When Can an Alcoholic Take Prescription Drugs?

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.