Roy Exum
There is an all well-meaning Senator, Rob Portman (R-Ohio), who has no idea what he’s talking about in his proposed quest to limit opioids to a three-day supply. As a man who has taken thousands of them over a 10-year span that included 137 surgeries, I could write a college thesis about pain and narcotics. As a matter of fact, my arthritic knee is swollen twice as big as my left right this minute, walking is excruciating, and either up-or-down on stairs absolutely rolls my eyeballs.
Over the last year the knee has gotten progressively worse and I have two orthopedic surgeons who tell me a knee replacement is long overdue, it is inevitable and the longer I wait, the worse it will get (something I can’t imagine based on the way it feels right now. I mean it.) Because of the infections doctors believe my body fosters due to a disease called osteomyelitis, surgery terrifies me just as badly as opioids do.
My suffering got so bad on Dec. 14, 2017, I asked my pain expert, Dr. John (Rhet) Blake, for opioids. Rhet knows I literally hate narcotics and he has also injected my knee numerous times so he immediately wrote me a prescription for hydrocodone. Yet so great is my fear of any type of opioids that now – some six months later – every pill that he prescribed is still in the bottle. So let’s talk about pain.
The worst thing that two medical patients can do is compare pain. I think it is different in all of us and, thus, it cannot be treated the same. There is no one-size-fits-all. I’ve had bones break inside of rigid casts, reconstructive surgeries fall apart eight weeks afterwards, and I’ve had a kidney stone, a cyst inside my spinal cord, but my topper is ‘deep bone infection.’ Each hurts a whole lot but can you imagine a naïve 15-year-old having a baby, stage IV lung cancer, or a battlefield soldier trying to push his intestines back into an abdomen that has been torn to shreds? Pain meds for 72 hours max!
Senator Portman has absolutely no clue what he is talking about but in America’s haste to fight this pandemic, the practice of medicine is short-changing a lot of desperate people. It is already well documented. Mitch Mutter, the prominent cardiologist who now heads the opioid task force as a Medical Director for the state, had knee surgery earlier this year and he looked at my knee on Sunday and told me, “You’ve got to take opioids, there is no way around it.” So now let’s talk hydrocodone.
The first fact is that they work better than anything else we’ve got for pain. The second fact is that if you suddenly stop taking them – cold turkey – you will become so sick that some of us have considered taking our life(!) Third: The best doctors in the country have never taken a course in pain management. This is true. Subsequently, they don’t tell their patients how to stop taking opioids and, believe me, brother, there is a science to it.
It takes the best part of a week – for me – to taper off opioids. You have to do it over four or five days, depending on the dosage when you start. If you just quit, the only thing that will stop the hideous agony is … another opioid. Don’t you see? You’ll take another, and another, and then the doctor will refuse to give you anymore. Then you go through every cent you’ve got buying illegal pills on the street, followed by heroin and sometimes death from synthetic fentanyl, which comes from some third-world country without a wink of oversight. You might as well take rat poison.
This goes on in every American city … and town … every day and, as one who has suffered “large pain,” I can tell you that a lack of instruction on the proper use of opioids is a huge part of the problem. Not one person wants to be an addict to anything. But 95 of 100 patients who abuse hydrocodone will believe you when you tell them two 10 mg tablet are far more effective than swallowing four at the same time.
The CDC guidelines? “When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”
Knowing my body, my tolerance for pain, and the effect of getting off pain medicine too quickly, is why I sought out Dr. Blake and his team. I hate to admit this: I learned to ‘disassociate’ pain, pretend it doesn’t exist, and concentrate intently on another task. Take more Tylenol, keep going so the way I know pain is getting ahead of me, is when I become nauseated.
On Jan. 30 of this year, I asked Dr. Blake to get me a lesser drug – tramadol – that is not an opioid and of 60 tablets he wrote at the time, I still have seven left. Oh, I’ve got all kinds of over-the-counter analgesics and freely admit I “sandwich,” which is two Tylenol at 8 a.m, two aspirin at 10, two Tylenol at noon, and so forth.
Are you kidding me – both bottles say every four hours – no problem with me! The doctor tells me not to do that and I tell him to arrest me -- I am the one who hurts. “Never take aspirin before surgery; you could bleed to death.” Bleeding to death doesn’t hurt as badly as my knee.
All of which is to say, America has millions with severe and chronic pain. They regulate their opioids and are less than five percent of the problem. You give them three-day supply, with a $30 co-pay every time they got back to the doctor, and $300 in co-pays every year. Trust me, Senator Portman, with his three-day supply, will instead hurt millions. And we already hurt.
royexum@aol.com