On June 9, Seth Mnookin wrote an article for STAT that quickly went viral. As someone in recovery for heroin addiction, he described a particularly frightening incident in which kidney stones became lodged in his ureter during a flight from Miami to Boston. After being wheeled from the airplane on a gurney, Mnookin quickly found himself receiving opioid after opioid from the doctors in the emergency room.
“One of the (kidney) stones was roughly twice as long as the ureter is wide, which meant it would require surgery – and the soonest that could occur was at the very end of the following day,” he wrote. “I’d need to be injected with a lot more painkillers before then – and I’d likely be sent home with a prescription for more. That was something I’d been dreading for years.”
Mnookin’s story is far from unique. According to the Centers for Disease Control and Prevention, or CDC, clinicians have been prescribing opioids at an increasing rate since 1999 for both acute and chronic pain. Roughly 1 in 5 patients with noncancer pain or pain-related diagnoses receives prescriptions for opioids in an office setting. At the same time, doctors are prescribing more opioids, which creates the problem of more individuals developing opioid addictions.
“And while everyone’s demons, secrets, and temptations are unique,” Mnookin wrote, “I’ve seen enough friends stumble after years of sobriety to know there is one chain of events that is especially dangerous: a surgical procedure followed by a round of medically necessary pain pills.”
Why are opioids so commonly prescribed? Although the addiction potential of opioids is well documented, researchers have yet to find any drugs that are more effective than opioids at treating pain. Some hospitals have guidelines that are supposed to keep people addicted to opioids safe. The hospital that Mnookin attended is responsible for creating Addiction Consult Teams, or ACT: a team made up of internists, addiction specialists, social workers and nurses who can help people with substance addictions receive the safest treatment possible.
ACT is implemented in every area of the hospital, with the exception of the emergency department, where staff shortages and an absence of certified addiction specialists pose a challenge.
Unfortunately for Mnookin, ACT was designed to help only individuals currently addicted – not those in recovery. Because of this, Mnookin often felt that his concerns were ignored during his hospital stay. Although he told “everyone (he) could” that he was in recovery for heroin addiction, many of his doctors appeared to forget. When he was instructed to take home a prescription for oxycodone, he received no counseling or instructions.
“No one talked to me about the risk of relapse – or how to guard against it,” he wrote. “No one offered to advise me as I began taking the powerful painkillers I would need to get through the next few days.”
Although Mnookin was able to avoid a relapse – his wife guarded the pills and made sure he never took more than two in a six-hour period – he began to feel progressively sicker as time went on.
“The pain in my bladder and kidney was, I’d been told, due to the ‘trauma’ of the stent removal – but that didn’t explain why my nerve endings felt as if they’d been electrified,” he wrote. “At 4 a.m., still unable to sleep, I began to irrationally panic that I’d poisoned myself by taking too much of a powerful, prescription anti-inflammatory drug.”
A formerly addicted friend helped him recognize the truth – he was in withdrawal.
“While two weeks of continuous use is quick to develop a physical dependence, it’s not unheard of, even in what doctors refer to as ‘opioid naïve’ patients – and dependence can occur even more quickly in people with a history with opioids,” Mnookin wrote.
Despite the intensity of his symptoms, Mnookin received no warning from his doctors that withdrawal was a possibility. He was left to blindly cope with intense physical and psychological symptoms. Mnookin credits his support network with preventing a relapse, but acknowledges that it was a real possibility.
“If I had filled that fourth prescription (of oxycodone), would I have convinced myself that it made sense to just keep on going for a few more days – and then a few more days after that?” he wrote.
In the end, Mnookin’s story reminds us of the necessity of teaching clinicians how to safely prescribe opioids, particularly for recovering and addicted individuals. It’s not enough to hide opioids behind a prescription wall. Clinicians must follow up with patients, discuss the risk of withdrawal symptoms and offer preventive counseling to reduce the risk of relapse. Through common sense and government initiatives, we must do what we can to make opioid prescriptions as safe as possible.
Sovereign Health’s addiction treatment program offers comprehensive treatment for individuals who are addicted to substances, including alcohol, opiates, cocaine and amphetamines. We do more than help our patients through withdrawal – we also provide therapy and restorative activities to educate our patients and prevent relapse. For more information, contact our 24/7 helpline.
About the author
Courtney Lopresti, M.S., is a senior staff writer for the Sovereign Health Group, where she uses her scientific background to write online blogs and articles for a general audience. At the University of Pittsburgh, where she earned her master’s in neuroscience, she used functional neuroimaging to study how the human cerebellum contributes to language processing. In her spare time, she writes fiction, reads Oliver Sacks and spends time with her two cats and bird. Courtney is currently located in Minneapolis. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.