Medical Opioids: The War Between Chronic Pain and Addiction
“Stretch” tells Robert J. Marks, the surgeries did not really work and he became addicted to the painkillers while trying to live a normal, working lifeIn a recent podcast, “A first-hand account of kicking Fentanyl addiction: reversing Hebb’s law” (May 12, 2022), Walter Bradley Center director Robert J. Marks interviewed a man who got addicted to Fentanyl as a medical drug. Some opioid addictions begin in the hospital. In the previous portion of this episode, “Stretch” told Robert J. Marks how he became addicted to medical doses of opioids while seeking relief from pain stemming from operations — because “neurons that fire together wire together (Hebb’s Law )”. Now he talks about the experiences that set his mind on the road to recovery.
Before we get started: Robert J. Marks, a Distinguished Professor of Computer and Electrical Engineering, Engineering at Baylor University, has a new book, coming out Non-Computable You (June, 2022), on the need for realism in another area as well — the capabilities of artificial intelligence. Stay tuned.
This portion begins at roughly 26:30 min. A partial transcript and notes, Show Notes, and Additional Resources follow.
Stretch: In July 2000, I had the colectomy [removal of the large intestine]. In December of the same year, I had another surgery where they opened me up again, went in, and created what they call a J-pouch, an ileal pouch out of the small intestine and fastened it to my rectal stump, planning to use my anus to evacuate this pouch…
This second part of the surgery was very difficult. It was potentially not a long enough recovery between my first surgery and my second surgery. It really wiped me out and … So I started using the opiates more just because I was a wreck, basically.
Robert J. Marks: And the doctors were happy to prescribe you the opiates, right?
Stretch: Yes, a modest amount of opiates. I think I had 20 Percocet or something… Just to give you an idea, after I got home from the hospital, it was two weeks before I could walk up a flight of stairs to get to the shower. I’d go sit down at the table and somebody would have to scoot me up to the table to eat… My perception was I didn’t have enough pain medication, but I got through it. And then the third surgery…
Robert J. Marks: Before that, did you consider yourself in any way addicted after the second surgery?
Stretch: No, no. I considered myself undermedicated because of the intensity of the recovery from that second surgery. The third surgery was not nearly as invasive as the first two. But at the time, I didn’t understand what the recovery was going to be like… I asked for more pain medication, which they gave me based on my experience the second time around. But then I didn’t end up needing them. That’s of the point I’m trying to make. I had most of a bottle pain medication left over after recovery from that surgery.
Robert J. Marks: Okay. But I do know that eventually you did get addicted. What happens with the addiction?
Stretch: The J-pouch never worked properly and it leaked into my abdominal cavity … for seven years. The pouch itself was always ulcerated and red and infected. And the gastroenterologist I had at Cleveland Clinic was a dedicated man trying to come up with solutions for these post-pouch surgery problems. They called it “pouchitis,” which is basically just an infection in a pouch that they didn’t understand…
Anyhow, the point is we did great lengths to try to get that J-pouch working. And I stuck it out the best I could, and I used pain medication to do it… What I should have done was said, okay, let’s cut this pouch out and do something different. But I didn’t have the wisdom to do that at the time. So I started medicating it with pain medication.
And my gastroenterologist chose… After I decided to utilize the medication, he didn’t want to be involved in prescribing the medication long term, which I understand. They were starting to get a lot of heat from the FDA, which was of course induced by the evil pharmaceutical companies. But they came down on the doctors. So the doctors chose to direct all their patients for chronic pain to actual chronic pain doctors at the Cleveland Clinic. So there was a pain management department.
Robert J. Marks: My understanding from Dr. Hurley, I think, that it was in 2018 that guidelines were put up for the prescription of things like Fentanyl and Oxycontin.
Stretch: I don’t know exactly what they were, but I know they really tightened up the ship as far as people’s access to the medications.
Robert J. Marks: Now, I think you mentioned to me that one of the ways that you took the medication was through lollipops. Is that right, Fentanyl?
Stretch: Yes. You may have heard the whole story about the company that developed those. I was prescribed those Fentanyl lollipops after having been on large amounts of tablet prescription medication. And I had started taking Oxycontin, which is oxycodone in some continuous release form.
Well, the continuous release mechanism doesn’t work very well for a person that doesn’t have a complete bowel system because it doesn’t stay in your system long enough for all the medication to release from the pill.
Robert J. Marks: Oh, that’s right. The Oxycontin is slow release.
Stretch: And for some reason this is very, very, very, very difficult for doctors to understand. I don’t understand why. So they assume you are absorbing all the medication. There’s no way for you to say no, I’m not.
Well, I found out a way. These pills would swell up. So I would have to force them through my anus to evacuate them. And they would plop into the toilet and I fished one out. I dried it, I cut it in half. I took pictures and I took it to the doctor.
Robert J. Marks: Oh, that’s so terrible.
Stretch: This is what you have to do with educated men. You have to fish stuff out of the toilet to make illustrations for these people that think that they know what they’re doing.
Robert J. Marks: We think about this as a gross way of talking about it. But when you’re experiencing pain, you go through all sorts of situations.
Stretch: It’s amazing how resilient humans are. It’s amazing how adaptable we are. And I’ve experienced that too. It’s like, you just find a new normal. But when you’re under the stress of constant pain, your body knows that you need to make a change, and it will basically force you to find some type of solution because your body won’t tolerate the pain. It’s basically a motivator, personal motivator, physical pain. You just can’t ignore it.
Robert J. Marks: So when did you know you were addicted?
Stretch: After I started taking it to just try to maintain. I was working full time and ove time and I was trying to travel… I was starting to become dependent on it because I would start to feel agitated. And I knew that this was because I didn’t have the medication in my system. Of course, there would be more pain. But on top of the pain, there would be this kind of mental — just aggravation, unhappiness.
Robert J. Marks: When you get addicted to opioids, such as Fentanyl, you have to take it — not to get that euphoria again — but to feel normal.
Stretch: Yeah, absolutely. The withdrawal becomes the motivator. The withdrawal is what you are mostly concerned about, and that is not being sick. Because after you become dependent, the withdrawal is more disturbing and painful and agitating, whatever, than the pain that you were trying to overcome. And you may end up with the pain that you were trying to overcome with the medication on top of horrible withdrawal symptoms. And then maybe on top of that, you’ve got actual disease that’s making you sick.
So you’ve basically compounded your problem dramatically when you take on an addiction, if you’ve already got a physical health problem. Because you’ve created another one for yourself, that’s as bad or worse… I believe the addiction was the hardest and most urgent thing I needed to take care of in the context of all that sickness.
Of course, as urgent as it was, it took me a long, long time and two stints in rehab, and then years with a Suboxone product, which is a synthetic opiate, that’s not supposed to be psychoactive, that basically eliminates your cravings for the actual opiates. It tricks your body into thinking you’re on opiates without the withdrawal associated with not being on them, somehow. And it’s basically how I experienced it, an easier letdown…
Robert J. Marks: You mentioned you went to a support group… Do you remember any of the people that you met in these groups?
Stretch: I met so many people, so many different people. And I’ve been in treatment with anesthesiologists and dentists.
Robert J. Marks: You had anesthesiologists in the group recovering from…?
Stretch: Yes. Dentists, nurses, chiropractors, wealthy businessmen, executives, down to people that had been on death row. I’m serious, the whole gamut.
Robert J. Marks: And this was probably a mix of people that got addicted both through prescription and through street drugs.
Stretch: Absolutely. Doctors self-prescribing to manage either an injury that they think they can fix themselves or managing their anxiety and problems with their family with medication. Nurses that have easy access to it, know how to game the emergency rooms and get a bunch of medication out of the system, that type of thing. Nurses’ boyfriends, who come in with the nurses who are addicted because they’ve had access to the drugs through their girlfriend, who’s a nurse…
Robert J. Marks: But you did go through detox and it was kind of self imposed detox, right?
Stretch: Oh, I tried many, many times. I tried cold turkey so many times and I would be so sick for a week or two, just trying, trying. Miserable, barely able to get out of bed, trying to do it myself. And I would dedicate all that time and misery for however long it was. And I couldn’t do it.. The sickness would not go away. So at some point, you become desperate and you become suicidal…
Robert J. Marks: My goodness. But you did finally kick it.
Next: How “Stretch” kicked the medical opioid habit
Here are the all three parts of the episode:
Some opioid addictions begin in the hospital “Stretch” tells Robert J. Marks how he became addicted to medical doses of opioids while seeking relief from pain stemming from operations. Stretch discovered Hebbs’ Law, “Neurons that fire together wire together” the hard way when he became addicted. Later he found that it can be reversed.
Medical opioids: The war between chronic pain and addiction “Stretch” tells Robert J. Marks, the surgeries did not really work and he became addicted to the painkillers while trying to live a normal, working life. When Stretch started in recovery, he met dentists, anesthesiologists, and nurses who were addicted to medical opioids too — as well as former Death Row inmates.
and
How “Stretch” finally kicked the medical opioid habit. It wasn’t easy but it was the high cost of staying alive while managing his chronic medical disorder. Stretch’s advice to kids who’d like to try opioids: “Maybe you’d want to try some skydiving without a parachute or cliff climbing without any ropes…”
You may also wish to read:
Opioids: The high is brief, the death toll is ghastly. Fentanyl has medical uses in, say, open heart operations where the patient is on life support; otherwise, it is a one-way ticket off the planet. Anesthesiologist Richard Hurley tells Robert J. Marks how Fentanyl affects the brain and why the street version is so deadly.
and
What anti-opioid strategies could really lower the death toll? Anesthetist Dr. Richard Hurley discussed with Robert J. Marks the value of cognitive behavior therapy — reframing the problem. Life expectancy in the United States is decreasing due to opioid deaths, though the problem is now primarily street drugs, not medically prescribed ones.
Show Notes
- 03:19 | Introducing Stretch
- 03:54 | Failed Surgeries and the Beginning of an Addiction
- 26:28 | Fentanyl Lollipops
- 29:45 | Withdrawal Becomes the Motivator
- 34:39 | The Difficulties of Detoxing
- 44:45 | Advice for those Undergoing Surgery
Additional Resources
- More information about Dr. Robert J. Marks
- Podcast with Dr. Richard Hurley on opioid addiction: Exercising Free Won’t In Fentanyl Addiction: Unless You Die First
- More information about Oxycodone (OxyContin, Percodan)
- More information on fentanyl
