He’s a recovering addict. So why did his doctors give him opioids and leave him on his own?

Seth Mnookin just published a must-read piece for anyone interested in the issue of recovery maintenance over the lifespan of people with a history of addiction.

Mnookin is in recovery from opioid addiction and recently required surgery for kidney stones.

That’s why, throughout the course of my 43-hour stay at MGH at the end of April and into early May, I told everyone I could — from the ER doctor who informed me that I’d need surgery, to the anesthesiologist who prepped me for the procedure — that I was in recovery from a substance use disorder.

And while my doctors all said they were aware of the issue, it still felt as if no one was listening.

. . .

“You know he has a history of addiction?” she asked the surgeon.

The reply surprised her: “No, I did not.” . . .

A few minutes later, still groggy from anesthesia, I was handed a stack of seven prescriptions. One was for 20 pills of oxycodone at 5-milligram strength.

When my wife and I talked about this later, we were nonplussed. On the very first page of the seven-page report generated before my operation, “substance abuse” was listed under “past medical history.” Three pages later, the first sentence of the “assessment/plan” for my care began, “Briefly, this is a 44 y.o. male with a history of … substance abuse (in remission).”

Despite that, I got no counseling before I checked out of the hospital that night. No one talked to me about the risk of relapse — or how to guard against it. No one offered to advise me as I began taking the powerful painkillers I would need to get through the next few days.

He warned doctors of his history of addiction, recruited recovery support from his family and still ended up physically dependent on opioids. His withdrawal was missed and he was offered more opioids to treat his discomfort. Fortunately, he declined the additional opioid prescription and it was a friend who is also in recovery from opioid addiction that pointed out that his discomfort was opioid withdrawal.

This happens every day. (I encountered similar care following an appendectomy last year.)

I’m glad Mnookin made it through this experience without a relapse.  Please read the whole article here.

• Previous posts on Mnookin here and here.
• Previous post on recovery maintenance and iatrogenic relapse here.

UPDATE:I shared with Mnookin my personal story of needing an appendectomy last year. Prior to surgery, I informally consulted an addiction specialist. That doctor suggested telling the doctors my history and asking for a few days worth of pain medication rather than their standard longer term prescription. He added something to the effect of, “They won’t listen to you, but try away.”

They didn’t listen. I came home with 120 hydrocodone. My wife asked the pharmacist if they could just dispense a few days worth. They were required to fill the prescription as it was written and could not dispense less.

I used 2 pills and had to dispose of 118.

In a tweet, Mnookin points out that a recent Massachusetts law allows pharmacists to dispense smaller quantities of opioids than prescribed.

This looks like a good target for advocates.

More info on the Massachusetts law here.