Withdrawing from painkillers

Travis Rider, a bioethicist at Johns Hopkins, was in a motorcycle accident that mangled his foot. To save it and make it semi-workable, he had six surgeries over a period of months. One of the surgeries consisted of removing flesh from his thigh to plug up a hole in his foot. As you can imagine, he was on lots of pain medicines—every type imaginable, but mostly opioids. 

After several weeks of being home, he wanted to get off the opioids and began calling various doctors about getting off them. They didn’t have a clue and didn’t want to be bothered by him. He called the pain management people at various hospitals with the same result. One doctor, off the top of his head, suggested that Travis cut his dose by quarter every week. Travis did this, and became horribly sick (nausea, sweating, chills, shaking, sleeplessness, depression) to the point of considering suicide. He says, “A whole slew of doctors gave me a medication that they weren’t willing to manage.” He stuck with the withdrawal for four weeks, after which he began to feel better, but “every moment in those four weeks was the worst moment of my life.”

Then he began doing research. Among other things, he learned that at most you shouldn’t taper off the meds faster than 10% a week and perhaps far less. He also learned that doctors receive little or no training in treatment of pain. Many doctors even lack the basic knowledge of when to prescribe opioids and have no idea how long it takes for a person to become dependent. (You can become dependent in as little as two weeks.) Many were taught to give opioids to anyone in pain. To make matters worse, doctors are motivated to keep patients pain free: they and their hospitals get higher ratings and they’re also financially rewarded by drug companies for prescribing pain meds. In his research, Travis also learned that opioids can increase sensitivity to pain, a condition called hyperalgesia.

He also says if he’d just been warned about the tortures of withdrawal he would have been prepared and been less despondent. Because his final surgery occurred after he’d gone through withdrawal, he was reluctant to take opioids for the pain, saying “I was more scared of withdrawal than I was of the pain.”

I think we've all experienced the ease with which doctors prescribe opioids. We had a bunch of unused opioids in our medicine cabinet until a neighborhood boy stole them. That's one solution, I guess.

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