Updated: Monday, October 2, 2017, 8:17 PM
An army of medical professionals was tugging at my placenta when the drugs began to wear off. It was at that moment that I realized I’d never discussed a post-epidural pain management plan with my obstetrician.
Just seven months earlier, I’d walked into my doctor’s office — 12 weeks pregnant and several years sober — for the first time. My intake went something like this:
OB: “Do you have any allergies?”
Me: “No, but I’m in recovery. My drugs of choice were alcohol and Xanax, but I prefer not to take opiates except in extreme circumstances. I’ve had surgery twice, and I was fine taking Percocet both times.”
While I realize my substance use disorder (SUD) is not technically an allergy, I’ve had this exact conversation with dozens of medical professionals before. I’ve never — not once — been asked by any doctor, nurse, or dentist if I have a history of or am in recovery for SUD. It’s always my responsibility as a patient to raise this subject and provide this information, and on that day, my OB — like most of the medical providers I’d seen before her — just nodded, jotted something down, and moved on.
So on July 17, somewhere between delivering a baby, spiking a fever, attempting to breastfeed for the first time, and learning that my hour-old daughter would be going to intensive care, I mustered up the energy to ask for some pain relief.
“It says something in your chart about you having a history with opiates,” the labor and delivery doctor replied, in a sorry-your-dog-died-but-you-still-need-to-do-your-homework kind of way. “We don’t want to cause any problems for you.”
My biggest problem at that time was the reason I was wearing a diaper filled with four-inch-thick feminine napkins, an ice pack and hemorrhoid pads, topped with a tube of Lidocaine. I’d just squeezed a human out of my body, and according to the medical professionals, Tylenol and Motrin were all I had.
Finally, though, after hours of complaining about the pain — which felt like a circular saw, rumbling through my uterus — one doctor caved. She wrote me a script for a single dose of Tramadol (an opioid analgesic) — no refills (yes, I asked) — to last me until the following day.
The next morning, I told my OB about my experience, assuming she’d be as furious as I was.
Her response? “You told us not to give you opiates, even if you asked!”
Her memory was 100 percent inaccurate (as was her shorthand in my medical chart). But also: What was she thinking?
It felt as if my doctor had seen a made-for-TV movie where someone pleads to a friend: “No matter what I say tonight, don’t let me do drugs! You gotta intercept the drugs, no matter what I say!” and used that as the basis for her treatment plans.
Her approach to handling my care was misguided, to say the least — and, sadly, my experience is not unique. I have heard many similar stories from friends in recovery.
One friend — 13 years in recovery — shared a story about being treated by medical professionals as if she’d used heroin the day before. Another friend said that while she told her providers that she’s in recovery, she was offered morphine as part of her postpartum care.
My own experiences sharing my recovery status range from strange — a general practitioner told me about a girl he dated who was addicted to heroin and whose father offered him money to marry her — to outright misinformed. The physicians at an oral surgeon’s office assumed I was on methadone.
Why, during a time in which opioid overdoses are the culprit for a drop in life expectancy in the U.S., are there so much inconsistency and confusion surrounding acute pain management for patients in recovery? And why don’t all providers ask about SUD and recovery during intake?
I understand we’re a complicated bunch to treat due to recovery’s many pathways: Some of us use medication assisted treatment (MAT). Some use harm reduction methods. And some are abstinent from medications, drugs, and alcohol altogether.
But we need to find a better way — and that begins with a conversation.
All doctors should be required to ask about SUD history and recovery status during intake. Then, if patients share that they are in recovery, doctors should ask follow-up questions to clarify specifics, like what those patients’ substance use was like and what their recovery means to them. Finally, doctors should always facilitate a conversation regarding pain management prior to major medical events, like labor and delivery.
But also, if we ask this of our doctors, our doctors need the support to handle the answers their patients give. This requires a complete policy overhaul that includes medical schools teaching a standardized SUD curriculum. Then — and only then — will physicians be better able to treat a population in a country where nearly 100 people die of opioid overdoses every day.
Jillian Bauer-Reese is an assistant professor of journalism at Temple University, where she teaches a course called Solutions Journalism: Covering Addiction. She is also a person in long-term recovery. You can contact her at firstname.lastname@example.org or @thesmallpicture.