.
13. He doctor-shopped with a new diagnosis of head pain.
14. He tried to cut back and found it to be too emotionally and physically painful.
15. He became distraught and started thinking of overdose.
When concerns arise, take action. Whether it’s for yourself or you’re concerned about a relative, friend or coworker, ask for help. No one can beat addiction by themselves. Catch it early and you may save a lot of pain and trouble from happening if you go down the road to dependence. The sayings, “See something, say something” and “Now, rather than later,” work.
There is plenty of help available. Call your USPS EAP for more information or help if any of this sounds familiar. Visit EAP4YOU.com or call 800-327-4968.