The personal histories of a pain patient, a recovering addict and an “opiate widow” typify the complexity of balancing effective therapy with the intrinsic risk of narcotic painkillers.
Three women shared those stories Friday with more than 200 treatment service providers at a two-day conference called “Addressing Chronic Pain and Addiction in Missoula, Mineral and Ravalli Counties: A Community Network Response.”
The conference drew state and national experts in the fields of addiction, chronic pain and mental health as they grappled with the challenges of balancing pain relief and addiction to prescription painkillers.
The women who told their stories embodied those challenges, and would identify themselves only by their first names – Trish, Patricia and Nichole.
Trish, an addiction counselor in Missoula, lost her 32-year-old husband to a methadone overdose after he struggled for years to overcome addiction, only to finally lose the battle after a relentless cycle of chronic pain and health issues. A self-described “opiate widow,” Trish said her husband was hypervigilant about not abusing the prescription pain medications, but after collapsing a third and then a fourth time due to chronic pancreatitis, he stopped telling doctors that he was a recovering addict.
Eventually, he was overcome by addiction and the drug-seeking behaviors he’d worked so hard to rehabilitate. On Sept. 7, 2008, he ingested a lethal dose of illicitly obtained methadone, told Trish he loved her, and went into cardiac arrest.
“I’m a good clinician. I’m savvy at what I do,” Trish said. “But I couldn’t see this because the addiction was so big.”
Patricia fought drug addiction for two decades and nearly attempted suicide after she spiraled into a $75,000 debt criss-crossing the state, doctor shopping for prescription pain medications. She said a 2001 arrest for tampering with drug records did not deter her drug-seeking behavior, and self-maiming was not unusual.
“Today, I have my own home, a job and 15 months of sobriety,” she said.
Nichole was diagnosed in 2005 with a degenerative nerve disease called Reflex Sympathetic Dystrophy, the symptoms of which were exacerbated after she dropped a wooden board on her foot. No bones were broken, but the swelling and pain in her foot continued for months before a neurologist diagnosed her with the ultra-rare illness.
Today, Nichole must use a cane to walk even for brief intervals and has just bought her first wheelchair. She takes opioids every day, and worries about being seen as a drug seeker. She even rejected the drug regimen at first, but the pain was too agonizing to function.
Nichole continues to struggle with the loss of her physical faculties, and as a practicing Buddhist uses meditation to cope, as well as a pain therapy counseling group.
“Letting go of the person I used to be is an ongoing struggle,” she said. “Thank you for trying to find help for those with addictions while also safeguarding those of us who use pain medications to have a better life.”
The three stories lent a human element to the message that nationally renowned experts repeated over and over during the conference – that understanding the addictive potential of pain medications is critical to effectively treating pain patients.
“If we don’t figure out some kind of middle ground, we’ll continue to go back and forth forever,” said Steven Passik, a New York City psychologist and an expert on pain management and opiate-related substance abuse.
“Addiction does not live in drugs. Addiction is the end result of exposing vulnerable people to potentially abusable drugs at vulnerable times,” Passik said. “We do a lot of opioid prescribing in this country. We unleashed the drugs without teaching a lot of Addiction 101.”
Passik said physicians should not be afraid to treat chronic pain as a legitimate disease process, and opioid painkillers are an oft-used tool, particularly for patients with acute back pain or who suffer from or have survived terminal illnesses, such as the 12 million Americans who are living post-cancer.
At the same time, Passik is all too aware of the addiction problems associated with opiates.
“I like to refer to these drugs as highly hydrofallic, because they have such a tendency to fall into the toilet,” Passik said, referring to substance abusers who have chronic excuses for why they need to refill a prescription early.
Passik encouraged doctors to assess every patient carefully and develop risk profiles, then to monitor their opiate intake, using drug screens, doctor-patient meetings and pill counts to discern aberrant behaviors that suggest misuse or abuse of the prescribed drugs.
“We’re trying to make functional people,” Passik said.