Ahead of surgery, is it worth it to tell your healthcare team about your addiction history? Amy Dresner shares her experience.
I went into the office to sign the consent form with a physician assistant for an intensive hand surgery I was having the next week. They would be slicing up all the tendons in my fingers, hand, and wrist. And while some people say I shouldn’t take pain meds at all, I disagree. The body can’t heal if you’re in pain, and I have put many safety stops in place with my sponsor and friends.
I complimented her on her big diamond ring as a way to break the ice. She informed me that I would be given Norco.
“Norco doesn’t work for me,” I admitted.
“Oxycodone?” she offered.
“Oxycodone gives me a rush, but it never lasts the full four hours.”
“Percoset?”
“Percoset makes me angry.”
There was an awkward pause.
“Listen, I’m 13 years in recovery,“ I confessed. “I’ve had a lot of surgeries, and I know what works for me and what doesn’t. I have strange reactions to narcotics … which is why I’m in recovery,” I said as I laughed nervously.
“I wrote a memoir, edited science for 7 years (I know my way around a research paper), and I’ve been an addiction journalist for over a decade. So I understand if my detailed knowledge of drugs is weird or alarming to you.”
“Whatever we agree on, I will give you 30 pills. If you take them before the surgery, there will be no refills.”
“Why would I take them before?” I was puzzled and offended.
“You can just have Tylenol 800s.”
I could see she was losing patience.
“I’ve been on heavy sedative epilepsy meds for 20 years, so I have a high drug tolerance and a low pain threshold.”
“Do you have a pain management doctor?” she asked, irritated.
“No, but my old sponsor was a hospice nurse for 30 years and advises me on any surgeries. That’s also why I know a lot about drugs.” I shrugged my shoulders. “He’d be happy to speak with you if you’d like.”
“I write prescriptions every day, all day. I don’t need to speak with your sponsor.”
“Got it. My bad.” Ooh, hit a nerve there.
“The anesthesiologist will call you one day before. We use propofol.”
“Propofol alone is a no-go for me. I cry for a week after. It’s certainly not ‘the best nap I’ve ever had’.”
“Well, you might just have to suck it up,” she quipped as she jotted something down.
Nice. I’m loving the personalized treatment they brag about on their website. (Oh, and the anesthesiologist never called me.)
I want to be able to tell my providers about my substance history
Now I was getting mad. In the end, I got the drug I wanted—the drug my old sponsor recommended—because I’m nothing if not convincing and manipulative. But everybody I’ve shared this with has said I shouldn’t have told them I was in recovery. That ‘I want this, not that’ sends red flags that a patient could be a drug seeker. I see that point. But I also see that the stigma of addiction is alive and well.
Am I not allowed to be proud of my sobriety? Can’t I communicate which medications work for me and which don’t? In trying to protect my sobriety, advocate for myself, and not be in pain, am I somehow doing something wrong? Is my knowledge about narcotics and which ones trigger me always to be considered dangerous? Should I be less educated (or pretend to)?
When I had my Vagus Nerve Stimulator put in my chest and neck, the anesthesiologist was shocked that at 115 pounds, it took twice as much Versed and Fentanyl mixed with propofol as he’d anticipated to put me and keep me down during the surgery. He was grateful I had warned him ahead of time. Based on this, I thought my history was something my current surgery team might want to know beforehand, so I don’t surprise them and wake up on the table while they’re cutting my hand up.
I understand I got a little snarky. I understand there’s an opiate crisis in this country. But when will telling a physician’s assistant which medications are dangerous for you or which don’t control the pain become just as mundane as telling them you’re allergic to penicillin? When will the medical system treat patients as individuals and drop the one-size-fits-all approach? When do I get to stop being ashamed of having been an addict? Is 13 years not long enough? When do I get to have some agency over the drugs they’re putting in my body, without judgment? When will being in recovery stop being some terrible secret? My surgical team isn’t responsible for my recovery; I am.
Memories of having to advocate for my mother to be given more morphine as she died in pain flooded my brain.
The PA called in two alternate prescriptions incorrectly multiple times, and my pharmacy called her at least 6 times with no return call. The day before the surgery, I paid out of pocket.
I was a little loopy on the meds. Slept most of the time. Had no pain. And wouldn’t care to feel that zooted all the time.
In the end, I got my surgery and the meds I needed
Of course, this is my own experience, and opiates were never my jam.
I got extended-release meds. My friend held the pills, and I called somebody before I took a pill (a personal choice for accountability). I am aware that many people lose their sobriety over pain pills. I did not and have never.
I won’t lie—it was nice to turn my brain off for five days. But I would not want to feel that way forever. Two days after I stopped taking those meds, I cried and cried. I guess this was the come down. It was not pleasant, but worth not being in agony in the immediate aftermath of the surgery. I’m on ibuprofen now, but I know it certainly wouldn’t have cut it at the beginning.
Know your own body. More than that, know your own motives. Be honest with yourself. Even if you feel sure you won’t be triggered, put bookends and precautions in place. Even with them, when my friend told me, “There’s only one pill left,” I felt a panic come over me. Yes, the dragon lives.