Dialogue Volume 13 Issue 3 2017 - Page 32

TK PATIENT PERSPECTIVES If a doctor is prudent when discussing the upsides and downsides of opioids, perhaps patients will be just as careful, she says. stranger to pain. As a child, her home life was tumultu- ous: alcoholic mother, physically abusive father, and an uncle who sexually abused her. At 12, she was in a group home. A year later, at 13, she got her own apart- ment. “I controlled who came in my door,” she says. Ms. Hache became pregnant at 16 and gave birth to a son at 17. The father wasn’t in the picture. She dropped out of high school, and was in and out of the social service system, but generally held down a job. As a young adult, Ms. Hache didn’t fully explore her past traumas. “My brain was able to tune it out,” she says. In retrospect, she understands that the opioids were soothing her physical and her psychological an- guish. It all blurred. When her doctor stopped her prescription, it didn’t take long for Ms. Hache to get Percocet on the street. Soon enough, she graduated to the same OxyContin that she had once feared. The substance abuse escalated. She started using speed and Ritalin, and was drinking more heavily. She even started to down mouthwash. “Anything to be numb,” she says. “I was a human garbage can. Anything to fill me.” Over the years of her addiction, Ms. Hache was afraid to go to a doctor for help. She had two children by that point, and worried that child services would take them away. “That was my biggest fear, because I was in the system as a kid.” Ms. Hache took a shot at tapering on her own. She went way too fast and it didn’t work. In 2009, she tried a treatment program, but didn’t follow any after-care plan and relapsed within two weeks. She ended up in hospital, got clean, and stayed that way for another 22 months. Then she crashed again; more alcohol, speed, cocaine and opioids. Four years ago, Ms. Hache went into treatment again. That time, she was exposed to the recovery community. She started to do some soul searching. “I had never dealt with the core of the problem: the abuse, emptiness and disconnection.” 32 DIALOGUE ISSUE 3, 2017 Not a long-term solution Ms. Hache has been sober since November 23, 2013. For a long time, she wondered what her life would have been like without that first Percocet prescription. What if she didn’t get it at all? Or what if the doctor had said it wasn’t a good long-term remedy and recommended other strategies? Then she realized that given her history, and her fail- ure to deal with it, she was at risk for addiction in any case. If it wasn’t the back pain and the pills, something else may well have triggered substance abuse. “You don’t have to feel when you’re high,” she says. Today she takes part in a 12-step program, and has coun- selling once a week. “I’m moving forward and healing.” Ms. Hache isn’t against the idea of opioids for anyone else. She knows people, such as her brother, who have used opioids, never became addicted, and experienced improved function. But she feels that based on her his- tory, she was not a good candidate for opioid therapy. Now she understands how easily they can be abused. If a doctor is prudent when discussing the upsides and downsides of opioids, as her brother’s doctor was, perhaps patients will be just as careful. She urges doctors to be cautious when talking to their patients about opioids. To pay close attention to their patients’ mental as well as physical health. To discuss non-pharmaceutical options. And to explain how opioids aren’t the ultimate solution. They can help you cope with the pain, but don’t fix the underlying issue. “Taking all the opioids,” she says, “didn’t help my back.” Ms. Hache has now learned to listen to her body when she has pain. When her back acts up, she takes it easy. She modifies her activities; instead of cleaning the whole house at once, she’ll do one room a day. She figures that she’ll never be 100% pain-free, and that’s okay. “Acceptance was huge for me, the hardest thing to do. This is my body, and I have to accept it,” she says. “There are people in this world who die with pain. I can live with the pain. Every day I’m just grateful to be alive.” MD