Drug Use, Substance Misuse even Addiction should not prevent access to good health care!

Drug Use, Substance Misuse,  Addiction, Substance Use, …Whether or not a person uses drugs or is addicted to them, should not affect whether or not a doctor will see them, treat them with dignity, respect, or listen to them for that matter, but it does!  I have experienced the most horrific stigmatizing ordeals with medical professionals, and I know that I am not alone.  I hear from people all the time—about their experiences trying to access help for something unrelated to their substance use; but because they are already labeled as a drug addict in the system, they will always be treated like “an addict”.  The only thing this person can do to improve their situation is to say and or be ” in recovery” ( this is a 12 step concept that means you are completely abstinent from all illegal and legal mind and mood altering drugs).  If this is not the case, then you are immediately labeled as an actively using addict, most likely lying to yourself and everyone else.  You are considered to be in”active addiction” which means you are not in control of your decision making.  You might be told you do not know what is best for you, you will be presumed to be lying and never, will be take seriously, especially if you are talking about pain you might be experiencing.   If you try to argue, you will simply be told you are in denial and that your addiction is keeping you sick.  There is no way to win.

A friend of mine was diagnosed with Breast Cancer a few years back.  She has smoked crack for 20 years and as far as I know has no plans to quit.  She works, tends to her family life and house,  she handles her business and lives a semi-normal life.  She is a heavy drug user that is functional.  I do not see  her changing her drug use too much.  She uses small amounts through out the day.  If you met her you would have no idea the amount of crack she uses. She knew dealing with a doctor was going to be difficult but she went into the situation with a good attitude.  She tried to be as honest as possible (leaving info about crack out of their conversations).

She was receiving chemo and radiation.  Right after she had her breast removed she accidentally wound up with a pain pill prescription from two different doctors (one from her surgeon and the other her oncologist) which was against the rules.  Her doctor, upon finding out gave her a drug test, accused her of pain pill seeking and doctor shopping.  The positive cocaine test destroyed the relationship between the doctor and my friend.  My friend reported that she was standing in the exam room feeling miserable and hideous.  Her hair had recently fallen out so she was bald.  She explained that she is used to being treated like shit, that is the life of a drug user ( “especially a crack user”), but standing there being talked to like this with no hair made her feel lower than low. The last thing on her mind at this point was trying to get an extra pain pill, she felt broken in this moment, just completely broken.  She needed to feel as if she had a team who was interested in her recovering from cancer and now this alliance felt completely broken.  Did her doctor feel she was unworthy of treatment, unworthy of health?  It felt that way! She wondered exactly what I wondered!  Why, when I am going through this, why in the world would any doctor think more about the silly pain pills than me, as a person. We were both clearly in legitimate, serious,  medical situations.  It just seemed odd to both of us that so much emphasis was put on the misuse of low grade pain pills, when we were clearly,both in the middle of difficult, real, traumatic experiences.

She had accidentally violated the policy, it was not intentional, she like myself could buy all the pain pills she could ever want on the street—neither of us needed to lie to get a few xtra pills.  She wished she could explain to the doctor how much she valued the medication she was receiving and how important it was to her to have a solid honest relationship with the doctor. She told me she had really worked hard to make sure she was taking her medication carefully and as prescribed.  It was like a slap in the face to be accused of abusing the medication.  Now- this relationship was doomed!  The doctor discontinued all narcotics as a result of the 2 pain pill scripts she had  and the doc. threatened to discharge her from her practice.  The doctor then made clear, that regardless of her pain and discomfort she would no longer be able to access any narcotics from her.   So basically now, she was not able to even talk to her doctor about her situation.  Here she was going through hell at home, her husband and her were struggling.  She felt less than a woman, having lost her breast and hair, she had few people to talk to about all she was dealing with and now she would have to get all of her pain pills and anxiety medication on the street instead of from a doctor.  This obviously put her at serious risk for abusing the medication because now it was not being overseen by a doctor.How can you ever feel like you want to talk to your doctor,  if they are treating you like this?

To someone who thinks addicts have to be protected from drugs, this may seem reasonable, and I believe it is important to be mindful and careful when prescribing pain medication and narcotics to people who have past and present addictions.  The thing we cannot do is just punish every person who admits to ever using any drug, regardless of their past and/or present relationship to the drug. This kind of punitive reaction will only ensure that no one is honest with their doctor about their substance use.  It would seem that medicine should operate on a level of complexity that allows for the many different experiences that human beings have.  The truth of the matter is that a person who has past experiences with substance use will probably require more medication to help reduce their pain not less.  Also, when you take drugs for legitimate pain it is very different that just taking pain pills without pain.  You do not experience the same euphoria.

After a traumatic hit and run I was left with an infection in my bone that would not heal.  There was complication after complication.  The pain was unbearable.  Never have I experienced anything like this.  I am already mentally ill, which means that have charged emotional responses that can be erratic when I am not in a balanced and healthy emotional state.  The horrible pain, combined with my inability to access pain medication lead to my decision to have an an amputation about 1 year and 1/2 ago.  I was in terrible pain for years.  One of the main reasons I decided to have the amputation was my inability to control my pain.  It was impossible to have an honest and reasonable conversation about my situation.  I would begin talking, as soon as I started to discuss pain it was like people just shut all the way down.  Doctors could not focus on my legitimate needs due to their belief that I was always lying for medication.  It was ridiculous.  I would be discussing something that was really happening and they were so caught up thinking I was trying to manipulate them for pills —they were not paying attention to what was actually happening.  One doctor that I was sent to, pulled my criminal record, which seemed insane to me.  In the middle of our talking about what was happening with my leg he whipped it out and said ….”what is all this”?  “I don’t know doctor?”  what is all this?  I hate the doctor, I cannot stand to deal with them.  I never want to feel that small and judged again.

My friend is now dealing with a heroin and cocaine addiction.  Shortly after the doctor pulled her pain pill script and anxiety medications she began using heroin as an alternative.  I fear that more and more people will just do what they have to do.

It is insane that we have come to a place where doctors are so afraid of getting in trouble they cannot afford to think beyond simplistic equations for abuse.  We have now created a situation where anyone with any deviation from the norm in terms of behavior (or none that show any indication that there may be lifestyle or behavior choices which deviate from the norm)is refused pain medication.

 

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