Our country is in the midst of a crisis – an opioid crisis. When we have pain – we immediately want it taken away and when that pain is relieved – we form an attachment to the source of rescue (in many cases, this is pain pills). Annie welcomes Dr. Leslie Cole, MD to the show today to discuss the dangerously addictive nature of opioids and narcotics. Dr. Cole has an impressive, diverse background and she shares extensive knowledge and information that you won’t want to miss!
About Dr. Leslie Cole
Board certified Addiction Medicine and Internal Medicine Physician. Works with opioid addicted people. Dr. Cole has an eBook coming out called Quit Pain Pills Without Withdrawal. How to break free from your dependence and finally wake up feeling normal with the website – QuitPainPills.com.
For the 10 years prior to working in an addiction clinic, I worked in a men’s prison and a women’s prison. I was the medical director for Tennessee Men’s Prison and Tennessee Women’s Prison. What I kept seeing over and over again was how much pain people had. How desperately they were trying to help their pain and how the emotional pain made the physical pain worse. So I started thinking about pain. Then the second thing I noticed was people needed to be believed. They needed to be believed that they were actually having pain, that their circumstances were as bad as they were. It wasn’t that I thought I’m going to work with opioid addiction. Instead it was kind of a providential. Someone calling me and saying, “Hey we’re looking for a doctor and this nurse practitioner says you would be good at this.” I thought well, I’ll give it a try and ended up just loving working with the people.
I think we all have a history and a story of how it could have been an opioid addiction. I had not had a pain pill because for whatever reason I’d been healthy, nothing had happened except I had Tylenol with codeine with a wisdom tooth when I was 18 and I didn’t like it. So nothing, nothing, nothing, no pain, no nothing until 2017 last year and I get diagnosed with breast cancer. I had been working with people dealing with opioid addiction for four years and I’m thinking, “What is going to happen? I’m having a double mastectomy. I’m going to have all this surgery and all of this chemo. And am I going to get addicted?” That was a thought in my head that then was gone as soon as I got into the surgery and all the thinking about the cancer. In the hospital I was prescribed medication. One time I’m waking up with a migraine headache because I’d not had coffee in two days. I’m having a migraine headache and I’m just hurting. I hear someone go, “Prescribe her some Valium.”
For the next week I am on Percocet and Valium. These are the things that I witness all day long that people are addicted to but I felt like I needed it. I couldn’t have done that, a mastectomy without Percocet and Valium. About week three a nurse is saying to me, “You’re not still needing the Percocet are you?” And the way she said it I think “need it?” Do I feel addicted to it? No, I think I still need it. So I’m taking them then I think, “Okay, you got to get off this. You don’t want to be addicted to it.” But one morning I have a terrible morning and I go to my husband, “Oh my gosh, I’m just going to take a couple of Percocet,” and I hear myself two hours later say, “Well, I feel normal, normal, normal.” That’s the word I’ve heard a thousand times.
All I could think of was thank you to all my patients who’ve told me their stories because it was like a warning sign to me of you are right on the edge. You’re now needing these to feel normal and that is what I hear everyday. That’s why I put the word normal in my title of my book because people need to feel normal which I think is actually another way of saying I want to feel well, a sense of well-being.
Are there other medicines that don't have the narcotic effect that would actually be helpful or not? Or are we just doing this because we have no other choice?
Opiates really help for a short period of time, maybe a two week period of time, maybe a three week period of time but then we need to be able to transition people off opiates and give them another way to deal with their pain.
I am really a believer in non-pharmaceutical ways to deal with pain. So as far as medications that help with pain, I do think there’s potential for the CBD part of the cannabis oil. There are NSAIDs and different types of anti-depressants. One of the things that makes physical pain intolerable is emotional pain attached to it. If the event that causes the pain has an emotional component to it, then it seems to me that that physical pain is intolerable to the patient. I’ve talked to so many people who’ve had different types of pain, different injury and they say, “Somehow I can handle my tooth pain but I cannot handle the back pain.” There’s an emotional component. So with that I think there needs to be therapeutic healing of that. That’s some of what I go talk about in my book and it’s healing the emotional components of the physical pains. But opioids help with the emotional pain. I think that’s the main reason people develop addictions to it.
Annie discusses dealing with emotional pain in This Naked Mind. Start reading for free today!
Treating Opioid Addiction
With buprenorphine, well with opioid addiction a few studies show if you go to a rehab and then you get out 30 days later and you take Methane, you’re trying to be what they say clean, you have a relapse potential of over 90% within the first year. When a person relapses on opioids after being clean, your tolerance is going down, and so it means that the amount that they were using before could kill them. And then with all the different types of stuff that’s out there now they could die. It’s slightly different than other addictions, you could die from a relapse so quickly. You can with other things but with this it’s really scary. So buprenorphine is a partial agonist. It does not give the big euphoric thing that regular opioids give but it’s the receptors so it just stops the escalating tolerance.
My thought with buprenorphine is it doesn’t have to be a forever thing but I think while the person is starting to think about their thinking and challenge their beliefs about underlying need or drive for opioids while they’re getting over their fear of withdrawal, while they’re changing their phone number, people, places, and things that buprenorphine is a wonderful thing to take in the in between period. It’s not swapping one addiction for another because it’s not an addiction with the increase in tolerance, the inability to take of your stuff but people do get dependent on it and have to be weaned down slowly and gradually. And people do wean down and they get off of it and they do fine.
Tune into the complete podcast to learn more about not only opioid addiction and how to quit pain pills but also dealing with emotional pain.
Special music thank you to the Kevin MacLeod Funkorama (incompetech.com)
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