Patients with Substance Use Disorder may struggle with relapse after surgery. In this article, we discuss how both Al and Paula needed to receive help from the Coleman Institute after having surgery and taking prescribed pain medication.
Al
A patient we have come to know very well is with us again — his third time — for help with rapid opiate detox. It won't be as rapid as when he was getting off a gram of heroin a day or when he returned for a detox off Percocet.
When Al called us last week, he was bummed. And desperate. He'd managed to go three years with using nothing stronger than over-the-counter non-steroid for the occasional back pain he was experiencing.
Al’s Business
Al is six foot three and owned his own business which offered land clearing, snow removal, excavate, and hauling services. So you can imagine how physically demanding his work is on his body. His wife and two small children have been with him through all the ups and downs of his struggles with benzos and opiates.
Tooth Pain and Surgery
About a month ago, Al was experiencing severe tooth pain from an abscess under his wisdom tooth. He needed some pretty serious dental work and needed it sooner than later.
Al says he felt ok when he woke up after the surgery. The oral surgeon insisted on sending him home with Percocet and Al refused. The surgeon "won" and Al immediately handed the pills over to his wife to be in charge of issuing them.
And by his own admission, after two doses, the whole situation spiraled out of control. Within a week he was buying pills and powder. And in a last-ditch attempt to stop using, he also bought a few Suboxone®.
Suggested Read: Why is it So Hard to Detox Off of Suboxone and Other Forms of Buprenorphine?
His Treatment
His urine was positive for opiates, buprenorphine, and fentanyl. (The latter was a surprise to him, as it is to many of our patients these days). He's almost done with the detox and he'll be fine, but the buprenorphine has extended the detox to a few extra days.
UNDERSTANDING ACCELERATED OPIOID DETOX
Paula
Now, contrast him with Paula.
Paula’s First Detox
Paula detoxed with us about five years ago. She is a lovely, hilarious, mother of 2 middle school boys, with a great HR job. Before working with us she would drive her "I'm the parent of a scholar"-bumper-stickered mini-van to meet her heroin dealer. She had been using heroin daily for about a year when we met her and she started treatment. She engaged in extensive treatment and came for about a year to receive naltrexone implants.
I hadn't seen her until a month ago.
Suggested Read: Naltrexone: Medication-Assisted Treatment For Opioid Use Disorder
Heart Surgery
Turns out after a visit with her primary care physician and cardiologist, Paula needed to have heart surgery. Both of those doctors knew her history of substance use and addiction, and they were as nervous as she might relapse after surgery from the use of narcotic pain medications after her operation. She scheduled a pre-op visit with us to discuss her options. Together we decided to put her on naltrexone for a few weeks after she no longer needed the pain meds. By creating a plan and informing her doctors about her history, Paula was able to use her pain medication for a minimal amount of time.
Conclusion
The reality is that many of our detox patients will have to face having surgery someday. Some find it useful to get all their providers on board and discuss a plan for pain control to minimize the risk of relapse after surgery. While it still may be difficult to come off the pain medications, the support of medical professionals who can check a realistic taper can make all the difference in a patient's remaining in recovery.
Last Updated: January 17, 2022
