I haven’t gone anywhere in case you’re wondering… but I recently started writing a blog on Psych Central, called ‘an epidemic of addiction.’   Please add it to your reading list!  This is my favorite time of year and the time I am most likely going to be outdoors, so watch for posts to pick up a bit as things get colder outside.
I’m probably in the wrong state of mind to be blogging, so consider this more along the line of venting.  I had an encounter with a local physician a couple days ago that left me shaing my head–  I have a solo practice so I have forgotten just how misguided medicine can sometimes be.  I was asked to speak with an orthopedist for a patient who takes buprenorphine, who was having major knee surgery.  The orthopod started the discussion by saying that he is angry that the patient didn’t say at their first meeting that he takes Suboxone– like it should have been spelled out on his forehead, to make certain that he didn’t give the patient some undeserved pat on the back or some measure of kindness.  I explained that people on buprenorphine find often find that they are treated differently by (ahem) those doctors out there who (AHEM) pre-judge people…  And the ortho guy said ‘well, for good reason!’  As I remember the encounter I’m having visions of the song ‘KILL THE BEAST!’ from Beauty and the Beast– I’m sure this particular doc wishes we ALL would just go away…

Is addiction treated like a disease?

Where was I?  Oh yes–  the doc then explained to me just how hard it is for him to treat people on Suboxone.  He explained how the ‘therapeutic window’ is narrower– meaning that the ratio of the dose that treats to the dose that kills is larger.  I tried to explain that it ISN’T– the entire window is HIGHER, but not NARROWER.  You all know that, of course– on buprenorphine your tolerance goes up, and it takes a much larger dose of opioid to get pain relief, and a much, much, much larger dose of opioid to cause death.  I tried to explain that this is not rocket science;  I would taper the person off buprenorphine ahead of time (I usually tell people to take 4 mg of buprenorphine per day for a week before the surgery, then skip it entirely on the day of surgery), and he could simply treat the person as he would anyone who is tolerant to about 60 mg of oxycodone per day.  I still cannot believe the response from him–that ‘nobody around here takes that much oxycodone’– that those are ‘big city problems’ and that there just aren’t people doing that around here. 
He told me that he doesn’t like giving pain pills to ‘these people’ (he knows, by the way, that I am an opioid addict).  Never mind that he is going to be doing a ‘total knee’, where the ends of the femur and tibia are sawed off and replaced with metal pieces.  I explained that proper treatment is to provide a basal amount of narcotic, and then use a larger than normal PCA (patient controlled analgesia) deamand dose.  I explained that fentanyl may work better according to some reports, but he said ‘I never use fentanyl.’  So I explained that he could use morphine, but that it would take at least 5 – 10 mg IV to have ANY effect on pain.  He said that he would never give that much– that he would give less than usual, if anything.
At some point he mentioned that it bothered him that the patient has taken buprenorphine for 8 months– that it bothered him to ‘think that there are people out there walking around on that stuff.’  I told him that in some states, the more progressive and intelligent licensing boards are recognizing that patents on buprenorphine are not impaired, and are treating them like regular people– to which he replied ‘then why don’t we just give alcoholic pilots a 12-pack and let them fly?!’
Wow.  I had a range of feelings after the discussion.  The first thing I did was contact the patient and strongly recommend that he seek surgery elsewhere.  The guy I am talking about is good enough at sawing bones, but is clearly an idiot when it comes to thinking through medical challenges– and my patient deserves to know that.  In a perfect world, someone would recognize that doctors like this one have no business working in the field of medicine.  I used to work with this doc when I was an anesthesiologist and I knew that he was bone-headed (pun intended!), but I had forgotten just how nasty and judgmental he could be.  I am tempted to post his name, but I won’t — it would only bring me even more headaches than I already create for myself!  But if anyone is having orthopedic surgery in Northeast WI, feel free to send me an e-mail and ask.
The main thing I’d like to say though is that I am sorry that the medical profession has those types of people among its memebers.  Those of you who feel like you are suddenly being judged, when your doc finds out that you have struggled with addiction– you are probably NOT going crazy.  Ignorance is alive and well, and the day when addiction is treated like other diseases is still a long ways off.  And that is a real shame.


angelo212 · September 4, 2010 at 8:18 pm

There are a whole lot of doctors out there like him. I tried finding a doctor for suboxone and when they heard I was on it for 3 years and had no plans on tapering off none of them would deal with me. I even supplied a million websites where doctors are recommending long term treatment. I went back on methadone.
You need to tell us the name of this doctor. Let his give him a piece of our minds. This dude has no idea about the disease of addiction. None. He is oblivious of life in general it seems.
Tell your patient to find another doctor. I have a feeling this doctor is going to leave him in a great deal of needless pain.

hatmaker510 · September 5, 2010 at 7:57 am

Wow, you must have left that conversation banging your head against a wall! At least your patient has you as an advocate…We all could use someone like you in such situations. At least now s/he knows they would be better off getting a new surgeon.
Thanks for posting this. It’s good to know when we think we’re being treated like crap that we’re indeed NOT going crazy.

Matt2 · September 5, 2010 at 9:32 pm

Lol sometimes I really don’t think it even matters how many studies there are that prove that individuals on maintenance bupe/methadone are not “impaired” some people just seem content to continue looking down their noses at addicts. I suppose it actually has helped me though to feel less inclined to judge anyone else but I can’t say I don’t really wonder and worry about what might happen to me if I were ever in some kind of an accident or medical situation that was particularly painful. When I had my spinal fusion done about 5 years ago I neglected to tell the surgeon that I was an active opiate addict (lol wonder why) and so there was a GREAT deal of pain to deal with post op. I remember waking up in the recovery room and feeling like I was both in withdrawal and in an extreme amount of pain. Now it was obviously unfortunate that at that period of time I wasn’t able to be honest with myself or others about what was going on with me but I really doubt that had I told the surgeon I was an addict that things would have been any different. It’s just sad to me that some people are content to remain indifferent to the suffering of others. I really would love to have a Sub doctor that knows what it’s like to be an opiate addict just so I could know that if something should happen he/she would not be ok with just sitting on the sidelines and watching me suffer.

ann · September 7, 2010 at 6:42 am

I was lucky. I had double knee replacement last August. I was up front about my addiction from chronic pain control that led me to abuse. I made it clear I was on Suboxone and would nrrd a higher dose of pain med post-op because Suboxone gives you a higher tolerance. I was treated with respect and even given a pat on the back for changing my life. I received a PCA (patient controlled I.V. pain med) of dilauded with an occasional extra dose if needed. That good pain control made it possible for me to do well in physical therapy and go home in 3 days. I took percocet for 10 days and then switched back to Suboxone and used ibuprofen. I did have to take more than the usual dose of 2 every 4 hours. I had to take 4-6 because of my tolerance. I would suggest that a person on Suboxone be up front with the surgeon and anesthesiologist, and if the surgeon isn’t educated then immediately locate another doctor. As an R.N. who worked on an ortho-neuro floor for many years, I witnessed that patients with good pain control got well faster, had less of a chance of pneumonia, fewer blood clots, and in general just recovered faster. WE are the consumers and have the right to the best medical care, with an emphasis on pain control. The physicians work for us. Do your homework when deciding on a physician. Ann

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