Hi, Orthopedic Surgeon, it's me. Your patient, who's having double knee surgery for two torn menisci and two Baker's cysts. You saw my MRIs and diagnosed the tears. So can we acknowledge I'm not some random ER patient complaining about indefinable back pain?
You know what I'm also not doing? I'm not exhibiting the drug-seeking behavior of a potential abuser. But do I want some opioids for my injury? Yes, please, absolutely. Five to eight pills would be perfect.
I know a meniscus tear is a fairly common knee injury. After all, everyone has a meniscus, a crescent of cartilage under one's knee that cushions the friction between the upper and lower leg bones. It's nice to have that padding for climbing stairs, running, kneeling, squatting - all that fun stuff you might do multiple times a day but don't think about until it hurts to do it.
I'm not overly sensitive to pain. On the contrary, I'm that patient who didn't go to the orthopedist months ago, when my left knee first started aching and throbbing. I kept exercising, assuming I had early-onset arthritis because of all those marathons. I didn't even go when I felt an egg-sized lump in the back of my knee. (For the curious: A Baker's cyst, named for William Morrant Baker, the 19th-century British surgeon who first described it, is one of your body's responses to a knee injury.)
The pain isn't unbearable, most of the time. It starts throbbing after I've walked a few blocks and, sometimes, it's a dull all-around ache. It's enough to wake me up if I sleep with my knees bent. Eventually, it became strong enough to stop me from normal exercise. So I made an appointment. Got the MRI. And the diagnosis. Now, I'm icing. Resting. Taking ibuprofen and naproxen. Except I'm not supposed to take ibuprofen or naproxen the week before surgery, because they are blood thinners.
This constant, nagging pain is bringing me down. Yes, I'm having surgery soon. It would be tomorrow if it were up to me. But until then, I still need to use my knees. Chase after my kids. Go to a friend's wedding. Get groceries.
But in this era of epic prescription-painkiller abuse, many doctors seem to view all patients as potential junkies not to be trusted with even the smallest amount of respite from the pain of a diagnosed injury.
That's an awful reality for many Americans. At the Justice Department's opioid summit in October 2018, then-Attorney General Jeff Sessions crowed that opioid prescriptions were at an 18-year low. But in tandem has come a flood of patients complaining about doctors failing to treat their pain. Earlier this year, the Centers for Disease Control and Prevention had to warn doctors about misapplying their 2016 opioid prescription guidelines.
I understand - doctors are responding to the catastrophe of the opioid epidemic. In 2016 alone, more than 42,000 Americans died from opioid overdoses, and about 40% of those deaths involved prescription opioids, according to the Department of Health and Human Services. Any American who has turned on a TV or opened a laptop or looked at a smartphone during the past few years knows that opioids such as OxyContin are addictive and potentially deadly. Who has been responsible for the carnage? The greedy drugmakers and equally rapacious doctors? The patients who gamed the system to get more painkillers than they need? Some combination of all of them?
That is for the courts to sort out. Right now, the overprescribing seems to have prompted an overcorrection. I like to think I have an enormous sense of social responsibility, but right now, I'm looking out for me. I don't want opioids so I can get high or do drug sales. I want them because they can temporarily combat the relentless drag and occasional depression that accompany injury pain. And forget about me, what about other people with far more intense and/or chronic pain, such as cancer patients, whose suffering tends to be undertreated even without the new wariness of writing opioid prescriptions?
The thing is, there are millions of Americans who aren't an addiction liability just because they want a narcotics prescription post-injury or post-surgery. Yes, the government says nearly 80% of heroin users first misused opioid prescriptions, but the research being cited refers to people who illegally obtained those prescription opioids. Not patients.
In conclusion, Orthopedic Surgeon (and all doctors, really), can you ease up on prohibiting medications that help patients in pain to relax a bit? They're not terrible drugs. They're terrible drugs in the wrong hands.