The moment of impact takes my breath away. Even now, over a year removed from that icy and snowy morning, the slick sidewalk, and seemingly slow-motion fall, my stomach heaves and my lungs contract when I recall the crunch when I hit the concrete. I had never felt pain like that in my life.
Huddled like a bug in the urgent care exam room, I listen to my provider give me the results of the x-ray: compression fractures of both L1 and L3 vertebrae (this was later amended to only the L1 with a herniated disc after an MRI but that’s for a later blog). She prescribes me 800mg of ibuprofen three times a day for 10 days and 5mg of oxycodone every six hours for five days.
With great pain comes a need for epic painkillers. However, as a reasonably informed individual who works in the health care space, I know the name of evil, and that name is “opioid.” I immediately vowed not to take any of the oxy. I am an idiot.
For the three days following the fall, my pain is out of control. I cave early on day one and begin to take the oxy as directed, which allows me to snatch hours of sleep between spans of staring at the water stain on the ceiling of my bedroom and enduring. By the time I see my spine specialist, it is clear that the ibuprofen has not brought my pain to a manageable level and he, bless him, switches me to another anti-inflammatory painkiller. Terrified of experiencing that white-hot edge of pain again, I also ask for a refill of the oxy – despite being equally terrified of the possibility of becoming dependent, though I have no real idea what that means.
The campaign against opioids has been effective…and scary. I know that there is an epidemic and people are dying and it is very easy to become addicted. Every person I spoke to on the phone about my accident made concerned noises when I told them that I was given Oxycodone. This, in turn, raised my anxiety level about taking the drug even though it was the only thing that made life remotely bearable for over 72 hours.
I have very few memories about the week of my fall. I remember the weird adjustments I had to make to do ordinary things (thanks to my aunt for The Claw); I remember the kindness of others (friends changing litter boxes and toting me hither and yon); and I remember fighting the pain and wondering how I would know when I became dependent on the oxy.
I spent hours trying to figure out how to recognize the symptoms of opioid dependence in myself while also trying to move as little as possible and keep my cat off my chest. I eventually came across a patient education flyer from the Centers for Disease Control and Prevention that laid things out in a way that I could assess and understand. I could watch for these simple things:
- Tolerance — meaning [I] might need to take more of a medication for the same pain relief
- Physical dependence — meaning [I might] have symptoms of withdrawal when a medication is stopped
By Googling “signs of an opioid dependency” and checking out the box of info that comes up alongside the search results, I learned that opioids can affect your mood, giving you a feeling of euphoria – I extrapolated that this could be a part of the reason that I enjoyed taking the oxy at bedtime.
As I tried to pre-emptively detect my addiction, I discovered that there seemed to be a heck of a lot more information out there designed to help people diagnose opioid use disorder in their loved ones than in themselves, and precious little about helping patients in pain avoid it all together. I grew increasingly frustrated with what appeared to be a remarkably obvious blind spot. I was astonished that so much of the material I found seemed to leapfrog the new patients to help those already dependent. Doesn’t it make sense to also focus on education so the new patients have the tools so they don’t follow the same trajectory?
I have vague recollections of possibly overwrought, teary, and repetitive conversations with my boss about how I didn’t know how I was going to know if I was addicted. Admittedly, I was highly medicated and had literally nothing else to do but lie in my bed and wonder about these things. In addition, we were beginning to research an opioid spot analysis just before I fell so I had done a lot of reading about the dangers of the drugs and much of the information was top of mind.
What was not top of mind, however, was that opioids can be an important component in a pain management plan – when coupled with the appropriate patient education. Maybe I didn’t receive any opioid-related education because my oxy prescription was for only five days and for an injury. Who knows? I didn’t find any such resources until I began research for this blog and learned that I had been Googling the wrong phrase last January. Turns out I should have typed in “what to expect when taking opioids.” This brings up an excellent article from the Mayo Clinic, How to Use Opioids Safely. Boy, this information would have allowed me to rest easier and heal rather than remaining ever-vigilant for my oncoming dependence.
In the end, I did not become dependent. The refill of the oxy from my spine doc was the last one I needed; though still scared of the pain, I confess to saving the last pill “just in case.” I took it New Year’s Eve 2018 when below zero temps sent me scurrying back to bed with an audiobook. I lay there, waiting for the weird, sharp, pinching pain to ease and thinking about how just a little education could have helped me cope with that dangerous, difficult to spell little pill.