Opiate use for my chronic non-cancer pain was chasing a ghost. I had pain, I would take meds, I would feel good and be able to function, and then have increased pain and need more meds. The cycle took 18 years to break.
I’ve been on pain pills in the past and never became addicted to them. I just don’t understand it. However, I’ve seen it so I know it’s real. What Purdue did blows my mind. I’m glad I never took that pill.
As a now retired neurosurgical PA-C, I dealt with a lot of chronic pain patients who required surgery and had to deal with their post-op pain dosing. I consulted pain physicians who advised me regarding pain medication dosing which included continuing their chronic meds and then dosing them at 50% of their chronic med in divided doses for post-op pain control. This generally worked well if my surgeon was agreeable. Then a gradual wean off the post-op pain opioids was completed with patient understanding. Other pain adjuncts were utilized post-op for other pain control. I experienced just the opposite spectrum for pain control on a family member with chronic pain when a resident just prescribed their chronic pain med as their post-op pain dose. I was told “That should be sufficient for the pain.” I was livid. Shows you how much understanding of narcotic dosing this resident understood. It is sad to say this
PA-C understood more about narcotic dosing than this physician in training, despite the resources available to him.
Yes for my now 60th surgery done last week (abdominal), I was able to use very little opioid and utilized cox2 inhibitors, heat and cold packs, lidocaine patches, positioning, and I refused a few drugs that are mildly mood altering as I’d never had them before. Pain control was pretty good and I’m back to nothing as of 4 days ago. I agree that those on chronic opioids are notoriously under-medicated for acute pain. Those who take bupe for addiction have it even worse, which is why I’m grateful to be on no ORT.
Great article and so awesome that you can share your story and provide so much insight for both the recovery community and the medical community. Love you brother!
This is a remarkable, redemptive story. So many people who are prescribed opioids do not become addicted to them but others do. I wish there time during four years of medical education for part of the student’s psych rotation to be dedicated to treating addiction cases.
I want to thank Dr. Cifu, who I admire greatly, for inspiring me to write this. I also thank all of the commenters here; it means a lot to know that I’m being the best messenger that I can be / and all I CAN be these days.
Jim, I remember seeing you at Methodist occasionally. (I was a pharma rep there, long ago.) I never heard all of your story--thank you for sharing. I am going to send this to my step-daughter (in recovery), who has an addiction clinic in KY. God bless you.
What an incredible article. I am not a medical professional so have no expertise to share but this kind of writing is what keeps me a loyal reader of this remarkable series of posts. We all need to understand our own advocacy. My deepest respect for this author and his journey.
Thank you for this very valuable and well written article. It should greatly improve the understanding of the problems faced by those who have to negotiate these hurdles. I know it did for me.
You are welcome and I thank you for providing an example of what can be accomplished with courage and determination. With your permission, I would like to share your story with some younger friends and relatives who think they have had it tough.
Thank you for this personal exposure you've given to us. I can't imagine how difficult it was to actually type some of those words.
I began thinking about a friend of mine who has been on opiate pain relief for decades. This article helped it dawn on me that her pain management is a full time job. She travels over 40 minutes twice monthly to meet with her pain mgt doc and then back to pick up her prescriptions. She has a schedule for each of her medications. She NEVER goes anywhere without her "little black bag" which has all of her pill bottles in it. She is a clock watcher, not in an intense way, but she will say, "It's time for my medication". She has multiple diagnoses and co-morbidities and a pill for each. She refuses any other treatments for pain. And yes, one of those treatments could result in a devastating manner leaving her worse off than she is. But she flat out refuses to try anything. I know for a fact if all of what is happening to her were happening to one of her friends she would tell them to try other avenues of pain relief. It's hard to say which came first, (like the chicken and the egg) her lifestyle keeping her a prisoner in her debilitating state or the opiates driving her lifestyle into a small, unfulfilled life.
My heart aches for her. Both of us work in the medical field and understand what is happening. But, I live in a glass house and due to her age, condition, and a life's time of this behavior I know she will never change a thing.
That is exactly how I felt for so many years. A bird in a cage. The chronic pain lifestyle is a tragedy with or without opioids. That’s why I dropped music (which I was relatively good at!) to become a clinician. I figured if I could to it, ANYONE could. And in my career, I never met one person who couldn’t do it once they put their hearts and minds to it
Opioids...another monster created by big pharma that is murdering hundreds of thousands every year. Sure, these drugs work well at first but they train your body to need more and more to get the same level of relief and eventually you take too much and your body says enough is enough.
Thus the conclusion that opioids cause pain. As has been stated in comments, there are some who use them without escalating doses over time for CNCP, but that is more often the exception rather than the rule. Opioids should not be vilified. But they should not be prescribed by non experts over time, either.
Been following Jim Reysers commentary for over a year and Dr Cifu for more than that. Always insightful and probing and honest. As a retired oncology pharmacist over 35 years I wholeheartedly participated in the sham science that Roxane and Purdue pushed out to us because there were doctors behind the “science” telling me that you couldn’t be addicted if you were treating the pain with opioids among other lies. We all must live with regret in our lives and that is one of my biggest. I value the seasoned clinicians who spend the years to accumulate active wisdom and advocate for the individual patient and give them the final authority and voice even when it is contra factual with current thinking.
After my last surgery I was able to discard 8 of the 15 hydrocodone prescribed. I took the opportunity to apologize to the pharmacist for the many I misused over the years to feed my addiction. She literally cried. So did I. The only “fault” I would place for our opiate epidemic on would be the ones who knew yet pushed it anyway. I see it today with many of those same “experts” pushing buprenorphine. All I can do now is be a good messenger.
Wow, what an odyssey. Trying to comprehend the depth of emotions per Jim Ryser's life story is overwhelming; imagine having lived and overcome those mega-obstacles. There goes a better man than I comes to my mind. As the French say: "chapeau" or hats off to you, Jim Ryser.
My first experience with the issue of addiction occurred as an intern at LA County-USC Medical Center (LAC-USC MC) in 1968. One of my rotations was on the Jail Ward, located on the 13th floor and having an incredible attending physician: Margaret McCarron. Dr. McCarron shared her knowledge about opiod withdrawl using a regimen of promazine (Sparine®). I believe the dosing was promazine 75 mg im every 4 hrs on day 1, then every 6 hrs on day 2 and then every 8 hrs on day 3 and off. I never witnessed a failure of this regimen and over my intern year it became clear that opiod addicts were admitting themselves to the "Big Mother" (name for the County General hospital) so they could withdraw and return to a much smaller and less expensive dose of heroin or whatever the opiod du jour was. Counseling of these patients was not being done during those years, at least not in the context of medicine at LAC-USC Med Center. I wonder now, 56 years later, whether or not the use of promazine could be effective coupled with our better understanding of pharmacology + the emotional/social/dependency aspects of opiod addiction.
In my 60 years of medicine, a lot of advances have been made. But I still find that the old saying "there is nothing new under the sun" is often relevant. Even the expression itself is not new:
What has been will be again, what has been done will be done again; there is nothing new under the sun. -Ecclesiastes 1:9
Sadly counseling is back seat to medication, which is why we will see an effect of the can being kicked down the road for many. I was lucky enough to be treated during the golden age of behavioral modification as a primary treatment.
Knowledge comes from a broad and open look a topic. As a FP with 43 years of experience I can attest that there are patients who require opioid medication long term to function and who have been maintained on stable doses without abuse
I believe the recent trend to vilify all opioid use has done a disservice to many patients. Of course proper patient selection, monitoring, and use of ALL pain reduction techniques, not just chemicals, is always vital.
With all due respect, I don’t think “require” is the best word choice. Although I absolutely agree that some function better on stable doses it is a delicate balance that I’m glad you have been able to provide.
I’ve been on pain pills in the past and never became addicted to them. I just don’t understand it. However, I’ve seen it so I know it’s real. What Purdue did blows my mind. I’m glad I never took that pill.
Such a great article, Jim! Thank you so much for sharing your wisdom. Appreciate you!
As a now retired neurosurgical PA-C, I dealt with a lot of chronic pain patients who required surgery and had to deal with their post-op pain dosing. I consulted pain physicians who advised me regarding pain medication dosing which included continuing their chronic meds and then dosing them at 50% of their chronic med in divided doses for post-op pain control. This generally worked well if my surgeon was agreeable. Then a gradual wean off the post-op pain opioids was completed with patient understanding. Other pain adjuncts were utilized post-op for other pain control. I experienced just the opposite spectrum for pain control on a family member with chronic pain when a resident just prescribed their chronic pain med as their post-op pain dose. I was told “That should be sufficient for the pain.” I was livid. Shows you how much understanding of narcotic dosing this resident understood. It is sad to say this
PA-C understood more about narcotic dosing than this physician in training, despite the resources available to him.
Yes for my now 60th surgery done last week (abdominal), I was able to use very little opioid and utilized cox2 inhibitors, heat and cold packs, lidocaine patches, positioning, and I refused a few drugs that are mildly mood altering as I’d never had them before. Pain control was pretty good and I’m back to nothing as of 4 days ago. I agree that those on chronic opioids are notoriously under-medicated for acute pain. Those who take bupe for addiction have it even worse, which is why I’m grateful to be on no ORT.
Great article and so awesome that you can share your story and provide so much insight for both the recovery community and the medical community. Love you brother!
Thank you Harish! Much love to you!
This is a remarkable, redemptive story. So many people who are prescribed opioids do not become addicted to them but others do. I wish there time during four years of medical education for part of the student’s psych rotation to be dedicated to treating addiction cases.
Appreciate your comment and I agree!
Nice read. Very inspiring and well said. Thank you for you
Thank you!
This is the very thing that kept Jim sober for so many years; telling his story. And what a story it is! Love you buddy!
Rudy is one of the reasons I am sober today. Love you too!!
I want to thank Dr. Cifu, who I admire greatly, for inspiring me to write this. I also thank all of the commenters here; it means a lot to know that I’m being the best messenger that I can be / and all I CAN be these days.
Jim, I remember seeing you at Methodist occasionally. (I was a pharma rep there, long ago.) I never heard all of your story--thank you for sharing. I am going to send this to my step-daughter (in recovery), who has an addiction clinic in KY. God bless you.
Oh wow! Fantastic!!!
What an incredible article. I am not a medical professional so have no expertise to share but this kind of writing is what keeps me a loyal reader of this remarkable series of posts. We all need to understand our own advocacy. My deepest respect for this author and his journey.
Thank you so much.
Thank you for this very valuable and well written article. It should greatly improve the understanding of the problems faced by those who have to negotiate these hurdles. I know it did for me.
Thank you!
You are welcome and I thank you for providing an example of what can be accomplished with courage and determination. With your permission, I would like to share your story with some younger friends and relatives who think they have had it tough.
Please do. And trust me, there are many others having it tougher than me! I’m just glad to be useful today!!!
Thank you for this personal exposure you've given to us. I can't imagine how difficult it was to actually type some of those words.
I began thinking about a friend of mine who has been on opiate pain relief for decades. This article helped it dawn on me that her pain management is a full time job. She travels over 40 minutes twice monthly to meet with her pain mgt doc and then back to pick up her prescriptions. She has a schedule for each of her medications. She NEVER goes anywhere without her "little black bag" which has all of her pill bottles in it. She is a clock watcher, not in an intense way, but she will say, "It's time for my medication". She has multiple diagnoses and co-morbidities and a pill for each. She refuses any other treatments for pain. And yes, one of those treatments could result in a devastating manner leaving her worse off than she is. But she flat out refuses to try anything. I know for a fact if all of what is happening to her were happening to one of her friends she would tell them to try other avenues of pain relief. It's hard to say which came first, (like the chicken and the egg) her lifestyle keeping her a prisoner in her debilitating state or the opiates driving her lifestyle into a small, unfulfilled life.
My heart aches for her. Both of us work in the medical field and understand what is happening. But, I live in a glass house and due to her age, condition, and a life's time of this behavior I know she will never change a thing.
That is exactly how I felt for so many years. A bird in a cage. The chronic pain lifestyle is a tragedy with or without opioids. That’s why I dropped music (which I was relatively good at!) to become a clinician. I figured if I could to it, ANYONE could. And in my career, I never met one person who couldn’t do it once they put their hearts and minds to it
I get that and agree. She has no will, no desire to change anything about her life. I just have to meet her where she is.
Opioids...another monster created by big pharma that is murdering hundreds of thousands every year. Sure, these drugs work well at first but they train your body to need more and more to get the same level of relief and eventually you take too much and your body says enough is enough.
Thus the conclusion that opioids cause pain. As has been stated in comments, there are some who use them without escalating doses over time for CNCP, but that is more often the exception rather than the rule. Opioids should not be vilified. But they should not be prescribed by non experts over time, either.
Been following Jim Reysers commentary for over a year and Dr Cifu for more than that. Always insightful and probing and honest. As a retired oncology pharmacist over 35 years I wholeheartedly participated in the sham science that Roxane and Purdue pushed out to us because there were doctors behind the “science” telling me that you couldn’t be addicted if you were treating the pain with opioids among other lies. We all must live with regret in our lives and that is one of my biggest. I value the seasoned clinicians who spend the years to accumulate active wisdom and advocate for the individual patient and give them the final authority and voice even when it is contra factual with current thinking.
After my last surgery I was able to discard 8 of the 15 hydrocodone prescribed. I took the opportunity to apologize to the pharmacist for the many I misused over the years to feed my addiction. She literally cried. So did I. The only “fault” I would place for our opiate epidemic on would be the ones who knew yet pushed it anyway. I see it today with many of those same “experts” pushing buprenorphine. All I can do now is be a good messenger.
Wow, what an odyssey. Trying to comprehend the depth of emotions per Jim Ryser's life story is overwhelming; imagine having lived and overcome those mega-obstacles. There goes a better man than I comes to my mind. As the French say: "chapeau" or hats off to you, Jim Ryser.
My first experience with the issue of addiction occurred as an intern at LA County-USC Medical Center (LAC-USC MC) in 1968. One of my rotations was on the Jail Ward, located on the 13th floor and having an incredible attending physician: Margaret McCarron. Dr. McCarron shared her knowledge about opiod withdrawl using a regimen of promazine (Sparine®). I believe the dosing was promazine 75 mg im every 4 hrs on day 1, then every 6 hrs on day 2 and then every 8 hrs on day 3 and off. I never witnessed a failure of this regimen and over my intern year it became clear that opiod addicts were admitting themselves to the "Big Mother" (name for the County General hospital) so they could withdraw and return to a much smaller and less expensive dose of heroin or whatever the opiod du jour was. Counseling of these patients was not being done during those years, at least not in the context of medicine at LAC-USC Med Center. I wonder now, 56 years later, whether or not the use of promazine could be effective coupled with our better understanding of pharmacology + the emotional/social/dependency aspects of opiod addiction.
In my 60 years of medicine, a lot of advances have been made. But I still find that the old saying "there is nothing new under the sun" is often relevant. Even the expression itself is not new:
What has been will be again, what has been done will be done again; there is nothing new under the sun. -Ecclesiastes 1:9
Sadly counseling is back seat to medication, which is why we will see an effect of the can being kicked down the road for many. I was lucky enough to be treated during the golden age of behavioral modification as a primary treatment.
Knowledge comes from a broad and open look a topic. As a FP with 43 years of experience I can attest that there are patients who require opioid medication long term to function and who have been maintained on stable doses without abuse
I believe the recent trend to vilify all opioid use has done a disservice to many patients. Of course proper patient selection, monitoring, and use of ALL pain reduction techniques, not just chemicals, is always vital.
With all due respect, I don’t think “require” is the best word choice. Although I absolutely agree that some function better on stable doses it is a delicate balance that I’m glad you have been able to provide.