Sobriety and Pain Medications
Potentially a Very Slippery Slope
Photo by Neal Hemphill
In my experience, one of the biggest reasons that I’ve known for people in recovery relapsing is due to being prescribed medication for pain.
Even among people whose problem centered on alcohol, not drugs, taking opioids or other addictive/mood-altering medications can be a trigger that leads to a drink.
And for alcoholics, after that first drink is taken, the allergy kicks in along with a mental obsession to take another drink, ad nauseum. And it's off to the races once again.
One of the challenging things regarding this type of prescription is that it’s often prescribed to be taken “as needed.”
There are a couple of things about this that make it dangerous. One, if you think you don’t need a dose and you decide to skip it, you can end up in very serious pain. Upon feeling that pain, taking a dose isn’t going to give much relief for a good while.
Two, feeling extreme pain can be a trigger for an alcoholic to take a drink or a drug, partly in an attempt to alleviate the pain, or as a way of changing the way one feels even if the pain persists.
Three, once one has the medication in their system, it begins to cloud one’s judgment, especially if they had been a user of opioids or benzodiazepines/barbiturates. Therefore, deciding whether a medication is “needed” can be a really tricky proposition. It requires a clear head.
What it really boils down to is clarity on why one is taking a dose. For the first 24-48 hours it is often wise to take the doses as prescribed. When the pain begins to subside is when the question regarding “as needed” begins to come to the fore.
At that point, the question becomes, “Am I taking it for pain? Or am I taking it because I like the effect? Do I need to take this dose?”
Those questions may not be answered easily. Striving for the truthful answer is essential.
I had a clean and sober roommate who had foot surgery. This type of surgery was very painful afterward, and she was prescribed pain medication. She is someone who had used opioids during her drinking and drugging years.
I was in charge of doling it out to her.
Thankfully, it was pretty straightforward. The pain was strong for a couple of days. After that, she only took it before sleeping for another day or two.
The rest of the pills then went down the toilet, and over-the-counter meds took over.
Two of the key elements that made it successful were a) having awareness that this could be a dangerous situation, and b) making a plan and building communication into it.
I had a friend who had surgery, and he was prescribed what had been his favorite downer of choice during his years of using.
Although he took it as prescribed, he admitted later that he loved the feeling it gave him. And he filed that away in his mind, thinking that he would revisit it someday.
That day came about a year later when a number of terribly difficult situations arose and piled up quickly. He turned to alcohol and drugs.
Fortunately, he escaped the clutches quickly and got back to sobriety. But it wasn’t without pain and consequences that could have been much worse.
Other stories of friends and acquaintances end in death or a prolonged and destructive return to addiction. Prescribed drugs that have addictive tendencies are dangerous. Something about the label and the prescription and receiving it from a legitimate facility for a legitimate purpose seems to remove an element of alarm about it.
The bottle should have a skull and crossbones on it, with a warning that overdosing must be avoided. In this case, that overdose may be just that one extra pill that isn’t needed. This can set off the mind and body to seek more.
I’ve had a few surgeries over the last five years. I don’t think I’ve taken more than one or two prescribed pills. I quickly moved on to prescribed NSAID medications, which have no addictive quality. Examples of these are Motrin, Advil, and Alleve. Prescripted NSAID’s are stronger, and in these cases were appropriate.
A big part of that was my communicating to the hospital team that I would have a proclivity to abuse. They helped me to understand what was to be expected, and it turned out that the pain I had was easily treated, for the most part, without opioid or benzodiazepine medication.
Awareness and preparation are key.
I’ve found that if I put sobriety first and foremost, I’m good. I plan to keep it right there again today.