The Recovering Addict and Opiate Medications for Acute Pain

There are instances when opiate medications are required to control severe, acute pain (e.g. dental procedures, kidney stones…). How can these pain killers be used safely in recovering addicts?

First and foremost, the recovering addict needs to establish excellent communication and honesty with his/her family doctor. The family doctor needs to be completely informed of the patient’s addiction history. If the patient has an addiction specialist, the family doctor should be in communication with the addictionist in order to safely formulate a pain management plan.

If an emergency room doctor or dentist is prescribing the opiates, then these specialists need to know that the patient is a recovering addict. What they are prescribing needs to be communicated to ALL of the patient’s treatment providers. In other words, ALL the treatment providers need to be in the loop. When it comes to prescribing addictive pain-killers, anything less than this kind of top-notch communication, especially in our much-lauded age of computer technology, is totally unacceptable.

The prescription short-hand instruction “prn” or “as necessary” (which allows the patient to take pain-killers “as necessary”) is completely inappropriate for the patient with a history of addiction. The instructions need to be precise and specific with respect to dose and frequency. These specific instructions can be revisited or re-evaluated fairly frequently by the doctor and replaced with other just-as-specific instructions every couple of days. The patient however must never be left in charge of deciding when to take any medications, let alone addictive pain-killers. Many doctors still don’t know how to prescribe pain-killers appropriately.

If possible, the prescription bottle should be kept in a safe and secure location known only to the patient’s family member or another reliable person. The pills should be administered to the patient by this other person at the precise prescribed interval and not left to the patient’s discretion. The doctor should be tapering the dose over a period of a few days (again using specific instructions) and switching over to non-addictive, non-opiate pain relievers as soon as possible.

In Summary

Some key points to follow are as follows:

1. Excellent communication between all health professionals, patient, and patient’s family and/or friends;
2. Patient honesty;
3. The patient giving up control over the dispensing of medications;
4. The precise, specific and limited prescribing of opiate medication by ONE doctor over a few days;
5. Closely monitored re-evaluating and re-assessment of patient by the doctor;
6. Administration of medications by a trusted family member or friend;
7. The storage of the medications in a safe, secure location unknown to the patient.

Narcotic medications do sometimes have to be used in acute pain management. The past twenty years’ experience in the disastrous opioid epidemic has taught us that the risks to an addict are never zero, no matter how “legitimate” the pain may be. However, with these guidelines, the risk of the patient’s addiction being reignited is reduced.