I understand the lure of addictive substances. Recalling the ultra marathon called OB/GYN residency, I was typically scheduled for three places at once—prenatal/gynecology clinic, labor and delivery, and the post-surgical hospital floor. 34 hours into a 36 hour shift, when the attending physician was urging us to move faster through a backlog of patients, residents would joke that it was time for a Xanax.
Except it wasn't. At our most vulnerable, when we really needed to lower our stress, it was the most important time to just say “no”.
I understand chronic pain, both as a physician and as a patient. At the end of my surgical career, with hands that were failing me, causing excruciating pain, I tried to run that “ultramarathon” again. I was extremely vulnerable to the lure of addictive medication, especially as I endured multiple ineffective hand surgeries.
Instead, I retired. And because I could still hold a kayak paddle with my distal fingers, press a camera button, and care for others, I channeled my energy into volunteering for Team River Runner. There I began to work with veterans who had chronic pain, disablity, and substance abuse problems.
My Congressional district is especially hard hit by the heroin epidemic. People who make their living doing hard physical labor typically have chronic pain. Anyone who has had a sports or work injury, an accident, or surgery has probably been prescribed opiates for pain relief by their physician. The problem starts when the pain remains and the addictive medication continues. At some point the doctor says “no more” and the dealer steps in to fill the void.
During my training as a physician I learned not only from scientific research but also from my professors and colleagues. It was routine to order opioids for pain relief. Every doctor did it, but it didn't sit well with me. Not wanting to take potentially addictive drugs myself, why would I order them for patients? Instead, I performed a small unofficial study at Christ Hospital using the nurses who had just given birth. Asking each nurse if she would like to try using staggered dosing of Ibuprofen and Acetominophen as an alternative to opioids for pain relief, each readily agreed. Although her motivation was that she didn't want opioids to show up in her breast milk, the result was actually excellent pain control. I continued to do this for nurses and, as it was so successful, branched out to offering the Ibuprofen/Acetominophen regimen to all my patients.
Staggered dosing of Ibuprofen and Acetominophen remained my drugs of choice for pain control during my medical/surgical career. I can safely say that I did not prescribe the opiates that started a patient's heroin addiction.
For more information about the physician's role in the epidemic see