The opioid crisis is an increasingly well-reported fact in the United States. According to the Department of Health and Human Services, more than 33,000 Americans died from opioid overdose in 2015. Currently, according to the National Institute on Drug Abuse, more than 90 American die each day as a result of an opioid overdose. Yet while these numbers are staggering, they tend to create a distance between so-called “addicts” who are most likely to die of overdose, and nonaddicts who are largely insulated from the crisis. The reality, as I experienced over the past 15 weeks, is that there is no such gap. We are all just an accident away from opioid addiction. Here is my story:
On July 28, 2017, I was injured is a very serious bicycle accident. I severely broke the neck of my right femur and my right leg was awkwardly dislocated. In the minutes that followed the accident, a generous bystander helped me off the road and called an ambulance. Within 30 minutes, I was sprawled on the sidewalk with an IV started on my arm, trying not to move a muscle because of the excruciating pain. The emergency medical technician (EMT) told me that it “might hurt” to be moved onto the stretcher and into the ambulance. The pain was unbearable, as if a long sharp knife were being thrust into my leg. In response, the EMT asked me the question that I expected, but was unprepared for: “Do you want something for the pain?” My first reaction was “no,” because even in my agonized state, I knew what “something” meant: a narcotic. Yet after just one bump in the ambulance and a return of the knife-in-the-leg pain, I said “yes.” He immediately prepared to insert a narcotic into the IV and told me that I would feel “warm all over” within a few seconds. It didn’t take more than a split-second, and I was high on Dilaudid, the chosen narcotic.
From ‘narcotic-naïve’ to a ‘dependent’
Therein began my personal entry into the opioid crisis. I began as what my doctor called “narcotic-naïve” – i.e., I had never before been exposed to narcotics. I ended an addict, or as health professionals sometimes euphemistically call it: a “dependent.” My addiction can be divided into four stages: 1. The accident and the five-day hospitalization; 2. The five days at home during which I continued to take the narcotic; 3. The acute withdrawal; 4. The months of withdrawal symptoms. During stage one, I was in acute pain. During the first 18 hours between the accident and the surgery, I was kept high on Dilaudid. I don’t remember the size of the doses, but I do remember fading in and out of consciousness. I was asked many questions by the doctors, nurses, and other hospital staff, and I gave consent for the surgery. The most common and clearly most important question was: “Are you in pain?” According to my family, they were never counseled about the risks, nor explained the possible side effects. There was simply the quest to make me “comfortable.”
Post-surgery, the pain was dramatically diminished. I was given a “patient-controlled analgesia” (PCA) machine to give myself a small dose of narcotic (2 mg per dose). The doctors and nurses pressured me to “stay ahead of the pain” by giving myself regular doses of the narcotic. What I asked what were the risks of taking the narcotic, my question was dismissed with, “There are no risks.” Instead, I needed to manage the pain. It seemed that the entire focus of my post-surgery care was to make me “pain-free.” I listened to my caregivers, and pushed the PCA several times each day to maintain a small, but consistent doze of Dilaudid in my system. After three days, the IV was removed and I was given Oxycodone, tiny pills that I took orally every three hours, again to “stay ahead of the pain.” Notably, the doctors prescribed 20 mg per dose, of which I only took half – much to the chagrin of my nurses. They openly worried that I wouldn’t be able to keep the pain in control.
In preparation for my discharge from the hospital after five days, my wife went to the pharmacy to pick up the narcotic I was prescribed. The pharmacist literally had nothing to say about risks of the narcotic, any potential dangers of overdose or drug interaction. Moreover, no doctor, nurse or health care professional came to talk to us about the narcotics. We were reminded repeatedly, however, to “stay ahead of the pain.”
Decided to try to taper off
When we arrived home, despite the pressure from the health care staff to take all of the narcotics, we decided together that I would begin immediately to try to taper off the drug to make sure I didn’t become addicted. On the sixth day, I took the narcotic once every 4 hours (rather than every three hours). For the next four days, I delayed taking Oxycodone by an hour, and by the 10th day, I only took three pills (once every eight hours). I resolved to stop taking the narcotic the next day.
What followed was three days of physical and emotional agony as I went through acute withdrawal. In 10 short days, my body had gone from “narcotic-naïve” to “addict.” While I took smaller-than-offered doses at every opportunity, and tapered off the narcotic as quickly as possible over five days, I was hooked. My body had become heavily dependent on the drug, and after only 12 hours after the last pill, I experienced horrendous withdrawal symptoms. My body shook with chills and fever, I experienced terrible headaches and dizziness, my stomach felt like it was churning through the worst food poisoning, and my brain felt cloudy and vacant. It is difficult to articulate this fact: that opioid withdrawal is not about “wanting the drug.” I didn’t feel addicted in the sense that I felt like I needed to get high. Rather, I felt excruciatingly sick and knew that the only way to stop feeling so awful was to take the drug. I knew, however, that I would have to go through the worst of the withdrawal without any narcotic.
Today, 16 weeks later, I still feel some of the symptoms every day (although not as acutely). When I contacted both my surgeon and my primary care doctor, I was told that the withdrawal symptoms had nothing to do with the narcotic. I hadn’t taken enough or over a long enough period of time, they told me, to develop an addiction. And yet, I knew that the symptoms were not psychosomatic, and were not coincidentally caused by some other illness.
Extremely potent drugs
As I worked to recover from the injury, and also to recover from the addiction, I have been doing research on narcotics and opioid addiction in general. I have learned that Dilaudid, the brand name for the generic hydromorphone, is an extremely powerful drug. According to Stanford University, Dilaudid is 20 times more potent than oral morphine. Oxycodone, the tiny pills I took home with me, is roughly 1.5 times more potent than oral morphine.
I also learned from the same Stanford website that doctors and nurses are trained to say that addiction to narcotics is extremely rare. That’s exactly what I was told. In effect, my concerns about addiction were dismissed as an “overly worried” and “anxious” patient. In searching other hospitals, university, public and private alike, there seemed to be the same message: Narcotics are not “addictive” when prescribed by doctors to treat medical pain; any worry about addiction is due to misplaced concerns by patients and their families.
Yet I have also learned from the Physicians for Responsible Opioid Prescribing that addiction can develop in only five days, and that withdrawal symptoms can last for up to a year.
This opioid “message” is not an accident; the dismissal of concerns from patients and their families is not simply bad medical practice. It is a clear strategy by the pharmaceutical companies to promote their product and to diminish the risks. For example, Purdue Pharma is one of the largest manufacturers of narcotics in the United States and makes Dilaudid and Oxycodone. In 2007, three Purdue Pharma executives and the company pleaded guilty to misleading regulators, doctors and patients about the risks of their narcotics. The company’s guilty plea cost Purdue Pharma $600 million. Yet while this settlement was huge, it paled in comparison to the annual sales of OxyContin: $1 billion.
No discussion about weighing risks
It seems clear that my addiction has to be understood in this context: I was given narcotics by overemphasizing the pain-reducing benefits and by hiding the risks of addiction. And it seems clear that my experience is not isolated. When we examine the so-called “opioid addiction crisis,” we need to understand how this is a manufactured crisis. In my case, there was certainly a moment – maybe several hours or even a couple of days – when my pain was so excruciating that I needed strong medication. Among my doctors and nurses, there was widespread agreement that the best way to treat that pain was a narcotic. I have no knowledge or expertise to challenge this decision. Yet as the severity of pain diminished, there was no discussion about weighing the risks of addiction against the benefits of pain reduction—in fact, quite the contrary. I was actively encouraged to continue to take the narcotic; I was offered the narcotic constantly as health care staff worked hard to persuade me to take the medication. I was also prescribed far more doses than I needed. In effect, I was “pushed” to take the narcotic, with no recognition, discussion, or acceptance of the risks of addiction.
In order to understand our national opioid crisis, therefore, we need to come to terms with the role of pharmaceutical companies, and the doctors and nurses they have profoundly influenced. We also need to face the fact that those of us who have experienced narcotic withdrawal are not making it up. The pain of withdrawal is real, and continues.
Matthew Filner is a political science professor and chair of the Social Science Department at Metropolitan State University. His views do not necessarily represent the views of his employer.
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