Pain In Recovery

This has been an interesting few days.  On Wednesday I felt some pain in the back of my mouth.  I figured it was TMJ joint pain due to tension, since I'd been a bit uptight for a few days while my daughter was in the hospital for a Cesarean delivery.  By Thursday it was clear that it was a tooth, and by that evening, the pain was getting fairly severe.  I began taking prescription strength ibuprofen (Motrin), and called the dentist.  To make a long story short, by the time the penicillin took effect on Saturday morning some time, I'd spent about 24 hours in fairly severe pain, kept partially in check by the pills and swooshing cold water on the tooth.  Missed a night of sleep, but I made up for it later.

I'm okay now, and waiting to make an appointment to see the dentist, who will likely remove the tooth.  Been there before.  No fun, but not a big deal.  I got to thinking, though, about what a dangerous thing it would be to be in a situation like that in early recovery.

I don't know about you, but back when I was active in my addictions I saw every potential malady as a source of drugs or an excuse to hole up and drink.  A cold — no problem!  I knew how to handle that.  Fortunately I never had a problem that required heavy duty painkillers, or I would likely have been able to add that to my list of addictions.  Martial arts bruises, sprains, aches and pains were all chances to get messed up, and excuses to stay that way for a couple of days or more, but nothing ever happened that required opioids, thank goodness!

This toothache episode could have been another example of that trend.  If it had occurred in the first few months of my recovery, I could very well have been off to the races, because back then I really believed that I needed powerful drugs to kill pain.  It had never occurred to me that painkillers, for some kinds of pain, are like hunting rabbits with an elephant gun.  Since dental problems go part and parcel with addiction, it's an issue that all addicts need to consider carefully.

Alcoholics and addicts are, almost by definition, folks who don't know that it's okay to not feel okay.  We start out thinking that every little twinge means terminal pain, and that each needs that elephantine response.  The fact is, most pain can be adequately handled with non-addictive drugs that pose no threat to our sobriety.

We need to find doctors who understand addicts, and what meds are off our list of remedies.  We need to consult with our pharmacists about possible side effects, and  need to research the drugs themselves online and elsewhere.  We need to discuss the matter with our sponsors and significant others.  We need to avoid secrets.  Even if our pain is such that more powerful drugs are necessary — and sometimes they truly are — we need to get others involved who can monitor our use and help us stay on the straight and narrow to the extent possible.  Most importantly, we need to be upfront with all of them about our addiction(s) and our inability to use mood-altering drugs.

There is no reason that anyone who is serious about his or her program of recovery has to relapse because of pain.  We need to be proactive, getting dental and other problems dealt with before they become emergencies.  When emergencies do arise, however, there are tools to handle them without giving up all we've gained.

Oxymorphone — an increasing threat for overdose among drug abusers

Recent reports indicate a rise in the abuse of oxymorphone (Opana® and Opana ER®) a semi-synthetic opiate drug related to Percodan, Percocet and Oxycontin. Like the other opiates, it is used as an analgesic for moderate to severe pain.  However, because of some unusual characteristics of the drug, overdoses and deaths from oxymorphone abuse are on the rise, and likely to continue to increase.

Oxymorphone in varied strengths - USDOJ

Since January of 2008, oxymorphone deaths have been reported in California, Colorado, Connecticut, Florida, Michigan, New Mexico, North Carolina, Ohio, South Dakota, Washington, Tennessee and Kentucky. Between January and April of 2011, there were nine deaths in Louisville, KY alone. Newport, TN officials reported five fatalities within a three month period in March of 2009. Other deaths may have been oxymorphone-related as well, since toxicology results may not have been available for some victims at the time the reports were made. Like abuse of other prescription opiates, cases seem to be clustered in, but by no means limited to, areas with economic depression and high unemployment, and in areas such as Florida, where prescription drug mills proliferate.

Oxymorphone is known as: blues, biscuits, octagons, stop signs, pink, pink heaven, biscuits, Mrs O, Orgasna IR, OM, Pink O, The O Bomb and a variety of other names. Like other opiate drugs, it causes feelings of euphoria, well-being, increased sociability and similar effects that make it a desirable drug of abuse. The euphoria is usually less intense than with the other opioid drugs, and there is a tendency to take larger doses to obtain the desired level of intoxication. This, along with the fact that the effects of the drug vary widely among individuals due to physical condition, the presence of other drugs, food eaten and other factors, creates a situation where the “right” dose for one person may have little effect on another, while creating extreme intoxication or overdose in a third.

These circumstances are further complicated by the fact that when taken with alcohol, the availability and effects of the drug are nearly doubled — in addition to the added effects of the alcohol itself. These three factors, varying response, relatively low euphoric effect, and the synergistic effect with alcohol, combine to create a “perfect storm” for overdose. This is especially true in those who purposely attempt to enhance the effect of the drug by drinking. Oxymorphone overdose typically involves lethargy, relaxed muscles, respiratory depression and sometimes low blood pressure, progressing to coma, cardiac and respiratory collapse, and death if not treated quickly.

We will be hearing more about Opana® and oxymorphone abuse, addiction and overdose in the coming months. Parents, professionals and law enforcement, in particular, need to be aware of this “new” and deadly trend in illicit drug use.  Even more, we need to be aware that these tragedies are, to a great extent, avoidable. Painkiller abuse and addiction are treatable conditions.  Addiction is a recognized disease that responds well to proper treatment and aftercare.  The ill-conceived “War on Drugs” has diverted billions of dollars into an unproductive endeavor that does nothing to address the root of the problem — the drug users who make dealing profitable.  We need to develop a national policy of education, treatment and rehabilitation, and act as though we mean it.  It would save a lot of money but, more importantly, it would save a lot of lives.