Seek help, alternatives before struggle with painkillers becomes dangerous

Issue December 2004

Q:My law partners and colleagues know that I'm alcoholic and have not had a drink in almost a year. However, they don't know about my struggles with painkillers, which I began using on a prescription basis years ago to deal with a very painful, recurrent medical condition. Sometimes these pills offer me the only means of relief I can find (short of returning to drinking). But I have also quickly developed a tolerance, needing higher and higher dosages. Subsequently, things have gotten out of control - first, I've had to go to multiple doctors when no one doctor will prescribe enough, and later I've endured debilitating withdrawal symptoms in order to get off these drugs. When I begin to discuss these matters at meetings or group therapy, it's clear that people see me as no-longer-sober. But they have no concept of the kind of physical pain that recurrently hits me. Do you have any ideas?

A:Painkillers, as you know, are opiates (may also be referred to as opioids or narcotics), and can be addictive. The pain relief literature indicates that the vast majority of those who use prescribed painkillers (such as Percocet, Vicodin or Oxycontin) do not abuse them and, if at appropriate dosages, get no "high." This may also be true for some individuals with a history of addiction, but the risk for abuse is much greater. Some of us are simply "wired" in such a way as to readily develop tolerance, leading to the pattern you describe. Others feel so drawn to the psychological effects of opiates (described as a kind of cushion from life's sadness and worry accompanied by an artificial sense of wellbeing) that they are compelled to use more than necessary. Those who do not abuse the painkilling medication still run the significant risk of triggering their primary addiction (in your case, alcohol).

No one would suggest that you bear with constant, severe pain, nor would anyone advise you to discontinue opiates abruptly. In fact, a detox may be needed. But a recovering person in pain might do well to consider the following:

•  There are many non-addictive pain reduction measures (medical, behavioral, physical). Although none of these will provide the powerful, immediate relief of an opiate, they do provide means of reducing pain without risk of reviving an addiction or creating a new one.

•  If there really is no reasonable alternative to opiate medication, there are a number of strategies you can employ in order to minimize the likelihood of escalating, addictive use. These might include: openness with a physician who will collaborate respectfully on this issue; openness with and active connection to others who are supportive of your recovery; appointing someone to hold and administer the medications; monitoring yourself for inclinations to take more pills than necessary, or to continue longer than necessary. Even if you use an opiate, it is possible that, with adjunctive use of the non-addictive alternatives alluded to above, you may have fewer episodes of intensified pain.

Feel free to come in and discuss these matters with us at LCL, where, on a confidential basis, we can help you put together a well-considered plan.


Questions quoted are either actual letters/e-mails, or paraphrased and disguised concerns expressed by individuals seeking assistance from LCL.