The history of researching why we feel pain dates back to the mid-20th century. Since then, the field of medicine has begun to better understand why we feel pain, but we’re still learning about how to manage long-term, chronic pain. Dr. Jane Ballantyne joins us today to share the history of pain management and the ways that we can seek treatment for chronic pain safely and responsibly.
Additionally, we’ll hear a moving story from Cassie, a patient in treatment for Opioid Use Disorder.
- Purchase Ending the Crisis by Dr. Holly Geyer
- Learn more about pain management and safe opioid use on our Opioid Resource Center
- Comments or questions? Email us at mcppodcasts@mayo.edu.
If you or a loved one are dealing with a substance use disorder, visit Substance Abuse and Mental Health Service Administration.
Read the Transcript:
Dr. Benjamin Lai: Hello. Welcome to Ending the Opioid Crisis. I’m Dr. Benjamin Lai
Dr. Holly Geyer: And I’m Dr. Holly Geyer.
Dr. Benjamin Lai: This is a podcast series aimed at getting a deeper understanding of the opioid crisis that has ravaged our country. Today, we’re thrilled to have Dr. Jane Ballantyne join us for our podcast. Dr. Ballantine moved from Harvard University to the University of Washington in 2011 as professor of anesthesiology and pain medicine. She has editorial roles in several leading journals and is widely published.
Dr. Benjamin Lai: She was an early advocate for the restraint and opioid prescribing for chronic pain and has continued to focus her teaching and research on the clinical implications of evolving opioid science. Dr. Ballantine, welcome to the podcast.
Dr. Jane Ballantyne: Thank you. Thank you for that introduction.
Dr. Holly Geyer: Well, what a privilege it is to have you with us today. We’re going to be talking about pain and how we feel. It’s going to be interesting to really delve into this topic because we know there’s such a tremendous overlap between pain and its biological, psychological, physical, spiritual manifestations, much like addiction. And Dr. Ballantine, thank you for joining us to talk about this particular topic, which I know you have great expertise in, I guess where we might want to start off with is really understanding why we feel pain in the first place.
Dr. Holly Geyer: Maybe start by describing to us the different kinds of pain there are out there and what its purpose might be.
Dr. Jane Ballantyne: Well, pain is universal. I think usually when we use the word pain, most people are thinking of bodily pain, although it’s a word that’s widely used and used beyond bodily pain. But I think here we’re mainly talking about bodily pain, and that is pain that’s experienced in some body part. So let’s confine our language to that. That’s what mostly I will be talking about pain.
The ability to feel pain is part of a defense system or stress response. So it’s a very important aspect of how we live and how we respond to stress. And in particular, the thing we often think about is an immediate response to an injury or a hot plate or a reflex response. But pain actually goes way beyond that, and it’s a way that we have evolved to protect ourselves sometimes against a threat that’s not even there.
But it’s been learned that we need to protect ourselves against that threat. So the brain has an amazing ability to change the signal that comes into it and give us the experience of pain so that they experience the pain itself. So what’s a patient will tell us about pain may be very different from what we can predict from the injury we see or the disease that we know is present.
And that’s what makes pain very complex and also makes it very amenable to treatment. If we accept that actually the pain is formed in the brain and it is a way of holding on learning what pain needs to be felt of pain that needs to be ignored in order to be protected. Animal, human being in our case.
Dr. Holly Geyer: So if I understand you, it sounds like sometimes pain does serve a purpose for I would imagine, most of our listening audience there, probably much like me, and spend the majority of their life trying to avoid it. Is there a purpose to pain to help us heal? And are there different kinds of pain, some of which may not be beneficial?
Dr. Jane Ballantyne: I think a simple way to think about it is that most acute pain there is a purpose to acute and there is a purpose to having an immediate response to an injury. One of those purposes is it forces one to rest after an injury. So if you injure yourself or have surgery, you’re going to have pain for several days after that injury unless it’s a really quick withdrawal from the pain.
And that’s the end of the story. But for a more extensive injury, you’re going to have pain for a few days. And the purpose of that pain is to encourage you to rest and that helps you to heal. So that is pain for the purpose. chronic pain, we often say doesn’t seem to have any purpose, and chronic pain is the most troubling sort of pain because…exactly that reason. But why have I got it? What is the purpose of having this pain that goes on forever and doesn’t seem to serve that sort of purpose of protecting me in that way?
Dr. Holly Geyer: I’ve often heard chronic pain described more so as a disease than anything else. How would you classify chronic pain?
Dr. Jane Ballantyne: Well, I think that the idea that pain is a disease really started in the 1950sand before the 1950s. Pain was considered to be, quite simply, a symptom. And if a doctor couldn’t find a cause, an underlying cause or disease process that was producing the symptoms of pain, it was often said that the pain was just in the head and there was nothing they could do.
So they were dismissed from the doctor’s office. And that was partly because it just wasn’t understood the important role that the brain plays in pain, and also that that’s what is happening in the brain can be treated. There are treatments that help that. So in the 1950s was when there was a movement to have pain clinics, to categorize chronic pain as a disease and to have pain specialists.
The way I’ve come to think of it is the pendulum swung too far the other way, and we began to think that all pain is a disease. Well, if you think about it now, especially given our knowledge of pain, some pain is a disease. I mean, are chronic pain states that are amenable to treatment. And of course, there are lots of definitions of disease.
It’s a word that people can debate what a disease actually means. But in the way I think about it, a disease is something that can be treated medically. So there are chronic pain states that can be treated medically. There are also chronic pain states that there is no help for medical intervention and self-management and acceptance. So the better way to deal with it and they’re also pain like chronic arthritis, where I think it’s a mistake to call it a disease because in that case it’s a symptom of an underlying disease.
It’s the cause of that symptom. So not all chronic pain is a disease, but some is and some definitely it’s not helpful to think of it as a disease, especially thinking about it as a disease makes you think that doctors have a treatment for you when doctors don’t, because sometimes doctors don’t have a treatment.
Dr. Holly Geyer: What a great way to kind of frame this in our minds, to categorize the different kinds. And I think you’re highlighting the importance of having these discussions with your provider. You’ve also interjected the personal experience component to all of this, and I think through to a couple of days ago when I had my three year old and my five year old out for a walk, both started to run, both trip at the same time, both skin their knees.
The five year old got up, brushed yourself off and kept going and the three year old was attempting to call 911 very different manifestations of the same problem. Would you mind talking a bit about why these tend to be so personal experiences and why they may manifest with the same degree of injury very differently in different people?
Dr. Jane Ballantyne: Well, the story you tell about your two children, I think pinpoints or seems to pinpoint that they may have different personalities because they’re too young to have learned much in terms of what their life experience has been or what they’ve learned in terms of how they need to protect themselves. But if you were to tell me the same story in an adult, I would say that there are many things a personality does affect how you respond.
Culture affects how you manifest pain and your past experience affects how you’ve manifest pain and your current circumstance. So whatever the circumstance is, effects what you will report as your display is pain or your pain behaviors, which they’re not necessarily related to the incoming signal. So, for example, the pain of childbirth is severe, as we know, but the suffering is very different from childbirth and having terminal cancer because the circumstance is very different.
And so if you take all these layers of pain, then one of the last layers is suffering. And that in itself depends on all the factors I just mentioned. It’s a very complex layered process, which is how we manifest pain.
Dr. Holly Geyer: What a great point. And you mentioned the concept of suffering as something germane to experiencing pain in some situations, and I can imagine that’s probably a bit more common in people suffering, maybe with chronic pain. Could you talk to us a bit about the whole biology that’s occurring in someone whose experience is in chronic pain and how that’s very different than the pain that might be experienced by an acute injury?
Dr. Jane Ballantyne: Yes. So as I just said, chronic pain is not a single thing. It’s lots of different things. If we just focus for a moment on chronic primary pain. So it’s another way that you can try and categorize chronic pain and that it’s between primary and secondary. So chronic primary pain is pain that exists where there doesn’t seem to be any underlying cause or there’s nothing you can actually find in terms of a broken bone process such as postherpetic neuralgia or an injury or prolonged pain, just surgery.
There’s not nothing that you can find and secondary pain is pain that occurs secondary to things you can find or things you can treat. And so the pain is secondary to that. So for example, and it may be a differential diagnosis if you have headache, could be chronic primary pain like migraine or tension headaches, or it could be chronic secondary pain because it’s an underlying tumor or vascular issue.
And so you need to distinguish. But if you take chronic primary pain, which is the most perplexing pains because you can’t find anything underlying it and so you can’t treat an underlying thing, you’re left with the pain of its source and in that case, what is often happening is that you’ve got heightened sensitivity. So everything that should not be painful becomes painful for someone who’s got chronic primary pain.
And what underlies that is often this is where the risk factors over again to overlap with the risk factors for addiction. Because what underlies chronic primary pain is often psychiatric co-morbidities such as depression or anxiety, or particularly post-traumatic stress disorder is very common in people with chronic primary pain. But it can also occasionally less often be to due to some sort of inflammatory response.
So you get a chronic pain like syndrome, for example, with post-COVID syndrome, for example, you can get an inflammatory response. And the third thing we look at is whether you’ve got so called neuroinflammation. So the nervous system has mounted an inflammatory response that in itself causes pain or a nerve cell interaction that in itself causes pain. But by far the commonest underlying problem with chronic with all these chronic primary pain conditions, it’s stress, particularly post-traumatic stress disorder, depression, anxiety and other comorbid psychiatric conditions are often underlying chronic primary pain condition, and they’re the most difficult pain conditions to treat.
Dr. Holly Geyer: Is there a timeline between when we call a pain syndrome chronic?
Dr. Jane Ballantyne: Well, that’s another thing that we began to debate on the pain field because traditionally and still you’ll find in most textbooks and articles about pain, it’s defined slightly, variously, but always on the basis of time. So the commonest is 90 days or three months that if you have pain persists for longer than 90 days or three months, you call it chronic pain and you call anything that is earlier than that acute or subacute pain.
But, nowadays we’re beginning to think that that really is rather arbitrary and doesn’t make sense because there’s no scientific basis for saying that anything at all changes just because you got to a certain time point for 30 days. And so we’re beginning to think about not making that distinction, but making the distinction between peripherally generated pain and centrally maintained pain.
In other words, what’s wrong is in the periphery versus what’s wrong is in the brain or the nervous system. And that’s actually a much more logical way to look at it.
Dr. Holly Geyer: Wow. It seems like the field is changing. We are learning more every week, every month. We’ve talked a lot about how chronic pain can impact different aspects of our life. And I wonder if you could share a bit about what that would look like in a person experiencing chronic pain. What parts of life will you see changed over time?
Dr. Jane Ballantyne: Well, it’s very hard for someone with chronic pain to live a normal life, to enjoy life, to or chronic pain that hasn’t been addressed or hasn’t been treated, that it’s a miserable stage. It isn’t easy to continue being fully active at work. When you have chronic pain, your social life tends to suffer, your family interactions tend to suffer, you become reclusive, you don’t want to go out, you don’t want to enjoy doing things.
And in fact, a large part of pain treatment. When you go to a multi-day, spluttering pain clinic is helping you start to do those things again. Because in starting to do those things again, you can suppress pain to a large extent. You can improve pain just because you can become more accepting of the pain’s existence. And once you start rehabilitating, once you start doing these normal human things again, the pain actually improves on its own.
Of course, there are other aspects and important aspects to multidisciplinary pain management, and they are the physical side of the movement and physical therapy, occupational therapy. The benefits of it is that this type of pain carries and addresses everything together and it uses behavioral interventions. So a lot of the success of multidisciplinary pain management resides in the behavioral component, even if it’s physical therapy, it’s the behavioral physical therapy that really helps.
Dr. Holly Geyer: We are definitely coming to increased recognition of that, and I think it’s great information for our audience to know that taking that comprehensive approach to treatment and chronic pain is key to part of the recovery process. Could you talk a little bit about the role of opioids in chronic pain? What do we know? When are they beneficial? When aren’t they?
Dr. Jane Ballantyne: Well, one thing that we’ve learned in the even in the two decades or nearly three decades now since we started encouraging opiate treatment of chronic pain, which was always rather off the table before the 1980s because past history had taught that it really didn’t help very much and the risk was too high. So doctors tended not to prescribe opiates, and then in the eighties they were popularized.
So it’s not really that long. But the advance in the science, the understanding and even the accumulation of clinical data has taught us some very important things. And to me, the most important thing is that if you use opiates continuously for a long time, they don’t provide very good analgesia. So quite quickly the analgesic effect wears off.
And to me that’s very important because you consider that why would you take any risk? The other side of it is that the risks are increased markedly over time. It’s almost inevitable that you will develop dependance, which isn’t necessarily the same as addiction, but it is a very high risk for developing addictions, especially if you can’t continue to get the drug.
If somebody says Right, I’m going to take this away from you because it’s not doing you any good, then that leads to trouble in many cases. So what we have learned is that when you use opiates for a long time and use them continuously, that the brain adapts in a way, that it tries to equalize itself. So its response to the drug is opposite to the drug’s effects.
So over time, the brain’s response is dragging down the positive things about the drugs. So the euphoria that you get or the feel good effect that you get or the pain relief that you get is being sort of corrected by the brain in a way that is enduring. So if you stop the drug, that negative effect doesn’t go away very quickly.
And that’s the problem. So you’ve got a twofold problem. One is that it’s not providing very good pain relief over time, and the other is that you can’t do without it. And even when you stop the drug, you’ll still, because of those brain trained changes at very high risk of needing to go back on the drug or if you can’t get back on it because the doctors doesn’t want to prescribe anymore, you need to find it elsewhere or you develop serious depression.
And so what we’ve learned from all this science and this clinical experience is that it’s not a good idea to use opiates for chronic pain generally. And I’m talking about continuous use. These changes probably don’t occur if you just take opiates occasionally or if you are able to control use and you just take it occasionally and you have this sort of patient that can just take it when they’re having a bad day or in the morning, help them get up. Or particularly older patients can manage it that way but a lot of younger patients just can’t.
Dr. Holly Geyer: I think these are some great insights. We had done a large national survey back in 2018 here at Mayo Clinic, and we found of the general public more than 50% of the general public thought that one of the best indications for opioids was chronic pain management. So clearly we’ve got some national education to do on this topic and maybe a mind shift change even in our society.
It’ll take some effort to get there. But if you were to give an individual struggling with chronic pain today just three pieces of advice, what would you offer them?
Dr. Jane Ballantyne: I would give them hope. I would say that treatment can help. And I would also say that treatment for chronic pain is not simple. You can’t go to a doctor and be given a pill, which is going to be the answer to your problem or answer to your prayers, because we just don’t have those sort of pills. There is no easy answer.
But treatment and your own involvement in treatment is what is going to help even if it takes a lot of work, which it might, but it can completely turn things around if you’re willing to to do that. And so I would say find yourself in the right treatment or with the right doctor or the right program and be willing to work hard at getting better.
And you can get better and you can get completely better and have a much better, happier life. Even though we wouldn’t promise your friend the pain can be taken away completely, that’s unrealistic goal. But the goal of being able to live with the pain and reduce it considerably is very realistic.
Dr. Holly Geyer: Those are sound words of wisdom. Thank you. Dr. Ballantyne. Dr. Lai, any thoughts?
Dr. Benjamin Lai: This was very educational session. Dr. Ballantyne. Just on the same vein, along with Dr. Geiger’s question, we’re starting to encounter more and more patients who have been on opioids for many years for chronic pain, who come to us and say, I’d like to get off this opioid. Do you have any words of advice or any pearls that you might have for these patients who are interested in tapering off opioids – what to Expect? I think one of the greatest fears is worsening pain. How do you counsel these patients on that?
Dr. Jane Ballantyne: There are obviously complex. Every patient’s different and there are always exceptions to the rules, but generally the pain doesn’t get worse. It may not change, but in general it’s rare for pain to get worse. So that’s an important thing for patients to understand. It’s not going to be easy. It’s been very rare where you can just come off opiates and everything’s fine because your patient has become dependent on the opiate and it takes a while to get off opiates.
But you can get off opiates you can get off by tapering very slowly. You can also accept being on a much lower dose, but not coming off altogether. It’s very difficult to come off altogether. There’s nothing wrong with being on a very low dose of opiate expects it’s necessary. And we have found buprenorphine, a very useful tool for getting off that strong opiates.
It’s a much safer drug and somehow stabilizes things much more effectively than staying on the stronger opiates, which is alternative, really motivated person, can come off opiates, but it’s hard work and some patients just can’t they just can’t do it because of dependance is such. They’ve been on opiates for so long and at such doses that they’re better staying, actually staying on.
Even if it’s a much lower dose you can usually achieve getting someone to a much safer lower dose and try buprenorphine. I mean, buprenorphine carries a lot of stigma, but it really shouldn’t because it was originally analgesic. It’s a very effective analgesic and it’s a very safe analgesic compared to the strong opioids.
Dr. Benjamin Lai: Jane Ballantyne, thank you very much for your time and for your expertise.
Dr. Jane Ballantyne: Thank you.
Dr. Holly Geyer: Well, we are so privileged today to be joined by Cassie to give us updates of how your life has changed since entering the world of opioids and working your way towards treatment. Cassie, thank you. Welcome to the show. Would you mind just giving us an overview of your background in the world of opioids?
Cassie: Yeah, so I started using opioids when I was 19 years old, an ex-boyfriend that introduced me to them. But then I started liking them and I realized how easy it was to go to the E.R. or just my doctor and kind of manipulate my way into getting them. And so that’s what I did a lot of the time.
Cassie: And that led to me buying opiates from people who had prescriptions when I could no longer get them prescribed to me. And then that also led me then to using fentanyl for the last six years. So it’s been a long road, but it’s not been a pretty one either. I entered into treatment about a year ago and I’ve been able to recover from that, which has been super awesome.
Cassie: But when I first realized how easy it was to manipulate to get opiates from my doctor, it became something I did quite often. And then when that started getting more difficult because the opiate crisis did start getting higher and more impactful, I guess I had to turn to buying them from the streets. With that, you just I never knew exactly what I was getting, and that eventually turned me to getting really, really addicted to fentanyl.
Cassie: And once I found out I was doing fentanyl, that’s all I searched for. I didn’t even care about, like, legit opiates from over the, like, over from pharmacy. I just wanted fentanyl. And it was just a really dark path. And it was not a fun one either. My husband and I both were addicted for about six years before we came into treatment, and being able to get off opiates was very difficult.
Cassie: It was very hard to do by ourselves. We had the support of my family and just wanting us to get better because it had gotten so dark. We were doing like the unthinkable just to feed into our addiction. We think we have the support of my family and then we came into treatment. We also think we did not have to go off of cold turkey.
Cassie: We were able to do Suboxone and weaned off of that then. And so we’ve now both been off of that for almost two years, so completely sober and all that stuff. That’s been really great, I don’t think either without having like to have had support during that, we would have been able to have done it because the withdrawals were so bad it felt like I was dying every time I had to go through a withdrawal.
Cassie: So that would lead me to making sure I always had like fentanyl with me. And I couldn’t go more than a few hours without it. Typically before I came in the treatment, going through treatment and being able to not have to rely on opiates anymore has been amazing. My life was so dark when I was using that it just seemed like there was no hope.
Cassie: But that’s all. That’s all I cared about was using. And I hardly even cared about my husband or my family or even myself. All I wanted to do is just use. And that all started ten years ago when I was 19 years old, realizing how easy it was to get prescribed just because I said my back hurt.
Dr. Holly Geyer:Cassie, thank you so much for sharing your story. It sounds like it’s been a long journey, but you’re finding the end of it and we’re so excited for you. I was curious, you’ve talked a lot about how you were able to manipulate medical professionals through this process, and would you mind just sharing with our audience a bit about some of the techniques you used and things doctors might want to look for from individuals that come forward with complaints that may not be legitimate?
Cassie: Yeah, so what I would do a lot, I would just I would go for the er a lot actually, and complain that my back really hurt or that I twisted my ankle walking down the stairs or just like silly little things that if I made myself cry enough or I made it sound believable enough it was believable. And then have you follow up with your doctor however many days afterwards, and I’d tell them oh I’m still in a lot of pain, so then I would be able to get another prescription.
Cassie: And also even with like dental work, I would try to find reasons to have like oral surgeries or whatever. And I knew that I would be able to also get prescriptions that way for after that. And so it just became like easy once I got used to it and like the words I needed to use and how to like, make myself cry to almost get pity.
Cassie: Yeah. So that’s what I did a lot. The E.R. was probably the easiest place for me to go because it felt as though I was just easier for them to give me a prescription and then get me out of there so I could move on to somebody and, like, more somebody that needs their care a lot more.
Dr. Holly Geyer: One of the interesting trends that we saw through the opioid epidemic, which is still going on, is that despite the fact that doctors are prescribing less, overdose deaths are rising. As we think about this, do you see how this might play a role in your life as you didn’t have access to opioids to then turning to street drugs?
Cassie: So when I was been able to prescribe them and even people that were around you that were still prescribed them and I was able to get them from those once they started getting cut and what they were then, I definitely was more prone to go to the streets because I couldn’t. Everybody is getting less and less.
Cassie: And at that point all I care about was not being sick. And so going to the streets to find whatever I could is what I had to rely on. And then that is how fentanyl kind of fell in my lap.
Dr. Holly Geyer: Many people describe opioid addiction as much more of a journey, and the beginning of the journey can look very different then in stages of addiction. As you look at your life, did early stages of addiction impact the way you interacted with family and friends and kind of overall life very differently from later stages when you were on hardcore illicit drugs from the street?
Cassie: Yeah, definitely. When it when I first started using it was I could just function. It would be, you know, I could go a couple of days without it. Every once in a while I was fine and just kind of went about living a normal life. I was working three jobs at one point. I’ll just casually using. But once that casual using went to using it every single day and not being able to go through the day without depending on that, my relationship with my family and my friends and even my husband started getting more and more distant because I didn’t care so much about what was going on in their lives as I cared more so about what was going on with me and if I could get drugs for the day. And so I pushed everybody away, possible that I could, especially if they weren’t helping me in the way that I wanted them to be helping me so I could get what I wanted.
Dr. Holly Geyer: As you look back during those times, do you see any times or circumstance when you were approached about your addiction problem and did those types of interventions help? If not, how could things have been done differently in your family?
Cassie: I’d say they probably didn’t help. cause I think perhaps because I was in such denial that I actually even had a problem, I thought because I was living a normal life, working, you know, married and doing all of that, that I wasn’t doing anything wrong and that I was just a functioning person no matter what. And so I would blow up and no matter how gentle or harsh, my family tried to tell me that I needed help or I needed to stop using.
Cassie: It didn’t matter because I never I didn’t want to. So any way that they would try to help wasn’t super beneficial because it came down to me wanting to get the help and to get sober.
Dr. Benjamin Lai: And at what point along your addiction course did you finally come to the realization that you truly were addicted?
Cassie: Man, I’d say that was probably about seven and a half years ago when I was pc’ing for a lady who walks through a pain clinic and she was basically selling to me every single day just so I could not be sick. And that’s when, you know, I just sat down one day. I was like, Wow, I can’t go a day without making sure I have something so I don’t feel sick.
Cassie: And it just kind of blew my mind at that point. But I felt like I was already so far in that trying to get out was going to be too difficult. And because I was making money and I was working the three jobs, going to school, doing everything, I thought, you know, like a 23 year old should be doing.
Cassie: So yeah, I just really had to come to the conclusion that that was not okay to use that it much all the time, but it was also too far gone and that I just didn’t care.
Dr. Holly Geyer: If you had the chance to tell our audience one thing about your addiction story that may be impactful for them to understand when it is and isn’t addiction, what would you say to them?
Cassie: I guess the fact that once I decided I liked the feeling further along, it was when it was that I found out that I was addicted in the beginning and it was just, you know, help me sleep a little bit, help with pain here and there. But then once I realized I couldn’t function without using, that’s when I realized I was full blown addicted.
Cassie: And that led me to being homeless and countless times watching my husband overdose and just like not living a life worth while, it seems like to when I went from just regular Percocet thirties to like the press fentanyl thirties from there, it seemed like a really quick slope down into a dark, dark hole where we can hardly crawl ourselves out of it.
Cassie: And it was really, really quick to happen. And so addiction just really doesn’t discriminate and it will get anybody at any time. And yeah, it’s just it’s not it’s not fun out here.
Dr. Holly Geyer: You made an interesting comment about how fentanyl gives a very different feeling than other drugs. Could you just elaborate a little bit on why fentanyl was different for you both for the high and the low?
Cassie: Yeah. So I guess for me, I lost my brother about seven years ago and so then shortly after is when we found fentanyl. And for me it helped just numb every bit of pain. I felt both emotionally and physically, and it just made it seem like I was just floating at all times. And so everything was just numb and I couldn’t feel anything.
Cassie: And I could just go about life, not feeling what I didn’t want to feel and what was a high that normal Percocet very couldn’t give because those were just the normal ones were more so they didn’t know my entire emotions, they just more so helped with pain. It’s when I realized that fentanyl numbed my emotions, that I realized that I wanted that more than I wanted the real Percocets.
Dr. Holly Geyer: So we’ve talked a bit about buprenorphine or Suboxone as a part of your treatment process. I’m curious, at any point did you try going what we call cold turkey, meaning going off the drugs completely on your own? And how did that compare to the process of using one of these drugs we call and or would your medications for opioid use disorder like Suboxone?
Cassie: Yeah, There was multiple times I tried to go cold turkey where I would maybe make it two or three days of just being sick, throwing up the cold sweats, just really uncomfortable restless legs. And typically by that third day, I just couldn’t take the sickness anymore that I had to figure out how to get more, whatever. It could have been regular Percocet at the time, fentanyl, it didn’t matter.
Cassie: I needed to figure out how to get something. So I want to be sick. But when I was able then to instead go from the fentanyl, to Suboxone and then be weaned off the Suboxone, and I wasn’t uncomfortable. It was a healthy process and it wasn’t it just wasn’t uncomfortable. It helped to actually start thinking clearer and that I figured out that I actually wanted to be sober through that process.
Dr. Holly Geyer: We’re seeing a push within the medical field to start offering drugs like Buprenorphine or Suboxone without any of the other adjunctive. Agents like counseling assessment or other components that we often like to pair with use of those drugs. Can you tell us a little bit about how on your treatment journey, the use of these other approaches, like the counseling or vocational training, things like that, to get you reintegrated into society have been beneficial?
Cassie: Yeah, for sure. So like through counseling and just like mental health event, I’ve been able to figure out like what the root causes of me even wanting to use were. And I feel like if I wouldn’t have had the help of learning all of that or learning that, you know, going down slowly off of Suboxone is like a healthier thing.
I probably, and if I would have had advice from doctors, I probably would have tried to stay on Suboxone as long as I could, because even that was like a comfort thing for me where I wasn’t completely sober. But I had something to fall back on so I wouldn’t be sick. And with the counseling that I did get, it was easy for me to recognize that that’s not something I wanted to continue on because I wasn’t completely sober and I just didn’t want to be on any kind of substance like that, because for me, Suboxone kind of gave me it just I don’t know, it just wasn’t the best, wasn’t what I needed entirely. So getting out of if definitely reminded me how great it was to be sober.
Dr. Holly Geyer: We often time in the med, oftentimes in the medical field, talk about a collaborative approach to treatment between a client such as yourself and the provider. Sometimes providers think that they know the best regimens for a patient or a client, but sometimes the clients have their own opinion of what their goals are. What do you think the optimal approach to developing that relationship looks like?
Cassie: Yeah, generally how you’re feeling going through it, because if there’s no honesty or good communication about, you know what, like myself as a client would be feeling about how, you know, a certain medication is making me feel, and then, you know, a doctor just thinking that it’s A-okay because I’m not saying anything about it. It would not be beneficial in the end. It would just kind of be walking down a road like blind, not helping either one of us figure out what could be that has to help through a recovery process.
Dr. Holly Geyer: Thank you so much, Cassie. If you had one thing that you could communicate to our audience, what would it be?
Cassie: They’re going down a road of addiction is definitely not worth it. Or that, you know, if people are being prescribed opiates, it’s just good to stay in communication with your doctor. If you feel as though, you know, you’re starting to like taking them too much and get ahead of it. Because if I think if I were to realize when I started off just with really low dose that like five milligrams, I never would have continued to go down the road that I went down if I was just open and honest with my doctor.
Dr. Benjamin Lai: Words of Wisdom. Cassie, thank you so much for joining us today. We appreciate.
Cassie: ThankYou.
Dr. Benjamin Lai: That is all from us on today’s episode of Ending the Opioid Crisis. You can check at our website at mcpress.mayoclinic.org/opioids for more episodes of our podcast series and other resources for safe opioid use.
If you or someone you know are struggling with an opioid or another substance use disorder, we recommend speaking with your healthcare provider or going to the Substance Abuse and Mental Health Services Administration website.
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