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When Can an Alcoholic Take Prescription Drugs?

24 February 2014

OK. I need to start this off with a great big disclaimer. I am not a physician. Being an alcoholic in recovery does not give me special insight into the medicine of addiction. AA’s literature is very clear on this point. It says, “We are not doctors.” It says that in the context of saying that alcoholics should be honest with and listen to physicians. Opinions from members of AA about medicine are not to supersede the medical opinion of an informed physician. This is my opinion based on my experience. Your experience may vary.

The reverberations of Phillip Seymour Hoffman’s death continue to sound in many places. I wrote then that “Physicians keep prescribing opiates to addicts. And it keeps killing us.” Hoffman died in some part (as I understand it) because he was legally – and presumably appropriately –  prescribed opiates for pain. This led to abuse of the prescription drugs. Which led to heroin. Which led to death.

I’m not anti-opiates as a medication. As I understand it (poorly) they are a godsend for people who have intense acute pain. I have heard there are serious concerns about prescription opiates being used chronically, and my experience jibes with that. As an alcoholic, I could never, ever take opiates for long-term pain management. I have absolutely no doubt that that would kill me. Similarly, I can not take benzodiazepines. I love them. They’re awesome. They’ll kill me.

But if I were to have major surgery? I’m almost certain to need major surgery at some point in my life. Most of us do and I have a (very) minor heart condition that is likely to require surgical correction at some point in my life. If I have to get my chest cracked, chances are I’ll need opiate drugs to manage the pain acutely after surgery. I’ve had codeine before, as a kid when I had my wisdom teeth removed. I’m pretty sure I’d love to take a fistful of codeine and see where it can take me.

So, how do we manage this? What does it mean to be “clean” and “sober” if we take prescription opiates or narcotics or benzoes? My opinion, which is the one that I have taken from hearing it espoused in AA meetings, and at my rehab, is fairly, I hope, straightforward. I can still consider myself “sober” while taking opiates, narcotics, or benzoes if all of the following are true:

1. The medication is legally and appropriately prescribed by a physician.

2. The physician knows that I am an alcoholic in recovery.

3. I take the medication precisely according to the physician’s instructions.

4. I stop taking the medication as soon as is possible. i.e., as soon as I can endure the pain without anesthesia.

5. I never take the medication with the intent of experiencing mind-altering effects.

Additionally, the following is incredibly highly recommended, but may not be possible in all circumstances (such as acute injury)

6. The physician has experience treating patients with addictions.

Now, obviously, if I am in an accident and an emergency medical technician doses me with morphine at the scene, that’s not a breach of sobriety. Breaches of sobriety require intent. But opiates, narcotics, and benzoes cannot be prescribed to us “PRN”. There needs to be a schedule. It needs to be followed.

My intention for myself is that I will never take any of those medicines as an outpatient. If my pain is severe enough to need opiates, then I need to be an inpatient, under the care of a hospitalist. But the time I’m ready for discharge, I’ll need to be able to take alternative pain medicine. I will suffer pain rather than take any opiate or narcotic. I will suffer anxiety rather than take any benzo. I simply don’t have the option to take these drugs outside of an inpatient environment. They will kill me. I had a root canal with nothing but lidocaine and ibuprofen. I was fine.

I have seen many alcoholics die after being legally and appropriately prescribed pain medications. Even alcoholics with no prior history of abusing anything but alcohol. I have little doubt that I might well number among them if a physician gave me a 30-day supply of hydrocodone with three refills.

Engaging with medical care is always a dicey proposition. As addicts, it is a matter of life or death. We are, almost uniformly, tempted by the “free high” of appropriately prescribed opiates. Because we are addicts and alcoholics. We are tempted by death. I have never found a way to describe just how enticing an alcoholic death can be. But every alcoholic I know understands it.

8 Comments leave one →
  1. 24 February 2014 11:53

    Okay for you, that’s an entirely reasonable
    Position to take as an informed alcoholic. However, I would just like to point out that studies show that adequate pain medication speeds healing after many types of injuries and surgeries and that inadequate medication can result in poor healing and even loss of function. Especially when we are talking about physical therapy. The threshold you set – you will only take meds if you need to be an inpatient – is very high indeed, and personally I believe inappropriately high for most people. Part of being truly informed includes the risks not just of taking pain meds, but also
    Of not taking them.

    I am in a bit of an odd situation, as a person with a chronic pain syndrome. I can – and do – live with my pain using OTC meds only. But that involves accepting a level
    Of disability that would likely be improved by better pain managemt. I.e., I choose not to go hiking with my family because I know how much pain I will be in afterwards. If I had a Tylenol three prescription, I might make a different choice, and my quality of life might be that much improved.
    A reasonable person – even a reasonable alcoholic – might decide that the risk inherent in that scrip is a risk worth taking for the sake of more active time with family.

    • 24 February 2014 11:55

      Sure. But I stand by my position that it needs to be prescribed by a physician who knows the person is an alcoholic, and taken as prescribed.

  2. 24 February 2014 14:47

    In other words… I think you might be speaking from a place of able-bodied privelege 😉

    • 24 February 2014 14:48

      I have little doubt that that’s the case. But, surely taking medicine as prescribed – by an informed physician – is not only for the able-bodied?

      • 24 February 2014 16:21

        Of course. I meant that its easy for a person without pain to say they won’t take pain meds.

  3. 24 February 2014 18:17

    I got 2 years sober in 1989. I then got prescribed codeine for chronic neck pain. I then spent 20 years addicted to painkillers and started drinking again.
    I have 2 years clean and sober again now.
    I recently underwent surgery for cancer and was given morphine post surgery.
    I declined any more opiates to take home.
    I agree totally with your article.
    I can’t and won’t risk taking opiates.

  4. 26 February 2014 07:48

    There is an appendix in later versions of Living Sober which has good (and similar to your) advice on this.

    So – I feel I can answer your question in the affirmative. I suffer with Migraine Associated Vertigo – a condition I wouldn’t wish on my worst enemy. I don’t get crippling pain/headaches but I get a headache, like a pressure pain that builds, then I get sensory disturbance, often starting in my ears – a dulling of the hearing as though I’ve something in my ear. Then I lose balance. Simply I can’t stand up straight. Then the world starts to move, that is my perception, until it is moving in front of me at the speed of a spin dryer. I can’t stand, I constantly throw up – it is frankly absolutely awful. In one 18 hour episode when a doctor attended me in a hotel in Boston I seriously considered bribing him to give me an overdose to make it go away.

    Enough background. I was recommended by an expert – a proper specialist consultant – to use opiate pain killers in my treatment of it. However I didn’t want to do that given my background, I’ll be honest he was a bit dismissive of the alcoholic issue but that isn’t his fault. I do use them now – I have devised my own method – i.e. I use other painkillers first, then ramp up onto the Opiates if I’m getting nowhere. However I never take them more than 2 days at a time, the advice on the box is 3 – I shorten it to 2. I’ve never had an issue with this.

    Be sensible is my feeling – long term chronic pain management – that would be tricky maybe they do without a doubt “space me out”. However now I don’t like that feeling but I don’t doubt it would start to feel good at somepoint if I was on them permanently.

    But use then as advised – or close to in your regime which is what I do. Stick to that. Be honest – I even get my wife/daughter to check the packet so they know I’ve only taken what I should do etc.

  5. Syd permalink
    1 March 2014 15:12

    Many challenges out there for the alcoholic to think about. I minimize medications as much as possible.

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