This story emerged from research I presented at the Canadian Collaborative Mental Health Care Conference and was written as a guest blog post for the Addiction Assessment Psychotherapy Referral in Community of Toronto (AAPRICOT).
Each person who has faced addiction is an individual with unique life experiences and challenges that led them to seek solace in their substance of choice. We often hear about the devastation caused by addiction and dependence in the news with startling statistics. Behind these statistics are the personal stories of courageous individuals fighting battles we don’t always see.
Often these stories begin with pain. Many people live with chronic pain for a number of reasons. One group of people who face this complex issue are the 250 000 Canadians living with Inflammatory Bowel Disease (IBD). Crohn’s disease and ulcerative colitis, the two main forms of IBD, are autoimmune diseases that cause the body to attack itself and leads to inflammation of the gastrointestinal tract.
Abdominal pain is a common symptom of Crohn’s and colitis and is caused by intestinal inflammation, partial blockages and gut distention. There is no cure, no known cause, and little public understanding of the pain with which IBD patients must face on a frequent basis. Since there are so few options for the effective relief of this pain, many individuals with IBD are prescribed various forms of opioids while experiencing a flare-up of disease activity.
Ben’s story illustrates how this difficulty affects people’s lives. Ben is a Canadian in his thirties who has been living with ulcerative colitis since he was sixteen years old. As he has gotten older, the symptoms of his disease have increased in severity. Last year, Ben was very sick with a flare-up and was in unrelenting pain. He was losing weight at a rapid pace and was losing a dangerous amount of blood. Eventually, Ben was rushed to the Emergency Room where he was put on a high concentration of the injectable form of dilaudid, an opioid analgesic used to treat severe pain. He was relieved that the pain had finally began to subside.
Ben was quickly admitted to the hospital, and remained hospitalized for three weeks. For the entirety of his stay at the hospital he received an injection of dilaudid every three hours, whether day or night. Ben was not told about the risk of addiction, or given any information about the side effects of the medication that he had chosen to take to relieve his pain. By the third week, Ben had developed a physiological dependence on the opioids he was taking without being educated or made aware this would happen. He was never provided with any alternatives to this situation, and therefore was not able to make an informed choice about his treatment plan.
In order to leave the hospital, Ben made the decision to stop this pain relieving medication ‘cold turkey’ and quickly began experiencing excruciating symptoms of withdrawal. He experienced full body shaking, debilitating nausea, profuse sweating and an overall terrible feeling for about 24 hours. Ben developed Post Traumatic Stress Disorder (PTSD) from this hospitalization experience, and suffers from PTSD symptoms to this day. Ben has not received any support from his medical team for the psychological ramifications of this ordeal.
Despite the fact that this experience has left him with lasting trauma, Ben considers himself lucky. He is currently taking a biologic medication that is controlling the symptoms of his IBD and is no longer taking opioids for pain relief. Ben knows that many patients like himself are prescribed opioids and are never able to overcome the dependence, tolerance and addiction that is subsequently developed. He is now aware of the fact that opioid use, even taken as prescribed, can lead to dependency and various problems for individuals. For individuals vulnerable to addiction who are prescribed opioids for chronic pain, the risk of addiction increases.
Ben is not alone; his story reflects a general trend. Research has found that among patients with IBD, opioid prescriptions tripled during a recent 20-year period. Unsurprisingly, heavy use of strong opioids among this patient group was a significant predictor of all-cause mortality. Another alarming study noted that Opioid Use Disorder (OUD) - related diagnoses are increasing among IBD patients. At one of the clinics studied, chronic use of opioid medications used by IBD patients to manage abdominal pain was “alarmingly high”.
What do we do for patients who live with pain? How do we treat them without fostering dependency and addiction? This is a grave issue that we must contend with in order to effectively address the opioid epidemic. Patients and healthcare professionals must work together to overcome these challenges. It is imperative that patients are provided with all of the relevant information regarding their treatment options, and that we begin to expand the options available for relieving pain. Connection is the cure.
References:
Burr, Nicholas E., et al. “Increasing Prescription of Opiates and Mortality in Patients With Inflammatory Bowel Diseases in England.” Clinical Gastroenterology and Hepatology, vol. 16, no. 4, 2018, doi:10.1016/j.cgh.2017.10.022.
Cohen-Mekelburg, Shirley, et al. “The Impact of Opioid Epidemic Trends on Hospitalised Inflammatory Bowel Disease Patients.” Journal of Crohn's and Colitis, 2018, doi:10.1093/ecco-jcc/jjy062.
Susman, Ed. “Chronic Opioid Use High Among IBD Patients.” Medpage Today, MedpageToday, 20 Jan. 2018, www.medpagetoday.com/meetingcoverage/ccc/70645.