Shortly after receiving my liver transplant in 2009, I noticed a toxic relationship between caregivers and patients regarding opioids in general. In the unit I was in to recover from surgery, there was considerable verbal awareness from the healthcare staff to take extra attention to the use of opioids. That was a clear indication to me that opioids were not treated in the same way as the rest of my medication. I thought that my recovery was somewhat stigmatized when it came to pain. Days later, I started developing a form of anxiety in regards to my opioid medication. I asked to be seen by an addiction specialist, who surprisingly didn’t give me the same self-guilt speech about opioids that I had become used to hearing.
Since that time, it’s become clear to me that there is excessive prevention in regards to Opioids Use Disorder (OUD) for patients who are experiencing pain. Often, that prevention can be counterproductive and leads the patients to worsen their condition. From my experience, I feel there could be a form of unconscious self-medicated compensation when you’re too careful – anxiety about developing OUD could lead you to under-medicate yourself or to unconsciously over-medicate yourself. I call that “reactance”, a psychological phenomenon.
It’s a hard debate: on one hand, we don’t want to penalize patients who deserve to be treated. On the other hand, the risk for patients to develop an OUD is real – what is the right balance?