My GF just finished major surgery. As is to be expected she is in pain as she recovers.
She has always hated narcotics (for medical issues over the years…never recreational). They make her nauseous and dizzy and she finds it overall not pleasant. But sometimes pain is worse than those downsides so she’ll use them if necessary (of course under doctor supervision).
After her recent surgery she has tried to avoid narcotics and tried to cope with Tylenol but this has not proved sufficient. She has decided to go with the Oxycodone that was prescribed to her at the outset. Her worry is that her recovery will be long and using such a substance will make her addicted over that time period.
I suspect this is an issue that has no hard and fast rule. Some people are more prone to addiction than others. Still, are there any guidelines to this even if vague ones? E.G. Take it for a week no problem, take if for a month and you can’t help but become addicted kinda thing?
I realize this is not a place or medical advice and no answers should be considered authoritative. No suing anyone here for what they say in this thread. I am just curious if there is any advice to be had here.
I’m sure one of our experts will be along shortly, but I do have relevant anecdotal data. I had back surgery a number of years ago and was given percodan (which I believe is oxycodone). For about two weeks, I took them as indicated but never skipped a dose because it knocked me right out and sleep was otherwise very difficult.
I have a mild fear of narcotics addiction, so I stopped as soon as I felt I could get away with OTC painkillers. I think I’d gone through about half the script. For a couple of days I had a lot of trouble sleeping and some really weird mood swings. I broke down in tears during a very pleasant meeting with my boss at point. It was probably a month or two before I realized that I’d probably been having withdrawal symptoms.
But other than a little moody sleeplessness, no big deal. GF sounds like me - she’ll stop taking them as soon she’s able. I’d suggest a call to the doc about dependency concerns, they might be able to suggest lower effective dosages to try.
And remember that you don’t have to take it every four hours (or whatever) just because the bottle says so.
Sounds like an acquaintance of mine. He had back surgery and took some kind of prescribed opioid for pain management. Don’t recall for how long, but when he stopped taking them he experienced significant withdrawal symptoms, including (among other things) vomiting.
Good advice for dealing with withdrawal at that link. In a few words, it seems like the best advice is to use them as sparingly as possible during recovery, be aware that withdrawal symptoms may be an issue, and talk to your doctor if you’re having trouble with those symptoms.
There are no obvious authoritative literatures sources for “speed of addiction” that I could find on a quick google. I suspect “no hard and fast rule” is correct.
What kind of addiction are you talking about? Chemical dependency style psychological addiction; the compulsive psychological need to obtain and take the stuff despite severe negative consequences, that can afflict up to 10% or so of the population? Or the physical addiction that can occur in anyone?
If the former, one dose can start the slide, though the process may be very short or very prolonged. I had my first dose of codeine at about age 14, when given some Rx cough syrup for a horrible bronchitis. Expecting only some cough relief, I was suddenly struck by such a sense of well-being that I thought “this is what has been missing from my life!” By age 26 I was in my first treatment for chemical dependency. Others have progressed from their first dose to complete physical and psychological dependence in weeks.
If the latter, i.e. physical dependency and withdrawal symptoms when the drug is reduced or discontinued, it really depends on type of opioid, dosage and duration. Oxycodone addiction can occur in a relatively short time like 10-14 days if the meds are given around the clock (4 x a day dosing). But it’s generally regarded as safe for typical post op pain for lesser periods of time and/or lower doses. And the physical withdrawal symptoms are milder the briefer the time and lower the dose, and can be managed. It’s the psychological side of it that drives folks to distraction, and fortunately for the majority of patients without the trait of psychological addiction, that side of it is greatly reduced.
I’ve been clean for over 30 years, tho I have been prescribed strong opioids for severe acute pain at times, and it did not reactivate my addiction, thanks to careful dosing, close monitoring, lots of support, and having another person control the medication. Opioids were absolutely necessary for me to manage that pain; I’d optimistically and naively expected to deal with it with tylenol and ibuprofen, but that was NOT realistic. Sometimes opioids are the answer.
That’s my view in a nutshell, large books have been written on the topic elaborating the various aspects of different drugs in different patients with different comorbidities.
Another anecdote: my mother was on morphine the day after major abdominal surgery, back in the 70s. That day, she was in such good spirits that the nurses thought she was pre-op. Then they took her off the morphine, and, she told me, she cried for an entire day. She was relieved when someone suggested it was morphine withdrawal.
I think she was only on morphine for a day, maybe two.
That being said, she did not suffer psychological addiction, and she had no desire to take opiates by the time she was released from the hospital. While the withdrawal was unpleasant, i suspect the pain would have been worse.
A few years back I was hospitalized for a week, for peritonitis and a laparotomy. I had some narcotic pain med on an IV that I could trigger by pushing a button, as long as a certain minimum time had elapsed. It only took me a day and a half to realize I was trying to gage whether the minimum time had passed so I could push the button for the euphoria, and wasn’t trying to medicate the pain. Since I have had such a problem with alcohol decades ago, and recognized my tendency to get dependent on oxycodone during previous back and neck surgery recoveries and kidney stone misadventures, I really didn’t want to be doing that. so I stopped using the button at all. The nurses were surprised at how suddenly my surgical healing seemed to improve. Stopping suddenly did make me feel a little negative, IIRC, though this might have been a borderline subjective thing – I’m not sure if there was a trace of real withdrawal there or not. But I am sure I was getting a little addicted in just 36 hours.
I’ve had each prescribed for various short term conditions with no addiction issues. I appreciate the relief they offer but anything longer than a few days makes me feel mentally beat down and negatively affects my ability to sleep. As a result, I try to stop taking it as soon as I can and switch to tylenol.
Hydrocodone is prescribed for the long-term treatment of severe pain for which other treatment options are not effective, not tolerated, or would most likely not be strong enough to adequately manage the pain.
Hydromorphone is used for management of acute pain and moderate-to-severe chronic pain in patients when the use of an opioid is appropriate.
In my 20s I was hospitalized after having my appendix out. I was in a fair amount of pain and they gave me a shot of Demerol. Wow, did that feel good! The pain disappeared and I had a permanent smile the rest of the afternoon. That evening the pain was increasing so I asked for another painkiller and was sorely disappointed when they brought me Tylenol. My internal reaction was “what the hell is this? I want Demerol!”
That was after one dose, and I don’t have an addictive personality. I can totally see how rapidly one could get addicted.
She would not have developed addiction in a day or two. Any kind of major surgery can trigger mood swings.
To the OP: If opiates make her feel sick, it is extremely unlikely that she will become physically or mentally addicted to them. She should take the lowest dose needed to control her pain (which is NOT the same as being pain-free; a little pain is not bad because it can lead to reduced activity) and if she’s been on it for more than a few days, taper off - maybe take half a tablet for a couple days, or spread them out.
You would have had a PCA - patient controlled analgesia. Those are great for so many reasons, one of them that you don’t have to bug the nurse constantly, but another is that multiple studies have proven that people who are on this have much better pain control, and they use less in the end. You were wise to recognize that you had a problem, and nipped it in the bud. Did you tell the nurses why you stopped using it? Not a bad idea if you did, or to do it in the future.
Not infrequently, when I was practicing, we would see a note from the doctor that said, “Please tell patient’s (fill in the blank) to refrain from pushing the PCA button.” I remember when my BFF’s mother was in the hospital with terminal cancer, and his sister, WHO IS AN RN, was doing that! She should have known better, and she could have put her nursing license in jeopardy had she been caught!
That’s not how chemical dependency/psychological addiction works. It’s the overwhelming compulsion to use, despite negative consequences which quite frankly generally far outweigh the positive feelings.
I suspect it varies pretty widely. I’ve only once in my life used narcotics for more than a day or two after a procedure - back in 2018, when I had very painful wrist surgery. I was taking several a day (I think it was Percocet but might be wrong) for much of those two weeks. I never had any sense of feeling “good” while on it, it just dulled the pain enough that every movement was not agony.
I’ve never had that “wow. All’s right with the world!” feeling with any narcotic, though. The first time I had Percocet (wisdom teeth, nearly 40 years ago) I described it as not so much controlling the pain (though I’m sure it did reduce it) as making me so zoned out that I didn’t CARE. I’ve also never tended to abuse alcohol (rare to drink anything at all, and never to the point of being completely wasted).
In the article about the nurse with the lumbar puncture, s/he clearly had poor followup on the headache. As I understand it, severe pain after a spinal can be addressed a lot sooner than 2+ weeks - which would likely have prevented the physical and mental dependency that occurred. Major-league screwups happened that led him/her down that path.
Huh. I had thought codeine cough syrup wasn’t terribly addictive. That’s a scary story.
I guess I’m wired differently, because i still use codeine cough syrup. I had a really nasty experience with dextramethorphan the first time i tried it, and I’ve used codeine since i was a kid without yet running into trouble. It always makes my throat feel good as i swallow it, but i barely notice it systemically. I’ve worked (as an actuary, no heavy equipment) and played bridge on codeine, and that’s been fine.
