Dear Dr. Pat:
I was an administrator in the state capital of a mid-western state known for drug problems. Like so many other women I have read about, I developed an addiction to painkillers really quickly. Three years ago, I had extensive surgery for endometriosis and was given Percocet for pain. The postoperative period was complicated by an infection and a second operation for bowel obstruction. All told, I was in the hospital on these drugs for two weeks. My doctor sent me home with thirty days of Percocet pills. I did not know that I was hooked until I realized the prescription was almost out and I panicked. I made numerous visits to the gynecologist for “pain” and claimed the pain was due to the complications of the surgery, which is why I think the doctor kept giving me those pain meds.
After three months, I was told that I could not have more pain medication and was referred to a pain specialist who recognized that I had developed an addiction. I was unwilling to admit it and just looked for other sources for drugs. Soon I was driving to “pain clinics” three hours a way in order to get the drugs for my “pelvic pain.” My focus on finding and taking Percocet almost ruined my marriage and caused me to lose my job. My husband made me go to couples counseling where he outed my addiction and presented me with no option other than going to rehab. Frankly, I was in such a thrall to the opioids that his generosity and care for me almost didn’t mean enough for me to try rehab. One year after starting my journey into drug use, I entered a rehab facility. Many of the women there were “normal’ women, just like me. However, what really scared me was that many of these women weren’t there for the first time.
I knew that to regain the trust of my husband and the respect of my adult children and friends, I had to find a new way to live. Rehab was the first step. Sober living was the second step. I have returned to the life I knew before I developed this terrible addiction to opioids but it is a life where I know that I can backslide at any time. I returned to school and became an addiction counselor and am very involved in mentoring and supporting other women who are addicted to opioid drugs, helping them to recover their lives. I lobbied our state legislators to create a Prescription Drug Monitoring Program since we did not have one. I believe that I would not have become an addict to opioids if the original gynecologist had limited the quantity of Percocet that I was given and renewed it over and over again. I have chosen to tell my story because I want everyone to know that opioid addiction is not limited to men or to people who start this addiction just to get high. As we say in the program, my life will always be “one day at a time.” I am grateful to be alive, grateful for a supportive husband and family. I could have been an opioid death statistic.
Susan
Dear Susan:
Thank you so much for sharing your story of addiction and recovery. There are 2.1 million people suffering substance use disorders related to opioid pain relievers, according to a report to Congress by Nora Volkow, M.D., director of the National Institute on Drug Abuse. Opioids—prescription and illicit—are the main driver of drug overdose deaths. Opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999 according to the Centers for Disease Control and Prevention (CDC). Women over fifty have been fueling this growth in prescription opioid drug use disorders.
The CDC has been clear about the cause of the crisis: overprescribing of opioids, especially for chronic non-cancer pain. Opioid prescribing began increasing sharply in the 1990s, largely in response to a pharmaceutical industry-funded campaign that minimized opioid risks and exaggerated benefits. The increased prevalence of opioid addiction, caused by overexposing the U.S. population to prescription opioids, has also led to rising rates of heroin use in non-urban communities and other health and social problems.
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor this information for suspected abuse or diversion (i.e., channeling drugs into illegal use), and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.
The Prescription Monitoring Program used where I practice, New York State, is known as I-Stop (Internet System for Tracking Over-Prescribing). Most prescribers are required to consult the Prescription Monitoring Program (PMP) Registry when writing prescriptions for Schedule II, III, and IV controlled substances. The PMP Registry provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for their patients. Patient reports will include all controlled substances that were dispensed in New York State and reported by the pharmacy/dispenser for the past year. This information will allow practitioners to better evaluate their patients’ treatment with controlled substances and determine whether there may be abuse or non-medical use.
The Prescription Drug Monitoring Program Registry is intended as a tool for the physician to determine if a controlled substance e-prescription is appropriate. It remains up to the physician’s discretion whether to write a controlled substance e-prescription. Physicians in New York undergo extensive training in pain management with post training testing to document that they understand the cause and extent of the opioid crisis in America and how they can better care for patients with acute and chronic pain without contributing to the national epidemic of opioid addiction. The physicians in New York State are part of the solution to this national epidemic that is a growing cause of unnecessary deaths in all age and socioeconomic groups. They understand that it is important not to be an ongoing part of the cause of inappropriate prescribing of opioid medications.
Percocet is the trade name for a prescription pain reliever that contains Oxycodone, an opioid analgesic—or narcotic painkiller—with similar effects as heroin and morphine. Percocet is prescribed for short-term relief of moderate to severe pain that is not typically chronic in nature . Like heroin and morphine, Percocet affects the brain and the central nervous system, changing the way the brain perceives pain. Percocet acts on opioid receptors throughout the body to initiate a cascade of chemical events that ultimately modify pain perception and elicit a dopamine response in key regions of the brain. Dopamine is a neurotransmitter that plays an important role in the brain’s reward system circuitry—instrumental in delivering feelings of pleasure and motivation, as well as reinforcing behaviors that initiated the dopamine release to begin with.
When taken in large doses, Percocet can cause a “high” similar to heroin that is characterized by:
- Euphoria
- Feelings of calm and relaxation
- Heightened pleasure
Percocet and other prescription drugs are often mistakenly viewed as a safer way of getting high than using illicit street drugs, like heroin and cocaine. People may think that since a doctor is prescribing the medication that it must be safe and effective for their needs. Unfortunately, however, Percocet abuse can lead to the same dangerous problems of dependence and addiction as the illicit street drugs that share its origin. There are several validated screening tools to help providers assess the risk of possible opioid misuse. It is critical that all patients be screened prior to initiating opioid therapy. Validated screening measures include the Screener and Opioid Assessment for Patients With Pain. The pain management doctor was right that you had developed an unhealthy dependence on the Oxycodone, the main ingredient in Percocet. Your husband knew that your relationship with Percocet was almost more important than your relationship with him and your children. You had resources to find effective treatment and developed the resilience to learn to live without opioids. You knew that you could make a difference in the lives of others who were dealing with opioid addiction and continue to do so. Congratulations, Susan. One day at a time.
Dr. Pat
