Talking with your doctor about whether or not opioids are the right option
Hello! Welcome to Overdosed a newsletter on drug policy and people who use drugs by me, Diane Roznowski.
It’s been a bit since my last newsletter, but I’m back!
A week from today I’ll be having my third (and hopefully final) nose and sinus surgery which gave me the idea for today’s topic.
In March 2010, I broke both bones in my nose during a cheerleading competition. At the time my biggest concern was whether or not I would get to compete again the next day. I never expected the injury to be something still impacting my life daily nearly 10 years later.
I’ve had chronic sinus infections since I was little, but my broken nose has compounded them. I get regular sinus pressure headaches and my septum is severely deviated. I had surgery eight years ago to try and fix some of these problems but because I wasn’t done growing, the fixes didn’t last. I haven’t been able to breathe through my nose effectively and have lost the majority of my sense of smell.
I knew going back to an ENT would likely mean more surgery which kept me from going. My most recent surgery was extremely painful and for the first few days, the only thing I could stomach was the pain meds. That surgery happened about nine months before I learned my sister Emily had a substance use disorder.
Ever since learning my sister was addicted to opioids, I’ve been cautious about taking them. Over the years, the attention on the issue of overprescribing opioids has caused a significant decline in the number of prescriptions, but they are still frequently prescribed when they may not be necessary for effective pain management, while at the same time, many people with significant and/ or chronic pain have a hard time getting prescriptions for opioids which can provide them great relief on their most severe pain days.
Over the last few years, I’ve been prescribed opioids a handful of times. Each time I try to have a conversation with my doctor about whether or not they are necessary and if there is an alternative pain management option that has lower risks. Most of the time bringing this up has caught the doctor off guard, but all but one has been willing to talk with me about my concerns and options. Here are some tips I have if you would like to start having these conversations with your doctors.
Do your research (if you can)
Before I go to appointments, I try to always do some research about my symptoms and possible treatments that may happen. When I had to suddenly get my one wisdom tooth taken out in 2016, I knew I would most likely be prescribed an opioid for pain management. I read a handful of articles about whether opioids were the right treatment for wisdom tooth removal and determined I wanted to avoid taking them if possible with my pain levels.
Consider your risk factors and personal preferences
Do any of your immediate family members have a substance use disorder? Have you had any challenges with substances? Have you taken opioids before and had unpleasant side effects? Are you okay with handling some pain? Do you want to be able to effectively control your pain quickly?
Knowing your personal answers to these questions can help you make an informed decision about what is best for you.
Have a conversation with your doctor
Determine what you are comfortable sharing. I feel really strongly about sharing that my sister died from an opioid overdose and that that is the biggest reason I want to explore alternatives. Often doctors quickly catch on that this is something I want and need to talk about. I have had one doctor who dismissed me wanting to have this conversation, but for the most part, my doctors have been good about taking the time to have a conversation with me so we can determine together what is best.
Talk about your research and what you would like your outcome to be. I often say that I would like to avoid opioids unless absolutely necessary and would like to talk about what other options there are. Often depending on the procedure you are having you can take a higher dose of an over the counter medication to relieve your pain. It usually does matter which one you take and what dosage. Some types of over the counter pain medications can be prescribed by the doctor and dispensed by a pharmacist. In these cases, your insurance can cover it and you would pay a copay which can save you some money. Having a conversation with your doctor about which OTC pain med to use and what dose to take can often help prevent you from taking an opioid or at the very least help you determine what pain levels require one.
Ask how many opioids you will be prescribed
If the doctor is going to prescribe you opioids, ask how many you will be getting and how many days you should take them. Many states now limit the number of pills you can get without a follow-up appointment, but the doctor may prescribe that number instead of the number of pills you would typically need. Asking how many days it is typical for people to need to take them can help you know whether or not you might need a follow-up appointment to make sure everything is okay.
Watch for side effects and signs of tolerance
Opioids can alter your mood and cause you to be drowsy. Your body can also develop a tolerance for them quickly meaning you would need a higher dose to get the same amount of relief. They can cause withdrawal when you stop taking them. Watch for unpleasant side effects and when they outweigh the benefits consider stopping taking the medication.
Safely store and dispose of your opioids
Keep your opioid in a safe location that cannot be accessed by children. If you have any leftover medication, do not keep it just in case. Consider taking it to a prescription drug drop boxes near you. Many CVS pharmacies have started collecting unwanted prescriptions. If you can’t locate a disposal location near you, you can buy drug deactivation bags online. Additionally, the FDA has determined a list of drugs that are so dangerous to keep that they should be flushed if you cannot find another way to dispose of them.
Having ongoing conversations with your doctors about the risks benefits of opioids (and any medication) is a good practice to start or strengthen. At first, I felt really awkward bringing up my concerns, but now I feel empowered to help make the best healthcare decisions for myself. It makes me feel like I have more control over my treatments and my health overall.
Further Reading
Should You Use a Prescription Opioid Medicine for Short-term Pain Relief?
Opioids After Wisdom Teeth Removal Should be a Last Resort, Not a Routine Prescription
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Until next time,
