In Praise of Opioids

Tibia xray

Some readers of my blog mistakenly think I’m opposed to all opioids, all of the time. That’s not true at all. I’m only opposed to the misuse or addiction to opioids, which can cause undue suffering. I’m a big fan of opioids, when used cautiously and in the right setting.

The benefit of opioids was driven home to me personally when I fell and broke my leg several years ago. Here’s the post from several years ago, describing my experience. Far from opposing opioids, I was thankful for them.

While walking my dog, I fell and broke my tibia and fibula (both bones of the lower leg). The break was obvious; I had to hold my foot to keep it from moving to an odd and painful angle. I sat on the ground, thinking, “Oh shit. This is going to hurt, and I’m going to have to go to the hospital emergency room on a Friday night to get a cast.”

And of course it did hurt. It was the worst pain I’ve ever had. I couldn’t get into a car to go to the hospital, since both hands were busy holding my foot. If I let go, my foot drooped to a sad angle. I wasn’t going anywhere without additional help. So my fiancé called 911.

First to arrive was a huge fire truck, with ladders, hoses, etc. One of three or four firemen took my blood pressure, asked me a few questions, and said EMS would be there soon. When EMS arrived, three or so more young men sprang from their vehicle. They asked the same questions all over again. At one point there were five or six burly young men who all responded to the 911 call, standing around me in a semi-circle. It felt like a bit of overkill, but I didn’t mind.

The worst part of my whole ordeal was when EMS workers tried to splint my leg with a device obviously meant for a much taller person. Putting the splint on caused my foot to move to an angle that God did not intend. The grinding of my bones made me sick to my stomach, to the dismay of EMS personnel. I’m told I gave my neighbors quite a show.

Once I finally got inside the ambulance, the EMS worker easily slid an IV into my arm and gave me a dose of fentanyl.

I have never taken any IV opioids, to my knowledge. Immediately, I felt hot all over, and then started weeping with relief. I wouldn’t say I felt euphoria, so much as a profound relief that the pain no longer hurt. That also sounds odd; I still had pain… but it didn’t bother me, and I felt like everything was going to be OK. In that moment, I had a better idea what my opioid-addicted patients describe when they tell me of the allure of opioids. Under the influence, I felt like nothing would bother me, physically or emotionally.

Then my eyes felt like they were spinning around in my head like pinballs, but I didn’t care about that, either. Then I got very chatty and talked nonstop to the hospital. I remember I told the EMS worker about how traffic lights looked like candy – lime, lemon, and cherry – so I may have been a little out of it.

The emergency room doctor ordered X-rays that showed the tib/fib fracture. I thought I would get a cast, and then go home. Wrong. The nurse told me I was being admitted for surgery on my broken leg. I wasn’t happy about this, especially since I hadn’t even talked to the orthopedic surgeon who would operate. I had questions. Why couldn’t I go home with a cast? What was he going to do at surgery, and why was it better than a cast?

So I stayed in the hospital that night, edgy about what surgery was proposed and full of questions. My leg hurt, but the emergency room staff had placed a plaster-type splint, or partial cast, on my leg, which kept the bones from moving around. As long as I kept it still and elevated, the pain wasn’t too bad. I had several shots of morphine through the night. I didn’t feel high from the morphine, but the shots put me to sleep, a good thing.

The surgeon came into my hospital room mid-morning, and talked to me about the advantages of having an intramedullary rod place through the center of my tibia to hold the broken sections together. This sounded extreme, but the surgeon said in “someone your age,” with simple casting the bones would take longer to heal. At my age, there was a relatively high rate of non-union, which would result in surgery at a later date anyway.

It took me longer to process the information than it should; I was stuck on that “someone your age” comment. I’m a young-looking 52, and finally realized I had to be much older than this young surgeon, who could have passed for twenty-five… Maaaaaybe the comment fit.

Anyway, I agreed to the surgery. Pre-op, the anesthesiologist gave me fentanyl, and again I had the feeling my eyeballs were spinning in circles and I got chatty. Then he must have given me something else that put me out completely, because the next thing I remember I was waking up back in my hospital room. I was upset when I didn’t see a cast, because I thought that meant I didn’t have the surgery. I didn’t know that an intramedullary rod takes the place of a cast…kind of like having a cast on the inside.

Since that surgery, I haven’t had much pain. I took my last morphine injection the night after surgery.
I’m no martyr. If I have pain, I want pain medication. The surgeon, knowing what I do for a living, asked me if I wanted to go home with any opioids. I said yes. I told him please prescribe what you would for anyone else. He prescribed twenty-five Percocet. I took two the morning after I got home, and they relieved the pain, but left me a little groggy and sleepy. I’d had enough of that in the hospital, and was eager to do some reading and writing, so that was the last dose of opioids for my broken leg. After making it a week with no opioids, I flushed the remaining twenty-three pills.

I had one bad spell after falling on my crutches, twisting the broken leg a little. The rod held my tibia in place, but the fibula hurt intensely for about twenty minutes before I was able to calm the pain with elevation, ice, and ibuprofen.

I think I’ve done well during my recovery from the broken leg. This surgery allowed me to heal much faster. It’s now almost six weeks since my surgery, and the above x-ray was taken today. My leg hurts only when I walk around. Ibuprofen and Tylenol have worked fine. I’ve been careful, especially during the first few weeks, to keep my leg elevated and use ice for swelling. I’m convinced elevation and ice helped a great deal.

This week I can walk with the help of a cane. It does hurt to walk, but it’s the kind of hurt that’s necessary to build back my muscles. If the pain gets too bad, I sit down and elevate my leg again.

I know I’m very lucky. The fracture happened in a place where help was readily available. It was less than thirty minutes from the time I broke my leg until I got a shot of a powerful opioid, fentanyl. This medication was a godsend to me.

I have health insurance, and could afford to get the surgery to help my leg heal quickly. My surgeon did a wonderful job, even if I do have underwear older than he is. I was able to take several weeks off work to keep my leg elevated for better healing and less pain. I have a loving fiancé who didn’t mind being my legs for a few weeks. Some people don’t have any of those things, so I’m very grateful.

What is the point of this blog, other than to blather on about my surgery and broken leg? It’s this: opioids are great when used the in the right situation. For acute pain, they are truly a blessing to mankind. But these drugs produce pleasure, and anyone can get addicted to that intensely good feeling.
Doctors have to find a balance between empathy and caution. Let’s not be stingy with opioids during acute medical situations with intense pain. Even in a patient with known addiction, opioids shouldn’t be withheld for an acutely painful medical situation, because that would be unethical.

But we can’t ignore the dangers of addiction, particularly if opioids are used for more than a few weeks. Even if we feel uncomfortable talking about addiction, we have to have those conversations with our patients. And please, fellow doctors, see patients with addictions as people with a treatable disease, who deserve the same respect as patients with any other disease. You don’t need to kick them out of your practice; you do need to refer them for help.

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8 responses to this post.

  1. Posted by kevin on August 18, 2015 at 9:06 am

    I had surgery back in January of 2015 on a cyst, they had to leave my wound open to let me heal from the inside out, I had the worst experience because I could never get relief from the pain. I’m currently on methadone maintenance receiving 150mg methadone. They were giving me 2 mg dilaudid every 4 hrs for pain along with a 10mg percocet every 6 hrs. I never got any relief. You would think that with all the opoids I had in my system that I wouldn’t be in pain. Boy was I wrong. I couldn’t even get relief when I went home and I took my meds as prescribed and never even thought about taking more than prescribed. I had the mindset that it wouldn’t matter anyway if I did, I would waist the meds cause they wouldn’t do what they once did for me and I would run out too soon and be in worse shape than what I was at the time. It scares me that at some point I may be in the hospital again at some point. I don’t want to be in pain again like that and not be able to have it controlled by medications. Does it mean that if I am in a serious car accident that they won’t be able to get me out of pain? Will they have to put me in an induced coma just to keep me comfortable. I think about all this and it scares me. So much

    Reply

  2. Posted by Kristin Moore on August 25, 2015 at 5:05 pm

    Just curious, why did you feel the need to flush the other 23 pills… I know it’s a dumb question, I love your blog and read it daily, that was just one of the questions that came to my mind. I’m glad your surgery was a success and your leg is better.

    Reply

    • Because I didn’t need them, and don’t want to leave them in the house. My question for you is… why would you keep them?

      Reply

      • I guess I would’ve kept them, up in a safe place where children couldn’t get too, in case I was too have any more complications or pain from the injury that you had. That may not be the best reason , especially for a recovering addict, but since you’re not I don’t see the problem with keeping things on hand in case you may need them and couldn’t get to your doctor right away. That’s been one of my biggest problems in recovery is living one day at a time, because I’m such a planner I think about what could possibly happen in the future, especially with an injury such as yours. Just wondering how you didn’t know you wouldn’t need them in the future for emergency case only??

      • If I have an emergency in the future, I would see my doctor anyway, and can get a new prescription. They aren’t all that expensive, and it’s the right thing to do to get rid of controlled substances after they are no longer needed for the acute injury.
        And how do you know I’m not a recovering addict?

      • I guess I don’t know if you’re a recovering addict, are you?? It really doesn’t matter either way…sorry I even asked the first question to begin with, I didn’t think you would take it so personally. When you say throwing them out is the right thing to do, according to who, a doctor or recovering addict?? And yes it probably would be easy for you to get pain meds if you needed them in the future, but being on methadone, it’s not that easy…. Anyways, I’ll still continue to read your blog because you bring up very important information about MAT, and I’m sorry if I offended you with my question.

      • No offense taken in any way! and yes, as I’ve said a few other places in my blog, I am in recovery from addiction. Opioids never did it for me, but if they would have, I’d have taken them too.
        I don’t put my own recovery prominently in the blog because I don’t want focus on that. Rather, I want my blog to be about facts, both about addiction and recovery from addiction.
        So yes, I have especially good reason to be careful with any potentially addicting substance, legal or not, prescribed or not. That’s a big reason I don’t want pain pills hanging about the house.
        In general, doctors recommend you discard leftover medication of all sorts – controlled substances, and even stuff like antibiotics.
        It’s safer and a better idea for people to see their doctor with each episode of illness, and not just take old medication which may or may not be appropriate. For example, if you save leftover penicillin from a tooth infection, then get a soft tissue infection. If you took the penicillin, it’s possible your infection is resistant to the penicillin, since there is so much antibiotic resistance. Using old antibiotics causes bacterial resistance, too. Just one example.

      • You made a few good points, all in all I love your blog so just keep writing please and I’ll keep reading…..you’re AWESOME in my book!! Thanks hon!!

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