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Fearful of opioid addiction, some under-medicate



Magic Madzik via Flickr Creative Commons

As the nation struggles with an epidemic of opioid abuse, KPCC has launched an occasional series in which we share your stories of dealing with pain, and offer experts' advice on how best to manage it. Share your story and insights through the Public Insight Network.

Gena Olson broke her back, hip and shoulder in a motorcycle accident three years ago. For much of the time since then, she resisted taking opioids, relying mainly on over-the-counter drugs like Advil and Tylenol, and on yoga, mindfulness and rest.

Despite all of that, she lived in constant pain.

Here's how she describes the pain she endured, using the zero to 10 pain scale: "Most mornings I wake up at a two or a three, which means that if I'm at home and … I want cereal but I'm out of milk, … I guess I'm not going to eat cereal, [because] I'm not going to walk those three blocks" to the store.

"By the end of the evening, it is at least a six, which means I can't have a conversation with somebody," continues the 27-year-old Olson, who lives in Hollywood. "If you tried to talk to me, I would just stare at the ground with my eyes closed, doing concentrated breathing."

By 4 p.m., which for Olson is "the end of the night ... I lay down on my couch, on my back, and I call it quits for the day, because I can't let the pain get worse than that," she says.

It was only when the pain would get worse than that, says Olson, that she would take an opioid. She says she was reluctant to use them out of concern that she was at an increased risk for becoming addicted, since she has been diagnosed with depression and anxiety, and she says her mother is an alcoholic.

"A delicate balance"

Amidst an epidemic of opioid misuse and abuse, health officials and medical providers are trying to crack down on the use of opioids for chronic pain. While the drugs are effective for treating short-term, acute pain, their long-term use is associated with an increased risk of accidental overdose, addiction and death.

But there are exceptions to that rule; experts say in some cases the benefits of using opioids long-term outweight the risks.

Olson's doctors say she falls into that category, and that she has been under-medicating herself. Experts say this is not uncommon.

"As providers, we are fearful about overuse of the medication, and the clinical guidelines are really focused on minimizing risks associated with overuse," says Dr. Larissa Mooney, who teaches clinical psychiatry at UCLA and directs the UCLA Addiction Medicine Clinic.

"But there are certainly individuals who are worried about the potential side effects and risks of the medication, and they may be using it less than they might otherwise benefit from," she says.

Mooney says there are risks to not adequately managing pain: It can prevent people from undergoing physical therapy or leading productive lives. She recommends that patients taking opioids work closely with their doctor to ensure that the benefits of the drugs continue to outweigh the risks.

"There is often a delicate balance between the use of medication in chronic pain and also incorporating other non-pharmacological treatment interventions to really optimize their outcomes, the goal being improving functioning over time," Mooney says.

"A sneaking suspicion"

Olson got a wake-up call when she was referred to a specialized pain clinic. There, she described her pain to a doctor.

"She kind of looks up and me and goes, 'What would you say if I said that you are under-medicating yourself?'" Olson recalls. "And I was holding back tears and I was kind of like, 'I had a sneaking suspicion of that.'"

The doctor told Olson that she should be taking painkillers as soon as she wakes up in the morning and that she should try to never let her discomfort rise above a three on the pain scale. She prescribed Olson 90 pills, and told her to refill the prescription on a monthly basis.

That amount, Olson says, "sounds so extreme to people, but considering I was reaching the maximum dose of acetaminophen and ibuprofen every single day during the bad weeks … to say that I can have three of these painkillers a day is actually really not much at all."

"I can't believe I had been afraid of being seen as an addict for having one pill every 10 days or so," she adds.

Olson will soon have a follow-up appointment with her doctor. That's critical for patients using opioids, says Dr. Bharath Chakravarthy, who teaches emergency medicine at UC Irvine and co-directs SafeRX OC, an initiative in Orange County to stop misuse and abuse of prescription drugs.

"There are certainly upsides and downsides to pain medications," Chakravarthy says. "But close oversight, individualized plans and follow up are really what are the essential components to keeping people healthy. Pain medicines of themselves are not dangerous; it's how we use them and tailoring these treatment protocols to an individual patient."

What is your experience with using opioids or other treatments to manage pain? Share your story and insights with us through the Public Insight Network.