Excerpt: When Painkillers Become Dangerous

In this book excerpt, Dr. Drew Pinsky calls attention to the risks of addiction to patients using prescription pain killers.

Chapter One: How Addiction Develops

"Get in there and push six milligrams of morphine on that post-op femur. And debride his heel while you're in there." The orthopedic resident glared down at me with disdain. "Get on it." I, a wide-eyed third-year med student, ran into the open ward with six beds arrayed about the periphery of the dormitory. I found Mr. Resnick writhing in pain. He was too distressed to notice my presence. I grabbed his IV tubing, kinked off above the port, and slowly injected the morphine. Within seconds, his breathing became slower and deeper. A calmness swept across his face. As he became more comfortable, I remember my sense of awe and excitement that I had been able to help this man who had been suffering.

This was my first experience as a medical student administering an opiate to a patient. I cannot express to you my satisfaction at having been able to help this man so vividly and quickly. After all, this is what those of us who enter helping professions expect and hope from our careers; and rarely do we get to experience this sense of triumph so thoroughly as with our ability to take away pain.

Every physician learns early that we can reliably and easily relieve pain with opiates. Mr. Resnick had been in a motorcycle accident and suffered multiple injuries. He was an addict, but at that point in my training, I did not understand what that meant. It seemed to me that he was frequently demanding pain medication. But why not? He had just had an operation on his leg. The more he demanded, the more I dutifully came running with the morphine. As time went along, Mr. Resnick told me about his addiction to heroin. I was shocked. He was a college graduate. He maintained a small business. Heroin? How could that be? When it came time for discharge, I made sure that he had an adequate supply of Vicodin. He was extremely preoccupied with being certain of the amount and number of refills. I didn't think much of it at the time, and I agreed with him that he just needed to get out of the neighborhood where he lived and stay away from his heroin-using friends.

It sounds ridiculous in retrospect, but my lack of understanding of the disease of addiction probably did this man considerable harm. Was it wrong to give him opiates for his pain? No. He needed pain medication, and, in fact, because of his addiction and tolerance to opiates, he needed more than the average patient to control his pain. However, I had absolutely no understanding of the addictive disease process and how I might be contributing to it.

Addictive Diseases

I, like every medical student of my time, had essentially no training in addictive diseases. I was focused only on treating Mr. Resnick's orthopedic problems. He needed pain relief, and

it never occurred to me to consider anything beyond that. If he had a drug problem, well certainly he had now learned his lesson, and no doubt, he would avoid all those bad influences that "made" him use drugs.

As a doctor, I felt triumphant in my ability to help this man and rescue him from his suffering. Given what had happened to him as a result of his drug use, I couldn't imagine he would continue using. If he did continue, well, he just needed to take my direction more seriously. If he still continued to use drugs, well, then that was his problem.

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