Postoperative Painkillers: Avoiding Addiction

It seems like a week doesn’t go by without some high profile celebrity addiction story making the nightly news. The unfortunate reality that addiction to prescription medications has reached epidemic proportions in our society has many patients concerned that a trip to the operating room might render them a pain-pill addict. But when it comes down to it, to be able to make the right decisions for their own health, people need to put the hype into the proper context.

It’s true that prescription opioid medications can be addictive, and if used improperly these medications can have the opposite effect of which they were intended. But if taken properly, as directed by the prescribing physician, these medications can actually speed recovery after a surgical procedure and facilitate a return to full functional capacity. For many patients, fear of taking pain relief pills after surgery can actually increase their recovery time and may increase the potential for complications related to decreased movement. Early ambulation is essential. For most procedures it’s important to get up and about as soon as your doctor says is appropriate. For many people, pain is the limiting factor which prevents this early activity and in these cases opioid medications can have a positive impact.

Problems occur when patients continue to take these pain medications after they need to. If you find you’re taking these medications because you like the way they make you feel and not because you need them to participate in the physical therapy or other activities your doctor has prescribed then that’s the time to reconsider whether or not you should be taking these medications. When we talk about addiction we’re talking about the compulsive use of these pain medications despite the absence of pain and despite the negative consequences that come with inappropriate use. The risk of addiction in most patients is actually very low. If you’re taking the drugs as prescribed, and you don’t have a history of substance abuse or prior addiction, even if you become physically dependent on a medication and experience some withdrawal symptoms after taking it, it doesn’t mean you’re addicted.

These medications have the potential to cause physical dependence, even if used properly, which is why it’s essential to take them as directed and discontinue them as directed once you no longer require them. For patients with a history of substance abuse, the use of opioid painkillers becomes a bit more complicated. If you have a personal history of addiction, it’s very important to be straightforward with your doctor. Let your doctor know that you have a history of addiction, especially if you are in recovery from addiction to opioids.

There are strategies that your doctor can use such as using non-addictive pain medications or local or regional anesthesia for pain relief, and you should discuss these options with your surgeon and your anesthesiologist before having surgery. When opioid medications are required to manage pain after your procedure, there are ways you can avoid taking more pills than recommended. Some simple solutions include:

  • Having a trusted friend or family member who is aware of your concerns dispense only the prescribed dose. If your pain is not controlled, then have this designee call your doctor and explain the situation.
  • Avoid taking more than the prescribed dose as often these pills contain acetaminophen (Tylenol), which can cause liver failure and death if you take too many pills.
  • When you no longer need the pain medications, return any leftovers to a pharmacy or a police station drop box. Remember that most people who become addicted to pain pills get these drugs from a friend or a family member. Never keep or share leftover painkillers.

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Ethan O. Bryson, MD, is Associate Professor in the Departments of Anesthesiology and Psychiatry at the Icahn School of Medicine at Mount Sinai and author of Addicted Healers: 5 Key Signs Your Healthcare Professional May Be Drug Impaired.

One thought on “Postoperative Painkillers: Avoiding Addiction

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    Alberta DiPaolo

    April 18, 2014 at 2:38pm

    As always, an insightful and thought-provoking take on a modern-day situation.
    Thank you, Dr. Bryson, for your care and concern.

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