Not a Cafe Society thread, though occasioned by reading James Frey’s A Million Little Pieces. I’m not using spoiler tags because the information below is given at the outset of the book.
James Frey reports that he arrives for alcohol and drug rehab (at Hazelden, I presume) with a hole in his cheek big enough to put a finger through and broken teeth requiring root canals and crowns. He says that because he’s an addict, his facial and dental work must be done without anesthetic. I’m wondering whether this is
True, because he’s medically unstable and they’re afraid they’ll kill him with anesthetic (in which case, would it hurt to wait another few days until he’s detoxed? It’s already been at least two days since he fell from the fire escape)?
True, because he’s because he’s medically unstable and such a very bad addict that even Novocaine will kill him even after detox?
True, because anesthetic would be considered substance use by his treatment facility?
Not true, and reflective of his tough-guy posturing rather than an accurate account of medical necessity?
If 1-3, I’m curious to hear about alternatives/adjuncts to anesthetic that don’t appear in the narrative (e.g., acupuncture, Tylenol for goodness sake, topicals, etc.) that may safely be used by people with addictions when surgery is needed.
FWIW, I had a mild addiction to barbituates in high school. Kicked about about 6 years later had all 4 wisdom teeth pulled in one go. I just used novocaine because I didn’t even want the temptation. Sucked on a few hundred freezer pops for the next few days.
I can see where someone in recovery might make that choice, China Guy. I’m wondering though about the assertion that Frey couldn’t even have novocaine.
BTW I have most of my dental work done without anything for reasons of personal preference (including a root canal). But I got to choose this rather than have it imposed on me.
I have studied addiction medicine for years, and had many chemically dependent patients, and there is NO REASON to withhold xylocaine or novocaine from them. It is not mood altering. It is not a health risk unless one has a known allergy to the substance.
Now, in the aftermath of the procedure, one must be very, verycareful in prescribing narcotic painkillers to a recovering addict.
Anesthetic agents like Novocaine aren’t addictive, unless you’re insane. Some do contain a small amount of epinephrine which may cause a minute or so of heart racing but nothing that would be considered Cheech and Chong type fun. There are non-narcotic pain meds available for after treatment care and epi-free numbing agents for the very contientious 12 stepper. A topical isn’t narcotic either but wouldn’t help you out in a dental procedure like a root canal. Perhaps drug treatment facilities don’t want their patients to rely on ANY foriegn substance for anything; that’s uncalled for, ouch.
This has been discussed occassionally in AA meetings that I’ve attended. The consensus seems to be that pain medication is OK as long as you take it as prescribed. As prescribed is the key phrase. In my experience, it’s next to impossible to enjoy a high from the codeine you’re taking after major periodontal surgery.
Needless to say, any alcoholic worth his or her salt will find ways to finagle “as prescribed” into “enough to get me high.” Many of us will refuse pain medication just to be on the safe side.
I had a roomate who was a recovering heroin addict on methadone. She said they could give her enough novacaine to numb anelephant and it simply had little to no effect on her as she was accustomed to heroin. Perhaps what the author meant was that the aenesthetic was useless… thus, effectively doing the procedures without anesthesia. I know that the dentist my roomate was seeing wouldn’t provide her with any other pain relievers due to the methadone and her addiction problems.
I am not aware of any studies showing that opiate habituation alters the anesthetic response to novocaine or lidocaine. Certainly when drugs are ingested regularly the liver revs up to detox them faster, so often it is necessary to give an addict more lidocaine more often to achieve the same effective anesthesia in a non-addict. But it should not make them completely immune to lidocaine’s effects.
And I’ve numbed up lots of people with lidocaine who were on methadone or oxycontin, before doing repairs. No problems.
My dentist has told me that people who’ve developed a tolerance to cocaine are difficult to numb with the dental -caines. That’s unrelated to opiate use.
This author asserts that Hazelden did not allow him (as opposed to his making a decision not to use) any anesthetic. The description of the excruciatingly painful dental surgery goes on for a number of pages. The assertion caught my attention because as a psychologist I’d never had a client with an addiction refused a local anesthetic for dental work.
No rehab I’m familiar with would ever deny a client the use of anesthetic, at least in a short-term procedure like surgery. They would most likely confiscate any post-procedure pain medication and dole it out according to the directions on the label.
I myself have never refused anesthesia or pain meds if it were appropriate to the situation. As a sober alcoholic, I have been advised to inform all new doctors of this so that if it becomes an issue (as it did this past summer), we can both make an informed decision on the kind of medication that is most appropriate.
Quick question for Qadgop: Can the use of cocaine in nasal surgery (say a rhinoplasty) trigger a relapse in cocaine relapse even if the patient is under general anesthesia?
The mantra of all the addictionists I’ve worked with is that genuine acute traumatic pain must be treated appropriately even if that means using opiates in an opiate addict. To deny someone this medication for significant acute trauma or acute post-surgery because of an addiction history violates what I would consider the standard of care in the USA. The patient DAMN WELL better be a candidate for morphine during their MI whether they’re recovering or not!
Now this doesn’t mean everyone with a backache from a motor vehicle accident in 1995 must get percocet. I’m talking significant acute pain. Addicts with malignant pain (cancer pain, severe neuropathies, etc.) should also be treated with opiates if otherwise appropriate, without regard to their addiction history.
Robin I do believe that any addict who is given mood altering drugs for medical reasons is in need of their support network and their program even more than usual. I’ve had recovering patients struggle to get their heads back on straight after being under general anesthesia. Most did fine, but reported feeling like they were back in early recovery again, with all the emotional turmoil, and not a few cravings.
I agree, local anesthetics work in everybody. Heroin addicts (former and current), tend to be big babies when it comes to pain (note, the previous is my OPINION, derived from personal experience)
The only medical use I know of for cocaine is as a local anesthetic. Why would it be used in conjunction with general anesthesia? Also, when used as a local there is insufficient systemic absorption to produce a notable drug-effect.
Oops, a quick google search turned up that cocaine induces vasoconstriction in the area to which it’s applied (why can’y I remember my basic pharm?). In this instance, it could be used in conjunction with general anesthesia. Nonetheless, systemic levels would remain very low. In addition, several other (non-addictive) vasoconstrictor drugs are available as alternatives.
Many of us will refuse pain medication just to be on the safe side.