I am regularly asked about dealing with surgical procedures that require pain medication while also being in long-term recovery from substance use.
Having to undergo surgery while dealing with such issues can present challenges. It doesn’t matter if the surgery is major or minor, postoperative pain must be managed.
For years, doctors told me that at some point, I would need a full right hip replacement. Since I was relatively young for such a diagnosis, I put it off as long as possible, managing pain through anti-inflammatory steroid injections and non-narcotic pain meds. It, however, got to the point where I was in excruciating pain on a regular basis, unable to sleep because of it. I could not put it off any longer. It was time for a new hip.
From a surgical standpoint, in addition to cocaine and alcohol, my history also involved misusing prescription pain medications when I could get my hands on them. Oxycontin and Hydrocodone were among my favorites. I also misused black-market Xanax (in yet another classification of drugs called benzodiazepines, or “benzos”) and Ambien, a prescription sleep aid that many cocaine bingers know so well.
This history had to be taken into account in formulating my surgery recovery plan.
The key for me in approaching my hip replacement recovery was rigorous honesty, self-awareness and having a strong support system of friends, loved ones, caretakers and importantly, medical staff who knew about my past.
I also had to understand that even in long-term recovery, I could be susceptible to wanting that familiar “feeling” and cross the line from pain management into misuse which could then easily cascade into physical dependence and ultimately addiction.
I had to be meticulously upfront and forthright with all those in the chain of treatment and support about my past and my concerns about how narcotic medication could affect me physically and mentally. I couldn’t hold back without risking my sobriety.
From the start, I told my surgeons I am a person in recovery from drug and alcohol issues. We then discussed what medication would be needed to manage the pain after the surgery. We agreed that my doctor would be prescribing me Percocet. We talked about how long other patients normally took it, the standard dosage, etc.
I made it clear that post-op, I would not be allowed to self-administer narcotic pain medication. My girlfriend at the time(now wife) would dispense the meds. We also agreed that I was not to be allowed a refill without a face-to-face consultation with my doctor to discuss why I felt it was needed. The rule would always be to take the smallest dose possible to manage the pain and to eventually taper off to aspirin only.
Post surgery, I successfully tapered off from Percocet to Tylenol quickly with no adverse effects and no moments where I felt triggered to take more than the prescribed dosage. Every situation will be different, but there is one constant in a successful pain management program:
Honest with friends and loved ones. Honesty with doctors. Honesty with myself. Understanding my weaknesses and the level of support I needed to counteract those weaknesses.
Don’t be afraid of surgery because of an addiction past. Deal with the issues right up front and have a recovery plan that involves everyone in the chain. You can do it!
Brian Cuban (@bcuban) is The Addicted Lawyer. Brian is the author of the Amazon best-selling book, The Addicted Lawyer: Tales Of The Bar, Booze, Blow & Redemption (affiliate link). A graduate of the University of Pittsburgh School of Law, he somehow made it through as an alcoholic then added cocaine to his résumé as a practicing attorney. He went into recovery on April 8, 2007. He left the practice of law and now writes and speaks on recovery topics, not only for the legal profession but on recovery in general. He can be reached at firstname.lastname@example.org.