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"Taken as prescribed... by my addict brain."
January 31, 2012 11:16 AM   Subscribe

The perils of chronic pain in recovery: As a sober addict prescribed Oxycodone, comedian Amy Dresner was careful to follow doctor's orders. Then her disease kicked in.
posted by hermitosis (72 comments total) 7 users marked this as a favorite

 
See: Jeff Conaway.
posted by Melismata at 11:43 AM on January 31, 2012


Oh thank you, Amy Dresner, for continuing to make those of us who have chronic pain look like the shambling slaves to the pills we must surely be.
posted by strixus at 11:45 AM on January 31, 2012 [8 favorites]


I got kinda freaked out from the first part of that article, as I've been nursing a mysteriously sore shoulder the past two days (most likely caused from lugging a messenger bag filled with beer and wine around town Sat. night). Then I got to the end where she was all "Turns out I just had to wait for it to go away!" and breathed a deep sigh of relief.

In the meantime I'll stick with my self-prescribed smoke pot, cook eggs treatment.
posted by mannequito at 11:50 AM on January 31, 2012 [1 favorite]


I think it is pretty clear that she says that she was in recovery and the pain pills were a problem because of that. I don't think the takeaway is that people who take these meds for chronic pain are "shambling slaves".
posted by josher71 at 11:51 AM on January 31, 2012 [11 favorites]


Actually strixus, I'm pretty sure you weren't mentioned anywhere in that article.
posted by hermitosis at 11:53 AM on January 31, 2012 [3 favorites]


As someone married to an addict with six years of recovery, this is the kind of possibility that can keep me up at night if I let myself think about it. I was relieved when I got to the second page of the article - it sounds like she got off easy.
posted by something something at 11:54 AM on January 31, 2012 [1 favorite]


Oh thank you, Amy Dresner, for continuing to make those of us who have chronic pain look like the shambling slaves to the pills we must surely be.

I believe she is a recovering addict trying to deal with chronic pain, which is what this story is all about. She does not say that all folks living with chronic pain are recovering addicts.
posted by KokuRyu at 11:57 AM on January 31, 2012 [4 favorites]


someone in this room feels like a shambling slave to her pain medication.
posted by quonsar II: smock fishpants and the temple of foon at 11:58 AM on January 31, 2012 [1 favorite]


I tried everything—acupuncture, massage, Cortisone shots, Novocain shots, topical ketamine cream, Lidocaine patches—and none of it worked.

She didn't try cannabis.

Is marijuana a danger for addicts? Do they get medical recommendations for it? Honestly, I don't know.

I was on Norco for about month (every 4 hours on the fucking dot) after being on morphine, dilaudid, and percocet (some serious pain). It was a pain to kick even after that short a period. Hell, then I switched to ibuprofen and *that* was a pain to kick.
posted by mrgrimm at 12:14 PM on January 31, 2012 [2 favorites]


It must be difficult for chronic pain users who are recovering addicts. I would be interested particularly of studies on individuals who become addicts in the sense that they needed pain management for an injury with no previous symptoms of addiction becoming addicted.

Chronic pain sucks and just because x works on some people for pain doesn't mean it will work on everyone. Chemistry and pain perception is different for everyone.

While I am somewhat dependent on medication, and it is a disappointment, it allows me to have a more fulfilling life. Chronic pain is debilitating and medications aree sometimes the only or best course of treatment.
posted by handbanana at 12:15 PM on January 31, 2012 [1 favorite]


Seconding Cannabis. I swear while its complete mechanism of action is unknown, it has the ability to remove pain from the forefront of my consciousness to a few steps behind.

I am a huge fan and proponent, I just wish it wasn't demonized to the extent that it is. Cannabis use lowers my intake of other medications, and has significantly improved my life for the better.
posted by handbanana at 12:19 PM on January 31, 2012 [3 favorites]


Then I got to the end where she was all "Turns out I just had to wait for it to go away!" and breathed a deep sigh of relief.

Seriously, though, capsulitis doesn't necessarily go away. I had it in both my shoulders ( the doc said it was years' worth of abuse as a volleyball player) and it was painful. Not kidney stone painful, but bad; move your shoulder one millimeter past where it wanted to be and you get a serious shock of pain. It got to where I couldn't put on a shirt or tuck it in if I got in on. I tried waiting it out by taking PT, but ended up having to get both shoulders scoped.

IOW, I can understand why painkillers were prescribed.
posted by Benny Andajetz at 12:24 PM on January 31, 2012


@Strixus

I think that's unfair. She was chewing and snorting pills much higher. That was when she began abusing her drugs. If you aren't an addict then you are fine. I'm on suboxone as an ex-addict and don't consider myself to be a drug abuser anymore.
posted by jjmoney at 12:30 PM on January 31, 2012


Sorry, I get really worked up over articles like this, because the take away most people get from them is that 1) chronic pain will just magically go away on its own, and 2) pain management that includes opiate medication isn't necessary, and 3) everyone who ever takes ANY pain medication is instantly an addict.

Sure, there are people with addictive personalities who need to be aware of this when prescribed pain medication. But guess what? Those people are the exception, not the rule.

The scare over becoming addicted to pain medication had my husband so afraid to even take Endocet (a really mild opiate painkiller) once every few days for his fibro, that he was suffering horrible pain rather than take the meds the doctor prescribed for him. Why was he afraid? Because EVERYONE KNOWS (scarequotes) that such pills are horribly addictive.

On the other hand, some pharmacist are so bought into the scare that I've had a number of places refuse to fill my prescriptions for hydrocodone and Oxycontin on the same day. I've also had places refuse to fill my oxy perscription even a SINGLE DAY before my 30 days was up. Why? Because I might be abusing the medications that let me fucking function every day, somehow.

These sorts of articles do a horrible disservice to those who legitimately need pain medication, and while I respect recovering addicts for their strength, I would like people to realize that such experiences are THE EXCEPTION, and to not treat all chronic pain sufferers like we are all snorting our pills and doubling up on our prescriptions at every chance.
posted by strixus at 12:37 PM on January 31, 2012 [7 favorites]


Is marijuana a danger for addicts? Do they get medical recommendations for it? Honestly, I don't know.

Yes. It's a danger for addicts. Anything that alters mental state will lower inhibitions, so even if weed isn't your drug of choice it can set up a very slippery slope. That's why any decent addiction counselor will tell a cocaine addict not to drink, for example. A drug is a drug is a drug, and if you're predisposed to abuse one, there's a strong likelihood that you'll abuse anything that's available to you. I know lots of people who smoke weed and are productive, successful individuals, but I've seen it nearly destroy people, too. You can't make a blanket statement that marijuana is a safe option for pain relief, especially for a recovering addict.
posted by something something at 12:39 PM on January 31, 2012 [3 favorites]


These sorts of articles do a horrible disservice...

I get your points, but Imma stop you right there. This specific article was posted on a website that caters specifically to addiction-related issues, aimed at a community of people who are (for the most part) in recovery from one substance or another.

These people ARE the exception you're talking about, hence that take on the subject matter is totally appropriate. People who don't fit in that category aren't under any obligation to contort themselves into imagining that it applies to them.
posted by hermitosis at 12:44 PM on January 31, 2012 [5 favorites]


Jjmoney,

I technically "abuse" my medication. I generally do cold water extracts on my opiod drugs in order to pull out the shit that is acetometaphen. Paticulaly when I am taking doses in order to manage break through pain. Benefits to CWE are no fillers such as the acetometaphen as well as quicker system delivery. Downsides.none that I can see.
posted by handbanana at 12:54 PM on January 31, 2012


When I’d been taking 45-75 milligrams a day for a month (which any real Oxy addict, by the way, will tell you is nothing), I went to see an orthopedic surgeon to see if surgery was an option. He refused, saying that I was too inflamed and that an operation would just make my condition worse. I told him that I was a recovering addict and that my internist had given me Oxy. "I would never prescribe you any narcotics—ever," he said. As I left, he cautioned me, "Take it easy on the juice." At the time, I was offended.
Crazy. I don't understand how people can imagine that someone "addiction" is worse for someone then CONSTANT, SEARING PAIN. What is wrong with people?
posted by delmoi at 12:55 PM on January 31, 2012 [6 favorites]


handbanana: "Seconding Cannabis. I swear while its complete mechanism of action is unknown, it has the ability to remove pain from the forefront of my consciousness to a few steps behind.

I am a huge fan and proponent, I just wish it wasn't demonized to the extent that it is. Cannabis use lowers my intake of other medications, and has significantly improved my life for the better.
"

Sad thing is that for me, (I think due to my Venlafaxine usage) -- it ended up making my pain-attention worse to where I can't smoke it anymore less I feel every little ache and pain :(
posted by symbioid at 12:55 PM on January 31, 2012


I suffer from chronic pain. I'm 41. I feel 82. I keep imaging life would be better if I could abuse some drugs. Everything I've tried has only mitigated the discomfort. I also have what I would classify as an addictive personality, but being addicted to being pain-free is like a water or air addiction.
posted by cjorgensen at 12:59 PM on January 31, 2012 [4 favorites]


Metafilter: sometimes the only or best course of treatment.
posted by herbplarfegan at 1:00 PM on January 31, 2012 [1 favorite]


Symbiod, that is a bummer!
Its such a lovely plant with its characteristics as well as beauty (same can be said about the poppy).



Whats even better about cannabis? You can drop even after long term use (think daily use over 2 + years) with no withdrawl. I know that point is debatable but have an individiual claiming cannabis withdrawl doesn't know shit until going through opiate withdrawl.
posted by handbanana at 1:01 PM on January 31, 2012


Yes. It's a danger for addicts. Anything that alters mental state will lower inhibitions, so even if weed isn't your drug of choice it can set up a very slippery slope. [...] A drug is a drug is a drug, and if you're predisposed to abuse one, there's a strong likelihood that you'll abuse anything that's available to you.

This makes little sense to me as a chronic pain patient. Almost all serious pain medication alters one's mental state. For example, I spent six months in a fog thanks to Indomethacin -- a non-addictive NSAID drug which carries no more than the usual warning about "drowsiness". My mind felt so clogged up that it took me half a year just to figure out that the new pill was the reason why I was floating through life without getting anything done at work or at home (duh). This pill was much more negatively mind-altering for me than a medicinal (or recreational!) dose of marijuana... but it certainly did not "lower my inhibitions" in any noticeable way, and the same goes for medicinal doses of cannabis (unless you're talking about inhibitions regarding food).

Yet nobody says things like "a drug is a drug is a drug" about Indomethacin. Cannabis has milder mental side-effects than many prescription drugs for chronic pain, and it is not physically addicting, so I'm not sure why it should be considered "a very slippery slope" when other medical drugs are not.
posted by vorfeed at 1:05 PM on January 31, 2012 [1 favorite]


Dependence: Taking medication as directed in order to function like a normal person.
Abuse: Snorting pills because they don't come on fast enough.

This is a touchy subject for me, because my husband's efforts to get properly medicated for his degenerative spine disease has been met with disbelief or skepticism.

There are other drugs--like Neurontin and Tramadol--that might have been better for this particular person. Leave the opiates to those who can take them responsibly, please.
posted by luckynerd at 1:05 PM on January 31, 2012 [3 favorites]


Gabapentin is a godsend, and if tramadol didn't feel like death it would be a great option for me.

I feel for your husband luckynerd, I am in the same boat with arthritis of the spine. Getting meds is like pulling teeth. My doctor said she didnt want me goingdown the rabbit hole of opiate dependence/addiction.

My question is why do I have to feel like an abused prisoner in my own body? Why is being in pain more noble than being dependent on a substance that allows you to function normally when properly used? Why does it have to be a false dichotomy?
posted by handbanana at 1:10 PM on January 31, 2012 [4 favorites]


vorfeed, pain medications are considered a slippery slope. That's why Amy Dresner wrote the article, to describe what can happen when an addict is prescribed something that alters her mental state.
posted by something something at 1:14 PM on January 31, 2012


vorfeed, pain medications are considered a slippery slope. That's why Amy Dresner wrote the article, to describe what can happen when an addict is prescribed something that alters her mental state.

In my experience, NSAIDs like Indomethacin are not "considered a slippery slope" with regards to addiction, and that's what I was discussing. I am aware that opioids are "considered a slippery slope", but opioids are physically addicting -- unlike drugs like cannabis and Indomethacin.

Besides, if all pain medications are "considered a slippery slope", then what is an "addict" in pain supposed to do? Suffer? It should be obvious that some drugs are less mentally-altering than others, and that all altered states are not precisely the same; we ought to be able to discuss this without drawing an identical bright line around the entire category of pain medication.
posted by vorfeed at 1:27 PM on January 31, 2012


This specific article was posted on a website that caters specifically to addiction-related issues, aimed at a community of people who are (for the most part) in recovery

If the article is of enough general interest to be posted here, isn't it kind of odd to expect people to read it with the understanding that it's intended for a specialist audience?
posted by thelonius at 1:34 PM on January 31, 2012 [2 favorites]


I'm not familiar with Indomethacin. I'm familiar with addicts and very familiar with one addict in particular whose life was negatively affected by marijuana dependency to the point of a suicide attempt. The physical addiction is not really the important component for someone like that; it's the psychological dependency on the altered mental state, mild as it may be compared with other, more heavy duty drugs. So I'm just saying, for someone who identifies as an addict, cannabis use for pain medication is probably not going to be super helpful as a long-term life strategy. Just as you can't draw an identical bright line around the entire category of pain medication, you also can't say that a drug is going to be identically benign in its effects on every type of individual.

Relief for addicts suffering from chronic pain is a real conundrum, which I saw as Dresner's point in writing this article. People who have gotten off drugs know what they're likely to do when handed a bottle full of painkillers, and it's a reality that the best painkillers we have are also the most likely to be abused. A lot of recovering addicts do give their medication to a family member to dole out on schedule, but that can create a sort of uncomfortable codependency situation that can lead to all sorts of other problems. It's a shitty situation without an easy answer.
posted by something something at 1:42 PM on January 31, 2012 [1 favorite]


If the article is of enough general interest to be posted here, isn't it kind of odd to expect people to read it with the understanding that it's intended for a specialist audience?

I think the website and the article make it very clear which angle this is coming from.
posted by josher71 at 1:43 PM on January 31, 2012


Besides, if all pain medications are "considered a slippery slope", then what is an "addict" in pain supposed to do? Suffer? It should be obvious that some drugs are less mentally-altering than others, and that all altered states are not precisely the same; we ought to be able to discuss this without drawing an identical bright line around the entire category of pain medication.

I guess? Horrible to say, but it sounds like no matter what, all options here are horrifically bad.

Isn't this what killed DJ AM? He was in that plane accident, he HAD to take pain medication, and then his addiction kicked in again?
posted by jenfullmoon at 2:01 PM on January 31, 2012


>Crazy. I don't understand how people can imagine that someone "addiction" is worse for someone then CONSTANT, SEARING PAIN. What is wrong with people?<

You act like that’s two different things.

I love how people come on here freaking out about some perceived insult (that clearly wasn’t there), respond with "how dare you judge me, you don’t know what it’s like" and then proceed to judge and insult the addict. Non addicts telling addicts "You’re doing it wrong" is hilarious.

I don’t know what I will do if I’m ever in a hopeless situation, but I’m always going to choose the pain if possible. I would think about just killing myself if it came to that, and I know others who have said the same thing. I don’t take pain medication other than aspirin or tylenol. I don’t get put under for dental surgery or take anything afterwards. I don’t care what you do, am not going to judge you for it, and don’t care what you think about my choice. Everyone is different.
posted by bongo_x at 2:14 PM on January 31, 2012 [4 favorites]


I don't think that people perceived themselves as being insulted by the article. The issue that some people have brought up is that many doctors seem to see this kind of situation - a person with a drug problem, getting into trouble with prescription pills - as the paradigm case for chronic pain patients.
posted by thelonius at 2:23 PM on January 31, 2012 [2 favorites]


Anything that alters mental state will lower inhibitions, so even if weed isn't your drug of choice it can set up a very slippery slope.

Caffeine alters your mental state, and is physically addicting to boot. Walk into any 12-step meeting room and there's a giant vat o' coffee. And during the breaks at least half the meeting will be outside smoking cigarettes.

When my mom was dying of bone cancer, she was damn lucky to have doctors who weren't worried she'd get addicted to morphine in the last four months of her life. I had a very strange wink-wink-nudge-nudge talk with her main doc one day about how if I were to accidentally discover some marijuana, and that accidentally somehow magically got into her system, that it would be very helpful for her in terms of encouraging her appetite and managing the pain.

Our whole paradigm of addiction/dependence/proper pain management is fucked.
posted by rtha at 2:26 PM on January 31, 2012 [9 favorites]


many doctors seem to see this kind of situation - a person with a drug problem, getting into trouble with prescription pills - as the paradigm case for chronic pain patients.

Perhaps that's a reaction to what had been happening previously: drug addicts were doctor shopping, complaining of pain, getting the painkillers they needed. It was a serious problem, and it probably still is. I don't blame the doctors for being cautious now.
posted by Melismata at 2:26 PM on January 31, 2012 [1 favorite]


Many people with "drug problems" are also people with serious pain problems.
posted by rtha at 2:28 PM on January 31, 2012 [5 favorites]


I just wish thefix.com would hurry up and die already. I'm over their shitty stock photos, shitty writing, and shitty celebrity hang-ups. This is so far from best of the web it's unreal.
posted by phaedon at 2:33 PM on January 31, 2012 [1 favorite]


Oh, there is no question that this (I think they call it "drug-seeking behavior") is a big problem, and that diversion of medicines like oxycodone into the black market is also. I'm not without empathy for the doctor's situation. However, that is very little comfort to the patient in desperate need of pain relief.

It's very difficult, once a health professional has decided that you are an addict, to persuade them otherwise. I had a dog once, who went into a violent seizure. The veterinarian was CONVINCED that the dog had gotten into my (nonexistent) illegal drug stash. A different veterinarian diagnosed that the dog had botulism toxin from the stomach full of rotting chicken bones that she had eaten. That was an annoyance, actually more than an annoyance, because the animal's health was in the balance.
posted by thelonius at 2:33 PM on January 31, 2012 [2 favorites]


I have been sober for almost ten months now. In this time, I've had a number of procedures done to fix my messed up body, including getting my wisdom teeth taken out and getting stitched up for a small gash on my shoulder. Both of these things hurt. Both times I was offered pain medication – Vicodin for both – and both times I refused.

I also have made it a personal rule to never take any narcotic pain medication. I have also made it a rule to never live in a house or apartment that contains a gun. What I have learned from my drinking and my sobriety is that I cannot fully trust my own mind and my own decision-making process. I have to be vigilant to make sure that these do not go awry.

I never had a problem with pills or weed, but I know that if I got into the habit of either, I'd be drinking in no time. The reason? I personally think it's because the high that people quit is the one they loved the most. Other highs can't compare and eventually, as the other highs don't 'work' hey feel tugged towards it.

vorfeed, ALL pain medications are considered by a lot of addicts and treatment professionals to be a risk for any recovering addict. Practically anything abusable can be a problem. I was prescribed methylphenidate (Ritalin) for issues of hypersomnia but I refused to take it, a decision that my therapist and psychiatrist later agreed with. I'm also on Wellbutrin, which people have attempted to abuse, as it is a stimulant. Marijuana presents a tricky issue. It's technically not physically addicting, but for a former addict whose goal was (and often is) escape, weed is every bit as destructive as coke, heroin, meth.

If I have to suffer more because I reject painkillers, then so be it. But I'd rather deal with the extreme pain than go through being a drunk again. That was hell.
posted by Modica at 2:44 PM on January 31, 2012 [6 favorites]


Abuse: Snorting pills because they don't come on fast enough.

I believe that would fall under misuse. Abuse would be an (over)use resulting in an impairment. Using pain meds to get rid of pain is one thing, using pain meds to get high is another.
posted by P.o.B. at 2:45 PM on January 31, 2012


I quit drinking a few months ago, myself, and I honestly don't think that something like Vicodin for oral surgery would be an issue for me. Perhaps I'm wrong, we'll have to see, if it ever comes up. I'll need to consider my choices very carefully. I can certainly appreciate wanting to go to any lengths to avoid returning to the hell of active alcoholism, but I've heard some stories of stuff like people being convinced by their AA sponsors not to take psychiatric medication, which caused immense damage.
posted by thelonius at 2:51 PM on January 31, 2012 [1 favorite]


Just as you can't draw an identical bright line around the entire category of pain medication, you also can't say that a drug is going to be identically benign in its effects on every type of individual.

No one here has said this.

I'm also familiar with drug abuse, including people who've abused marijuana, and the idea that "a drug is a drug is a drug" does not reflect the full scope of drug use and abuse. Many people fail to moderate their use of one drug even while they continue to moderate or entirely limit their use of other drugs (note that the author of the article did not become an alcoholic or return to using "her bag" despite months of Oxycodone abuse, for instance). Many people who abuse drugs return to moderate use later on. This suggests that cannabis (or Indomethacin, or Oxycodone) use may well be a long-term life strategy for "someone who identifies as an addict"; there's really no way to tell without trying it, as everyone who "identifies as an addict" is different -- even at different times in their lives -- and so is the effect of every drug.

The idea that "all options here are horrifically bad" is a self-fulfilling prophecy which discourages harm reduction ("a drug is a drug is a drug") and treats drug dependence as universally identical to addiction and/or pain (as does the article). It's dogma, and it's the kind of dogma that leaves people in tremendous pain for fear of trying anything at all. If (on preview) you want to choose tremendous pain over the possibility of addiction and/or dependence, fine, but that's not the only option, nor are all options necessarily equally bad for everyone who has ever abused drugs.

Pointing this out does not constitute "telling addicts 'You’re doing it wrong'".
posted by vorfeed at 2:58 PM on January 31, 2012 [4 favorites]


treats drug dependence as universally identical to addiction

You know, there was a thread here last week that discussed the topic of chronic pain and drugs, and it had a very interesting link in the comments, to a statement by a guy who helped develop the DSM entries for drug abuse and drug dependence. He says that he thinks they made a big mistake by not including the category "addiction", and distinguishing it from "dependence". Dependence is a physiological response to some drugs, he says, while addiction is a complex, lifelong disorder that involves components such as obsession, or continued and/or escalating use despite increasing consequences., as well as the dependence. So, by trying to avoid the moral opprobrium of the word "addict", they failed to provide guidelines for distinguishing completely distinct groups of patients, and encouraged doctors to consider any habituation to a drug as the first sign of an inevitable decline into hopeless addiction.

I'll try to find the link, and repost it.
posted by thelonius at 3:11 PM on January 31, 2012 [4 favorites]


You say "...choosing tremendous pain over the possibility of addiction or dependence..."

It's not a matter of choosing one over the other because for the addict they are the exact same thing. For the addict, physical pain is generally a lot easier to deal with than mental or emotional pain, which is what addiction/dependence is more than anything else.

I choose not to take the risk of returning to tremendous emotional and mental pain. If it causes physical pain, so be it. But you saying that pain is worse than addiction is silly, because addiction is some nasty, nasty stuff.

Additionally, I want to know where you get the idea that many addicts and abusers return to moderate use later on and continue to use without a problem. Because everything I have read, seen, and experienced says otherwise.
posted by Modica at 3:14 PM on January 31, 2012


I haven't had a drink since June of 1976 but my recovery date is in March of 2006 due to my own slide down the slippery slope. I was an addict in 1976 and remain one today. I am also taking medication today that was a part of my slide back into addiction. It put's me at greater risk for a bad outcome but the quality of my life would be terrible without the medication and I could possibly end up on even more addictive meds.

So what's my point? Each person has to make up their own mind. It was great when my life was simple and the choice was an easy black and white one. But life doesn't always stay that way, so sometimes people just have to do the best they can each day and hope for the best.
posted by cairnoflore at 3:20 PM on January 31, 2012 [4 favorites]


But you saying that pain is worse than addiction is silly, because addiction is some nasty, nasty stuff.

Just...this may not be true for everyone, you know? For some people who have been or are addicted to something, the pain may well be worse. Do what you feel is right for your own recovery process; everyone's is different.
posted by rtha at 3:26 PM on January 31, 2012 [3 favorites]


He says that he thinks they made a big mistake by not including the category "addiction", and distinguishing it from "dependence".

All the literature I've read, and the half dozen psychologists I've talked to, about this stuff definitely make a distinction between addiction and dependence. What those definitions specifically mean? That's a can of worms.
posted by P.o.B. at 3:29 PM on January 31, 2012


The article I referenced

I hope my paraphrase wasn't too far off: I am not a doctor!
posted by thelonius at 3:39 PM on January 31, 2012 [1 favorite]


rtha, I realized that error in my own judgment after I posted. Ultimately, I think cairnoflore's got the right idea. It's all relative in the end.
posted by Modica at 3:45 PM on January 31, 2012


>so sometimes people just have to do the best they can each day and hope for the best.<

I would have left the "sometimes" out.
posted by bongo_x at 3:45 PM on January 31, 2012


Anyone who's interested in the subject of addiction/dependence/abuse - why humans use and misuse drugs, and what happens when they're high - should go read about Carl Hart, who is doing some really innovative research in the field.
posted by rtha at 3:52 PM on January 31, 2012 [1 favorite]


Perhaps that's a reaction to what had been happening previously: drug addicts were doctor shopping, complaining of pain, getting the painkillers they needed. It was a serious problem, and it probably still is.

Why is this a "serious problem", though? Who are they hurting (other than, some think, themselves)? If someone wants to smoke a joint or take any other drug recreationally, why should anyone else care? If someone isn't concerned about being addicted, as long as they aren't stealing or otherwise hurting other people, why is it anyone's business?
posted by biscotti at 3:56 PM on January 31, 2012 [3 favorites]


It's not a matter of choosing one over the other because for the addict they are the exact same thing. But you saying that pain is worse than addiction is silly, because addiction is some nasty, nasty stuff.

My point is that "the addict" is not some monolithic object that only works one way. I am not saying that pain is necessarily worse than addiction, simply that they are not "the exact same thing", by definition. They are a constellation of different mental and physical processes, and different people will experience them differently.

Additionally, I want to know where you get the idea that many addicts and abusers return to moderate use later on and continue to use without a problem. Because everything I have read, seen, and experienced says otherwise.

For one thing, some studies have shown that brief interventions (basically a series of discussions with a medical doctor) are roughly as effective as extensive treatment for alcohol dependence. In other words, many people who meet the clinical definition of problem drinking quit or reduce on their own once they're aware of the problem... and as the study points out, "[the] goal may be moderate drinking rather than abstinence". Likewise, NESARC is one of the largest surveys of drinking in the US, and they found that "a substantial number of people recover from alcohol dependence in spite of its chronic characteristics. This should provide a positive incentive for people seeking treatment and for providers working with these clients. Second, a considerable number of people appear to recover without professional intervention. [...] Third, some people seem able to go back to drinking without experiencing their previous alcohol-related problems."

Also, the National Household Survey on Drug Use and Health suggests that the vast majority of people move on from the frequent use of even extremely addictive drugs, including meth, heroin, alcohol and tobacco. As the study points out, "the number of persons with substance dependence or abuse was stable between 2002 and 2010". Given high rates of substance use and initiation, a steady number of dependent citizens would be impossible if large numbers of people didn't move on from dependence; the same goes for the difference between "lifetime", "past year", and "past month" use of extremely addictive drugs.
posted by vorfeed at 4:35 PM on January 31, 2012


Buddy was a great guy, a member of his recovery community, helped many people, truly was concerned with their well-being, which apparently can be a large part of the whole 12 step thing.

But Buddy had *real bad* hip pain and Buddy needed help for the pain — poor bastard hobbled with a cane, he'd never say anything about it but it wasn't hard to see — but he could not take the pain medications because he was a junkie and ANY opiate would set him off. A horrific quandary. And when he had surgery — more than once — he of course *had* to take the stuff. And, again, he was off and running.

Because Buddy was a junkie. The Real Deal. Opiates set him off and running.

It wasn't his fault. He wasn't any lessor a person than anyone else, though some — even some of those people in his recovery circles — somehow have their heads jammed so far up their fucking ass that they cannot see a goddamn thing.

People just cannot sometimes understand what they have not experienced. And they cannot know the terror that an addict feels, that terror of getting back onto/into that elevator plunging through the depths of hell on earth, the life of active addiction. They've never had the drinking dreams, the drugging dreams, they've never awakened in a cold goddamn sweat, jerked out of sleep in fear and shame, their heart hammering, those fucking Technicolor dreams, dreams as real, as vivid as your first fuck, or your first hit of crack.

Addicts are different, that's all. Rare is the person outside the rooms who "get it" on any real level, those in the rooms have paid the price of admission and they get it, no problem. That's who it was written for.
posted by dancestoblue at 4:37 PM on January 31, 2012 [2 favorites]


Sad thing is that for me, (I think due to my Venlafaxine usage) -- it ended up making my pain-attention worse to where I can't smoke it anymore less I feel every little ache and pain :(

Symbiod, I wasn't on any medication when I smoked regularly (but should have been), but I had the same problem. Did you have a chance to try pain-specific strains? Some strains, for me, were awful about this. On the other hand, a couple of strains that were specifically recommended for cramps/headache/etc., and which apparently worked wonders for others, did very little for me. I am an enthusiastic supporter of legalization but finally figured out a couple of years ago that almost every strain (with the possible exception of one I had for a week) is a terrible match with my version of bipolar disorder, and haven't touched it since. Users' responses to marijuana seem to vary wildly, far more than a lot of proponents seem to recognize. Sometimes it improves depression, for example, and sometimes it exacerbates it. The fact that it's approved in California for anxiety baffles me; nobody I know who also has a legitimate Xanax scrip can tolerate it. And yet it must work well for some people, just as the same SSRI can make some people come alive and others feel like zombies. So much more strain-specific, ailment-specific research is required here. I'm reminded of the woman who's written for Slate about her autistic son, whose symptoms respond wonderfully to White Russian in edible form but to no other strain or delivery system.
posted by Adventurer at 5:12 PM on January 31, 2012


How strange.

By the time I finished the linked article I was thinking that 'frozen shoulder' is a programmed response by the body to immobilize the injured shoulder joint so that it can heal properly, and that when it has healed the problem tends to resolve itself.

When I looked at the NCBI page linked in the article and the Wikipedia article on frozen shoulder (Adhesive capsulitis of shoulder), I was convinced:

Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

... Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.

This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement. ...

... The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.


I strongly suspect that, for most people we are vastly prolonging the course of frozen shoulder, including the pain and its attendant potential to cause addiction, by treating them to make the shoulder retain mobility, because that keeps the problem from reaching the point of immobility necessary for healing, and from which resolution-- Most people regain about 90% of shoulder motion over time-- can take place.

Here's what Amy Dresner herself has to say about her resolution:

When I emerged from my Oxy nightmare, I was in the second phase of Frozen Shoulder, where there’s much less pain but also much less mobility. I couldn’t raise my arm to shave my armpit in spite of physical therapy three times a week. But I slept like a baby and had no pain. Turns out I just had to wait for this thing to “thaw” before returning to my two-armed sober self. Waiting had never been my bag. But like I said, I didn’t know then that you could always get a new bag.

The appropriate treatment is probably to hurry it along by immobilizing the shoulder in the first place.

And I'd bet the same thing applies to lots of joint inflammation with pain syndromes for exactly the same reasons.
posted by jamjam at 5:20 PM on January 31, 2012


By the time I finished the linked article I was thinking that 'frozen shoulder' is a programmed response by the body to immobilize the injured shoulder joint so that it can heal properly, and that when it has healed the problem tends to resolve itself.

Eh, I'm not sure immobilization is what makes an injured part of your body heal faster, save a broken bone and even then, there are methods to have the bone move slightly.

Even after a surgery, PT is used so that you can start moving again. When I sprained my shoulder, what I wanted to do dearly was to work out, to aggravate the shoulder more, if not simply to get the blood moving in that area. Before I could work out, I had massage therapy, to do everything we could to get mobility back. I certainly can't lift what used to - or even want to try, but the range of motion is back and the long road to full recovery is well on its way.

Even if I go for, say a really really long bike ride (over 150 miles), the best way to recover is not to do anything the next day, it's to "actively" recover, with a much shorter, much slower ride.

There's certainly something to be said about injuries and how they hurt your range of motion and not going above we one can do, but immobilization I suspect isn't the answer.
posted by alex_skazat at 5:48 PM on January 31, 2012


And I'd bet the same thing applies to lots of joint inflammation with pain syndromes for exactly the same reasons.

Except that it doesn't. Exercise actually reduces pain and inflammation in many arthritis patients, especially those with certain auto-immune conditions.

The idea that frozen shoulder is "a programmed response by the body to immobilize the injured shoulder joint so that it can heal properly" strikes me as a just-so story, especially since the same article you quoted notes that adhesions tend to develop further if the shoulder is kept immobile.
posted by vorfeed at 5:52 PM on January 31, 2012


Also, frozen shoulder can occur in athletes due to trauma, but it most often strikes older diabetics, especially women -- or, in other words, it strikes people who often have very little strength or range of motion in their shoulders to begin with.

If immobility promotes healing and moving the joint prolongs damage, then how do so many people who don't move much end up with frozen shoulder despite a lack of obvious trauma?
posted by vorfeed at 6:05 PM on January 31, 2012


I love how people come on here freaking out about some perceived insult (that clearly wasn’t there), respond with "how dare you judge me, you don’t know what it’s like" and then proceed to judge and insult the addict. Non addicts telling addicts "You’re doing it wrong" is hilarious.
Uh, you quoted me so I guess you're referring to me? This has nothing to do with me, except for the fact that the idea of people being pain bothers me. Although I did get pain killers when I had my wisdom teeth removed. The idea of going through that without them seems pretty horrifying.

I also have no idea what you're talking about with respect to an insult. Here is what I quoted:
When I’d been taking 45-75 milligrams a day for a month (which any real Oxy addict, by the way, will tell you is nothing), I went to see an orthopedic surgeon to see if surgery was an option. He refused, saying that I was too inflamed and that an operation would just make my condition worse. I told him that I was a recovering addict and that my internist had given me Oxy. "I would never prescribe you any narcotics—ever, he said. As I left, he cautioned me, "Take it easy on the juice." At the time, I was offended.
That is to say, he thinks that it would be better if she was in constant pain then get relief at the cost of becoming addicted. In this case, she got a prescription from a different doctor. But in a lot of cases, the result is just that people go without medication and suffer constant pain.

That's an "Insult" The same way smashing someone's kneecaps in with sledgehammer is an insult. It makes people "feel bad" because they are in pain.
Perhaps that's a reaction to what had been happening previously: drug addicts were doctor shopping, complaining of pain, getting the painkillers they needed. It was a serious problem, and it probably still is. I don't blame the doctors for being cautious now.
A serious problem in what sense? What harm is caused by this?
It's very difficult, once a health professional has decided that you are an addict, to persuade them otherwise. I had a dog once, who went into a violent seizure. The veterinarian was CONVINCED that the dog had gotten into my (nonexistent) illegal drug stash. A different veterinarian diagnosed that the dog had botulism toxin from the stomach full of rotting chicken bones that she had eaten. That was an annoyance, actually more than an annoyance, because the animal's health was in the balance.
That Vet sounds completely fucking insane. Why didn't you report him, or sue him for malpractice? Who would accuse a dog of being a drug addict!?
posted by delmoi at 6:05 PM on January 31, 2012 [1 favorite]


delmoi - he came around eventually, was only the emergency all night vet, and, it wasn't my dog - I was caring for her. The owner's Mom took over at sunrise.

All this was 20 years ago, I can't believe I remember it so well. It was a horrible night.
posted by thelonius at 6:21 PM on January 31, 2012


-delmoi-
>Uh, you quoted me so I guess you're referring to me?<

Not particularly, just the first line. I’m never quite sure if I should write "the rest of this isn’t about you" or if it’s obvious enough. In this case I made the wrong choice.

For myself, I would agree with the sentiment of "no narcotics, ever". I think what many here are forgetting, besides the obvious -People Are Different-, is that one person may not react to physical pain in the same way another does. I haven’t experienced physical pain that I can’t deal with. I don’t enjoy it, but I can usually remove myself from it. I may someday reach a point where that’s not true.
posted by bongo_x at 6:32 PM on January 31, 2012


Also, frozen shoulder can occur in athletes due to trauma, but it most often strikes older diabetics, especially women -- or, in other words, it strikes people who often have very little strength or range of motion in their shoulders to begin with.

If immobility promotes healing and moving the joint prolongs damage, then how do so many people who don't move much end up with frozen shoulder despite a lack of obvious trauma?


Or all of the above. My shoulders were the result of years of volleyball, but it didn't present until I was in my late 40s, mostly sedentary, and a diabetic.

And immobility only makes it worse. You favor your shoulder due to pain in movement, and mobility gets worse and worse. You have to work the shoulder to increase movement - and even then surgery is sometimes called for.
posted by Benny Andajetz at 6:42 PM on January 31, 2012


Not particularly, just the first line.
What? There was only one line from me in that entire comment:

The line was
Crazy. I don't understand how people can imagine that someone "addiction" is worse for someone then CONSTANT, SEARING PAIN. What is wrong with people?
What I was responding to was this:
When I’d been taking 45-75 milligrams a day for a month (which any real Oxy addict, by the way, will tell you is nothing), I went to see an orthopedic surgeon to see if surgery was an option. He refused, saying that I was too inflamed and that an operation would just make my condition worse. I told him that I was a recovering addict and that my internist had given me Oxy. "I would never prescribe you any narcotics—ever," he said. As I left, he cautioned me, "Take it easy on the juice." At the time, I was offended.
There is no insult there. Just a denial of medicine. The result would be that people with a history of drug addiction won't get pills, and as a result they'll have to endure an enormous amount of pain. That, in my mind, is insane. Especially since people don't exactly get to choose whether or not they get the label 'drug addict' or whatever.
I haven’t experienced physical pain that I can’t deal with. I don’t enjoy it, but I can usually remove myself from it. I may someday reach a point where that’s not true.
Well la-de-da. I was actually totally anti-drug before I had my wisdom teeth removed. If you want to prove to yourself how tough you are, knock yourself out. I don't see why you or anyone else should get to make that choice for other people.
posted by delmoi at 8:49 PM on January 31, 2012 [1 favorite]


-delmoi-

I have no idea what you’re on about. There is some combination of me expressing myself badly and you reading something I didn’t write, maybe confusing it with some other post? Slow down a minute and take a look again. If you’re still angry, I apologize. Things must have across differently than I intended.
posted by bongo_x at 10:10 PM on January 31, 2012


And immobility only makes it worse. You favor your shoulder due to pain in movement, and mobility gets worse and worse. You have to work the shoulder to increase movement - and even then surgery is sometimes called for.

Pretty much exactly my experience. My PT -- 16 sessions over a month, then the insurance runs out -- made sure I understood this. If I left it alone it would only get worse.

But then frozen shoulder is poorly understood, etiologically at least. The thing that I also experienced was that for most people, it just eventually goes away. Mine lasted from about November till about June, though my therapy began in January. I worked it diligently until about March, when I had enough mobility and enough reduction in pain to mostly forget about it, and then one day I realized it had just pretty much disappeared (I still have maybe 5% loss of range in that shoulder, though). I hesitate to call it a disease; seems like more of a "condition" to me, but then these things are fluid.

The pain. Oh my God the pain. You have to understand this: there is hideous pain, particularly referred pain, so you think it's not where it actually is. I could be fine all day and then reach over to close the car door and need to double over.
posted by dhartung at 1:52 AM on February 1, 2012


I'm on suboxone as an ex-addict and don't consider myself to be a drug abuser anymore.

I'm glad someone brought this up. With suboxone on the market, no one has to be an addict if they don't want to be*. No willpower is required to stay on the wagon, it won't ever leave you sick, and you literally can't abuse it or OD.

* provided you can also afford it. We do live in Hell, after all.
posted by clarknova at 3:28 AM on February 1, 2012


Because Buddy was a junkie. The Real Deal. Opiates set him off and running.

I hate this reductive determinism that I associate most strongly with people in early recovery through the fellowships.

There are thousands of people, all over the globe who are 'The Real Deal', who take opiates on a daily basis, via their methadone programme without being 'off and running'. It actually does the opposite -- it gives them stability and a life where that hitherto hadn't been possible despite their best efforts at abstinence.

I commend to you William White and Liza Torres's recent monograph on Recovery Oriented Methadone Maintenance.
posted by PeterMcDermott at 3:36 AM on February 1, 2012 [2 favorites]


So, no biggie.
posted by telstar at 5:19 AM on February 1, 2012


There is some combination of me expressing myself badly and you reading something I didn’t write, maybe confusing it with some other post?

Okay I think I get what you mean -- only the first line of your comment was a reply to my comment. Yeah that part wasn't clear, sorry!
posted by delmoi at 8:48 AM on February 1, 2012


"Okay I think I get what you mean -- only the first line of your comment was a reply to my comment. Yeah that part wasn't clear, sorry!"

No problem. Like I said, I’m never sure how to respond to a quote, and then move on to something else and make it clear that the rest is not aimed at that person. It seems clear when I write it, but you know how that goes.
posted by bongo_x at 10:02 AM on February 1, 2012


But then frozen shoulder is poorly understood, etiologically at least. The thing that I also experienced was that for most people, it just eventually goes away. Mine lasted from about November till about June, though my therapy began in January. I worked it diligently until about March, when I had enough mobility and enough reduction in pain to mostly forget about it, and then one day I realized it had just pretty much disappeared (I still have maybe 5% loss of range in that shoulder, though). I hesitate to call it a disease; seems like more of a "condition" to me, but then these things are fluid.

The latest thinking seems to be that primary frozen shoulder (the kind which doesn't follow any obvious trauma like shoulder surgery or a rotator cuff tear) may be an autoimmune condition. It's been linked to HLA-B27, for example, along with other autoimmune problems such as uveitis/iritis, ankylosing spondylitis, and ulcerative colitis.

If frozen shoulder is autoimmune then that explains a lot -- the pain and adhesions are caused by the immune system's attack on the shoulder's connective tissue, and they both worsen and resolve along with the autoimmune response. This explains why immobility makes the condition worse, because this is often true of autoimmune inflammation; it also explains why frozen shoulder appears out of nowhere and then resolves without treatment, because this is also true of some autoimmune conditions. And as with most autoimmune problems, the root cause is a mystery...
posted by vorfeed at 11:12 AM on February 1, 2012


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