Pain and Percocet

Enough to start an addiction? Maybe so.

By now, you’ve all heard that there is an opioid crisis in our country. I did not fail to consider this when facing a surgery for which I knew I’d be prescribed narcotic painkillers. Before I go into my experience with Percocet, here is some basic information about the opioid problem of which we should all be aware:

1.     “Crisis” and “epidemic” are not overblown words. The CDC reports that in 2015, approximately 15,000 people died from prescription opioids alone. Last year, more than 64,000 people in the US died from all drug overdoses. (Compare to approximately 32-35,000 deaths from gun violence per year– go, USA!—and around the same number, maybe a little higher, from car accidents.) The rate of opioid deaths has quadrupled since 1999.

2.     This crisis is not about preventing kids from doing drugs (“Just say no, kids!”), though obviously some of the overdose deaths come from illicit drugs first taken recreationally. The majority of the people affected are prescribed these drugs by a medical professional. (The underlying cause of Prince’s death was not a drugged-up rock star lifestyle; it was chronic pain.)

3.     There is a difference between chronic pain and surgical pain—namely, one usually gets better and the other can only be managed. It is believed that one of the sparks to light the frenzy of opioid prescriptions was a short letter in the New England Journal of Medicine where a doctor pointed out that none of the hospitalized surgical patients showed signs of addiction or dependence. This letter got picked up by pharmaceutical companies and scrubbed of its context to read: “Opioids do not lead to addiction.”

Okay, now on to the drugs.

When I was thirteen and eighteen, the ages at which I had major abdominal surgeries, I was given injections or an IV pump of Demerol. Ah, lovely, sweet Demerol. It took away the pain and sent me off into comfy, fluffy sleep. I was hoping for some of that this time, but no such luck. Initially through my IV line, I received Dilaudid. Shortly after the first injection, I got queasy and threw up a little. I had just taken some cranberry juice or broth around that time, too, so it’s possible it wasn’t the Dilaudid. Worse, I had a sudden sensation of intense, hot itches prickling in my groin up through my chest. Fortunately, that only lasted a minute or two. The second time I received the Dilaudid, the itches returned but the nausea did not.

[Side note: When I realized that I was in danger of vomiting, I called out to my husband and sister that I required one of those yellow, kidney-shaped plastic emesis basins usually ubiquitous in hospitals. However, I was still pretty heavily anesthetized, so instead I yelled out, “Vomit bean! Vomit bean!” My impression is of them fluttering around the room in a panic, echoing “Vomit bean!” I was given a blue plastic-bag tube-thing instead.]

The next day, I was offered either Dilaudid through the IV line or Percocet by tablet. I went with the Percocet, which is a mix of acetaminophen and oxycodone. Fluttery loosy-goosiness was my experience. It was okay, or so I thought.

Dr. Mullan promised that my pain would not be considerable, and he did not lie. When I came to after surgery, I was actually surprised by how little my head hurt. I gave it a 2-3 on the 10-point scale. After some time, the nurses started prodding me to ask for pain meds. The highest rating I gave my pain, though, was a 4, and I felt like I was exaggerating a bit. I was afraid that if it was too low, they wouldn’t give me anything when I wanted to rest. I didn’t realize at the time that that was not the protocol.

The following Monday, I was lounging comfortably at home, listening to Minnesota Public Radio. They were doing an hour on the opioid crisis. I heard some things that frightened me, largely because they directly addressed my experience:

·       Addiction/dependence can happen in as little as five days on an opioid, even under prescribed circumstances. I was on day 5.

·       One caller talked about how nurses tried to get him to “get ahead of the pain” and take the pills before his problem set in. From a medical standpoint, this makes some sense; surgical pain can sometimes spike sharply and thus be harder to control, so they don’t want patients toughing it out. Any migraine sufferer knows this. If I feel the seed of a migraine, I treat it with Excedrin Migraine ASAP—any less and it’s just “poking the bear,” turning into a full-blown migraine later on. Additionally, when you’re in pain, your blood pressure rises, which can cause problems of its own. However, my discomfort was rather low and non-spiky. On my second day in the hospital, I took one Percocet in the morning and didn’t take anything in the afternoon because I thought I might be getting a visitor and didn’t want to be all drugged out at that time. I didn’t take another Percocet until 9pm, but after 45 minutes, I still didn’t feel any change, so the nurse gave me another. She told me she’d give me a double in four hours, so that I could “keep ahead of the pain,” which, I remind you, never got above a 4.

·       Another caller talked about how hospitals seem to have a rather unrealistic idea of pain management. The goal is 0 out of 10. I noticed that same “pain goal” on the board in my room. Sure, we’d all like to have zero pain, but is that appropriate for everyone at all times? I mean, we all often go to work with a headache or sore foot or minor back twinges. I had just had my skull sawed open; I expected a little head soreness—and I had much, much less than I expected. Why should I deal with dangerous narcotics just to reach zero when I can function reasonably well at 2 or even 3?

But, scared a bit though I was, I didn’t mind having some help sleeping comfortably. The Percocet, however, was not actually helping. An afternoon Percocet was not letting me drift off; it made me feel fluttery-relaxed but mind-buzzing. After waking in the middle of Tuesday night with a sore head, I decided on Wednesday night to take two Percocet before bed – you know, to get ahead of the pain.

I was miserable. I don’t know if I slept the entire night, though my body was leaden. My trouble sleeping was largely from Decadron, the steroid to reduce brain swelling, but Percocet was either not playing well with it or simply didn’t do anything to help my brain quiet down to sleep. I decided to forego the Percocet.

About a week later, I decided to do a science experiment on myself and try the big P one more time. I was tapering off the Decadron, the source of most of my sleep issues, so I wanted to see if, in a less agitated condition, Percocet would actually help me relax and sleep, since I wasn’t napping during the day despite my exhaustion and was only sleeping about 5 hours at night at most. Once again, my body felt heavy and sluggish. And once again, my mind perked (Perc-ed?) up and refused to let me actually fall asleep. (At one point, I opened up my Kindle app to read, but I read with only one eye because the other lid preferred to be immobile.) So I’m done with it.

My minimally painful surgery came with opioids—and I still have a rather full bottle of them—but I’m not sure it should have. How many others in my situation might get ensnared by the medication while trying to set themselves free of all discomfort?

For more on the issues and research around opioid prescriptions, check out these articles about how the epidemic in the US hurts other countries and research into dosages for surgical patients.