My Opioid Experiment
Mark 'RxProfessor' Pew
International speaker & author on the intersection of chronic pain and appropriate treatment | Consultant
Two Thursdays ago, I had surgery and strategically selected opioids for the associated acute pain. Not because I needed them but to verify my thoughts on their use. And they lived up (or down) to my expectations. Here's my story ...
At a dermatologist appointment in July it was discovered that I had basal cell carcinoma on the middle of my nose (not the best location for a public speaker) and it needed to be removed. They referred me to a dermatological surgeon who specializes in Mohs micrographic surgery and has a track record of minimal scarring. The process is to excise a layer of skin, perform a biopsy, and then wait for the results. If some skin cancer remains they take another layer, another biopsy, etc. until the skin cancer is completely gone. It took two "cuts" to completely remove all of the skin cancer from my nose. I asked him to show me a picture of my third nose hole before he stitched it up ... and I swear I saw my brain.
They numbed my nose three times - for the first "cut", the second much deeper "cut", and then the sutures (dissolving stitches both underneath and on top of the skin - a nice "frankenstein" look the full length of my nose). I couldn't feel most of my face from 8:00am until about 11:30am. But I sure felt it as the numbing agent wore off.
During the second "cut" he asked what I do for a living. One of these days I'm just going to say I'm a barista, but true to form I shared that I speak and write on the overuse of opioids for pain. We both laughed because on his take home sheet for my wound care there were two options provided for the pain - Extra Strength Tylenol and oxycodone-acetaminophen (i.e. the generic Percocet ... an opioid).
So I was presented with a choice. I have a relatively high threshold of pain and knew the sharpest pain likely wouldn't last more a day, so the Extra Strength Tylenol would have been sufficient. But ... I haven't had an opioid since an injury in 1982 (plenty of pain and injuries since then but no opioid prescriptions) and I muse about their use all the time. So I thought this would be a perfect time for an experiment and chose to fill the prescription for 15 pills of oxycodone-acetaminophen 5-325.
I took one pill when I got home about 2pm (as the numbing agent was diminishing). I took another pill just before going to bed that Thursday night. On Friday I switched to the Extra Strength Tylenol 200mg (one pill every six hours, as much for the anti-inflammation as for the analgesia) through Tuesday when I flew to California. So I only took two of the opioid pills and on Sunday disposed of the remaining 13 pills in a Walgreens "safe medication disposal kiosk" near my home. I knew exactly what I was going to do in advance and followed my own very public advice (well, except for accepting the opioids to begin with, but remember this was an experiment).
So let me tell you about those two pills ...
- If I sat down I could not stay awake (although I slept well on Thursday night, I woke up about 5am on Friday, caught up on e-Mails for about 90 minutes, then passed out)
- I zoned out easily (there were conversations that I was part of that I wasn't really in, if you know what I mean)
- I walked like a 125 year old man (my entire body felt horrible, almost like a really bad flu - you know, kind of like withdrawal symptoms)
- I was nauseous with little appetite (but fortunately no constipation)
- I felt fuzzy until Sunday (remember, the two pills were taken on Thursday afternoon/evening)
The pain on Thursday was real as soon as the local anesthetic wore off. It became more of a constant discomfort (to me) on Friday. I couldn't smile without hurting for a week, and didn't even attempt to blow my nose until earlier this week. But whatever pain occurred was either a spike that went away relatively quickly or just a constant irritant. In other words, the pain was completely manageable after the first night.
If the pain was essentially over after the first night, why did I feel so crappy until Sunday morning?
Two oxycodone-acetaminophen 5-325 pills taken on the first day.
So the conclusion of my experiment? I should have taken the Extra Strength Tylenol because the side effects from the opioids were not worth whatever benefit they were supposed to provide. And I will always make that choice. Not just because my experiment is over, but because of the data from Dr. Don Teater who presented this very important PPT slide (among others) at the State Board of Workers' Compensation annual conference in Atlanta on August 28 (just prior to the panel that I moderated):
In order to get 50% acute pain relief, which drug would you take?
Take it from me, your humble "lab rat" correspondent --- do not take opioids if given a choice.
Retired from Erickson Air-Crane
7 年Sounds a little fishy to me Mark, you must be one in a million. I've known hundreds of people thats taken opiates for a short periods of time, not one of them's ever told me they felt bad for 3 days because of the opiates. I think subconsciously you were looking for a bad outcome, or it could have been because you just about had your nose cut off. Any kind of trauma like that can can make you feel bad regardless if you take opiates or not.
Intergenerational Indulgence Manager
7 年Interesting and entirely anecdotal here. It is highly (pun intended)likely that the feeling poorly until Sunday was due to the surgical assault on your body; not the two opioid based pain pills. While we can agree that there is an epidemic of over prescribing, there is a place for properly supervised use of these pain killers. I had total knee joint replacement surgery last November and explained my reluctance to take the prescribed pain pills to my surgeon. They took the time to explain the proper intersection of the opioid based pain pills, tylenol and aspirin as pain management so that I would regain active motion and PT as soon as possible. I took far fewer than prescribed and completed my rehab uneventfully. Again, both stories are just that - purely personal and entirely different.
Registered Nurse
7 年Marc, this is an interesting experiment you did but it really tells no information. First of all the pain you felt from an excision of a skin cancer on your nose is not be compared to all acute pain. I have been through enough surgeries, big and small to know that Oxycodone for the procedure you had was probably not appropriate. An acute pain that will only last for that short of a period of time does not need a narcotic treatment for most people. However there are so many other surgeries that are result in much more pain for a longer period of time that an Opioid treatment afterwards is appropriate. Also everyone reacts to Opioids differently. My husband, if he takes an Opioid for pain, hours later he will be making no sense when he talks. He will be sleepy for days following also. If I take the same Opioid it has little effect on my abilities to talk and function. I do not get tired but it does help my pain. Again, everyone is different!!! I do not take Opioids in any chronic fashion anymore only because using them daily at prescribed amounts eventually does not help the pain anymore. That is a tolerance problem. Not all people who take these drugs everyday have the tolerance level build up so quickly as mine does. So I will chose an Opiate for short term use after a surgery that is noted to have significant pain for a period of time. It helps me to get up and do my walking and other exercises I do. I am never on them for a long time anymore. I am very aware of all the negative effects of using these drugs and i stop taking them as soon as i can take the pain without them.
Senior Managing Partner at Moriarty and Assocs.P.C.
7 年Thanks for taking 1 for the team Mark. Most informative.
Founder at Craig's Table- Recipient Summa Comp Laude 2021-22 Recipient Bloom Making a Difference Award 2023
7 年Thank you Mark for sharing the short period of time you tried the opiate options. Just recently I excused myself from a meeting due to the amount of physical pain I was in, a well intentioned person offered me a pain relief tablet I thanked them for their kindness and said that all I needed was some water and a short period of time to regain control. Had I taken the pain medication, I would not have been able to stay awake, nor would I been able to stop. Addiction never goes away- it can only be contained.