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or more than 50 years, the medical community has recognized that people with alcoholism and substance-use disorders are suffering from diseases, not from failures of will or character. Today, there’s more frank and open discussion about drugs and alcohol than at any point in history. Movie stars, athletes, and politicians talk openly and unapologetically about their struggles and their pasts. Nevertheless, a stigma remains attached to these fatal, often misunderstood conditions.

That’s one of the reasons I wrote recently an article on STAT that also appeared in the Boston Globe about the fact that I am in remission for a substance-use disorder. In the piece, I expressed surprise at the absence of discussion or counseling when I was prescribed opioids after surgery at Massachusetts General Hospital for excruciatingly painful kidney stones — even though I had told all of my health care providers about my history with heroin. The reaction to my piece serves as a reminder of how far we have come and how much work still needs to be done.

Some readers of the STAT article let me know they had had experiences similar to mine. Several doctors and public health workers thanked me for raising what they viewed as a critical issue. But the majority of responses I received were decidedly critical. “I was disgusted about the article in the Boston Globe about your visit to MGH,” one self-identified PhD wrote. “Many normal people are sick and tired of you drug addicts blaming someone else for your transgressions. Yes, you are a coward. We have to pay for your problems and people like you.” (I was unclear how my treatment for kidney stones, which was fully covered by my medical insurance, meant other people were paying for my problems, but no matter.)

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Other comments were in the same vein: “Your article is a joke and you should be embarrassed you wrote it. You’ll be on disability someday like millions of other americans [sic] who need coddling and blame everyone but themselves for their problems,” read one. Another reader wrote that he hoped my doctors would refuse to medicate my pain if I had “a compound fracture of [my] leg with [my] tibia sticking out.”

These aren’t fun to read. But I’ve been a journalist for more than 20 years, many of those spent writing about controversial topics. I’ve heard far worse — and have mostly learned how to let such aspersions slide off my back.

These mostly anonymous, drive-by insults illustrate one of the points I was trying to make in the article: if I was caught off guard by the effect that a round of prescription opioids had on me, just imagine what it’s like for people who feel embarrassed or ashamed about their pasts; those who haven’t spent years writing about health care and medicine; those who are intimidated by doctors and hospitals; or those who haven’t researched and written about substance-use disorders and their treatment.

It’s not just the general public that continues to attach a huge stigma to alcoholism, substance-use disorders, and other addictions. Some of the men and women trained to treat them do, too. That can be seen in something as simple as the language used to describe patients. In a 2010 study, more than 500 “highly trained” mental health professionals were given identical anecdotes in which the subjects were referred to as either “a substance abuser” or “a person with a substance-use disorder.” Those who received the “substance abuser” stories were significantly more likely to feel that the patient in question “was personally culpable and that punitive measures should be taken.”

Seth Mnookin
Seth Mnookin Greg Peverill-Conti

A simple solution?

I think hospitals can and should be doing more than they currently are. Mass General, to its credit, has just released new guidelines that address some of the concerns I raised. But I’m also pragmatic. I realize that most hospitals don’t have the financial or staffing resources to have addiction specialists on call to meet with every patient being prescribed painkillers, just as I know that it’s unrealistic to expect surgeons or cardiologists or primary care physicians to have the expertise to know how best to handle questions about opioid prescribing when they arise.

Here’s a simple, straightforward, and eminently doable idea: create a pain-control information sheet that a doctor and his or her patient can spend a few minutes reviewing. Such a sheet could explain to the patient that he or she is about to be prescribed a powerful drug that is uniquely effective in mitigating some types of pain; that these drugs have a range of possible side effects; that they can become addictive; and that they can cause symptoms of withdrawal. The sheet could emphasize that special care should be taken by individuals with a substance-use disorder, and offer suggestions to minimize the risk of relapse, such as having the medication administered by a spouse or family member. It could also include resources for people who feel like they need additional help managing their use of prescription medication.

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My desire to enact sensible solutions is not, as some readers suggested, the result of my looking to blame someone or something else for my past. Instead, this suggestion to use a simple information sheet acknowledges that we are in the midst of an opioid epidemic that has been fueled, in large part, by prescription drugs. Anything we can do to reverse that trend is a victory for us all.

Seth Mnookin is the director of the MIT Graduate Program in Science Writing and the author of several books, including “The Panic Virus” and “Feeding the Monster.”

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  • A major part of substance abuse treatment is relapse prevention. Opioid addiction relapse prevention includes conversations,plans and the foresight to deal with situations that may occur which necessitate the use of pain medication. Part of the problem rests in too many unqualified MH professionals treating addictions due to clinical constraints; too many clients, too few clinicians. The historic deep divide between ‘mental health’ and ‘substance abuse’ treatment was there for a reason. There are far too few qualified professions who can treat both issues. Substance abuse treatment professionals in Massachusetts are licensed in that specialty, and are effective in treating situations like this. You may find specialists in MAssachusetts by their LADC or CADC credentials.

  • I lost my only son in March to suicide after a long, heroic battle with depression, anxiety and alcoholism. He was a graduate of an elite university, star athlete and beautiful soul. He lost his heroic battle to get sober. Anyone who believes addiction is a choice, never found their child dead after watching them try everything to get sober. Some could argue “if they didn’t start…” But how many of those same people have drank or experimented without experiencing the disease of addiction? Thank you for spreading awareness and for your courage amongst those who just don’t get it.

  • Stop refering to stress-coping strategies as disorders, even if they proove maladaptive on an individual level.

    Society is sick, stop treating the symptoms and try to get to the disease.

  • The first major physical side effect, atrial fibrillation leading to hospitalization, led to my being told my father was being taken off amphetamines by the treating cardiologist at Brigham and Women’s. We were standing at the foot of the bed, and I looked up at him like what are you talking about? Dexedrine?

    Which explained what we’d been dealing with since we were kids and a local psychiatrist/friend from a church singles group prescribed Dexedrine to balance out the mornings after amitriptyline at night.

    No amount of Valium, Wellbutrin, Effexor, Ambien, etc did the trick to deal with coming off the Dexedrine, so the local ivy trained psychiatrist reinstated the Dexedrine until the stroke. (Our education in off-label prescription power picked up speed here.) We naturally figured that when we, as his adult family, persistently reported – in person, on the phone, in writing and signed by his adult children and spouses – the falls, shivering, slurred speech, diarrhea on the carpets, impossible personality following the stroke – well, we figured we would be worthy of being heeded. And, of course, that’s where the opioids come in.

    Six months after the stroke our father was scheduled for a knee replacement at the best place in town. We objected, pointing out his incoherence on any pain medication, objected to his primary care and psychiatrist, actually we begged for them to help us, but no. We wrote and all signed again (copies to both primary cares in the practice and the psychiatrist) concerning all the evidence that he could not do well on opioids of any sort, pleading for them to intervene while we intervened as a family again and again.

    Have you ever tried multiple interventions with a supercilious speed freak with prescriptions, money, a nice house and community ties with the best Yankee religious institutions?

    So no one would stop the surgery. Yes, the psychiatrist would get him evaluated at McLean (the primary care knew the psychiatrist had friends there) but no, he couldn’t get it done before the surgery. One last family intervention before the surgery, husbands, wives, and kids, and he was off to get a new knee and a state of delirium in which the nurses reported him playing with his feces. He spoke at length of moose and deer eating their young.

    We’re in Brookline, at the rehab, and they have noted the above as well as called in someone to evaluate the slurring when I receive my sibling’s text about the discovery of a little brown leather change purse full of little pills. Dexedrine and Ambien. Lots of them. So the copies of the letters are faxed to the social worker as well as a meeting set up with staff to ask for help. And they send him off to McLean for an evaluation and detox.

    After consulting with his off-label psychiatrist, they only detoxed him from the Dexedrine and Ambien and sent him back to rehab with tests ordered at Spaulding at the family’s request to evaluate his ability to drive. The test results were sent to the primary care who declared him fit to drive, peripheral neuropathy and all. The primary care retired.

    The psychiatrist reinstated the Dexedrine, and when his patient drove himself to the lovely office with signs of delirium or stroke months later, I got the message on my answering machine that he’d been sent via ambulance directly across the street to the local and good suburban hospital. The psychiatrist neglected to send his patient’s list of medications.

    After rushing to our father’s house to write down all the medications the ER nurse requested, we arrived to the ER to be told of this second stroke. After being admitted, we met with a hospitalist late at night who actually listened to us. I handed her the handwritten list of drugs and walked out with the weight of this large drug addicted man on my health proxy shoulders.

    Twelve days in the ICU, a security guy by the door for some of them, and he was off to Braintree for rehab, a newly detoxed man needing speech, physical and occupational therapy. That hospitalist, who it turns out teaches at our local Ivy League medical school, has my family’s sincere thanks. She gave this family a chance to get to know their father and grandfather without the drugs.

    Seth, maybe one at a time they’re hearing us? I don’t know. But the disrespect from the rest of them has been stunning.

    • It was serendipity that we found out from him that the State Police shut down 128 to clear the left hand lane after he’d he’d been run slightly off the road by that ridiculous truck driver while exiting the perfectly safe Route 24. We’d commented on a table he’d bought at the Jordan’s outlet and he figured we’d put two and two together with the news story.

  • Thank you, Seth, for your honesty, openness, and your courage. People are so quick to judge. May you continue successfully down the path of sobriety.

  • I don’t know what I can add, other than my support. I am no longer active in my alcoholism.
    There will always be people who will, without education or particular life experience, spout out their mean hearted, selfish opinions. I don’t know if there is a cure for them. But, we all know what opinions are like …

    Keep writing, Seth. Stay sober. Thank you for caring for others. May God bless you.

  • If you had led with “create a pain-control information sheet that a doctor and his or her patient can spend a few minutes reviewing. Such a sheet could explain to the patient that he or she is about to be prescribed a powerful drug that is uniquely effective in mitigating …. The sheet could emphasize that special care should be taken by individuals with a substance-use disorder, and offer suggestions to minimize the risk of relapse, such as having the medication administered by a spouse or family member. … ” in both your articles, you could have saved all of us some time. Thats a good idea. Why don’t you publish one?

  • I am in recovery from addiction 36 yrs. not opiates – primarily alcohol, and pot . I have had several surgeries over the yrs. Each time I took 1 – 3 opiates , even though I was given at least 15 each time , even after identifying myself as an addict in recovery . My knee surgery last yr at MGH , I waited until I was on the gurney and asked the anesthesiologist for as little pain med as possible . she told me ” the scripts have already been printed up in the computer for todays surgeries , you will get 30 percodan . ” this kind of practice speaks to the need you describe – a form filled out well before-hand . I have the type of brain addiction that does not get fired up by opiates but what an unnecessary, life threatening system we have for those who do . as far as the internet trolls , even an advanced education doesn’t keep one from fear , anger and judgement. just look at the Trump acolytes.

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