Since the rapid increases in recreational and addictive drug use, combined with the already high numbers of people in recovery, it is important to get significant chemical education to the general public. For this reason, I will share some important information with you.
Minimizing — don’t do it.
In the addiction profession, we routinely realize that patients minimize their drug use on admission to treatment, but this is a problem with most patients — not just those who are addicted. Most patients tend to minimize their use of substances.
All patients need to get better at being honest with their physicians about all legitimate medications (past and current) as well as any past and current substance use (both legal and illegal). Physicians are trained not to be judgmental when dealing with patients and their medical history.
Physicians, especially anesthesiologists and surgeons, need to know the drug/medication history of their patients. This is the only way to help provide the best care possible. Anesthesiologists are responsible for putting you to sleep for surgery, keeping you asleep during the surgery, and waking you up safely. Failure to be honest can result in the patient regaining consciousness during the surgery.
Alcohol and narcotics
A few years ago, when I was a visiting lecturer regarding chemical impairment, at the N.J. Medical School in Newark, we did team teaching with the anesthesiology and surgical departments. This is when I first heard about the need for medical students to learn the necessity for patients to self-disclose to their anesthesiologist and surgeon any past drug use before surgery. The problem of stigma was an issue then — as it continues to be today.
Students were told that it was important to let their doctors know about any history of regular narcotic use (prescription or illegal) as some permanent changes take place in the patient when alcohol or narcotics have been part of their history regularly over a long period.
The anesthesiologist might need to adjust doses of anesthesia to make sure that the patient remains unconscious during surgery. Failure to do so could result in the patient regaining consciousness during the surgery.
This includes all past use, not just current use. It includes “recovering people,” as well as those who were never treated for addictive disease. Fear of what the “physician may think” and issues of social “stigmatizing attitudes” keep many from making this self-disclosure.
It struck me as strange that medical students were told this information — but the general population rarely heard it. Most people mistakenly assume that so long as I am not currently “using,” I do not need to disclose.
This is not true. Remember that most people who have an alcohol dependency may not go for formal treatment. They sometimes stop drinking or go to Alcoholics Anonymous on their own. Their brain may have already been “switched on” for physical dependency or addiction.
Similar things happen with narcotic use. This includes legitimate use of pain meds as well as recreational use that requires formal withdrawal management, and spontaneous cessation of drug use.
Your brain does not know the difference between legitimate use of narcotics and illicit use. Your anesthesiologist needs to know your past, as well as present, drug use — legitimate or not. Your brain and neurological system are affected, whether or not the patient gets formal treatment. This is not just about those who are in formal recovery.
Marijuana
In recent times, when recreational marijuana use, or medical marijuana use, is common in most states, the American Society of Anesthesiologists has now put out an additional warning.
Patients need to self-disclose marijuana use as well. Regular marijuana users (legally purchased or purchased from the street dealer) are included in this group. Failure to do so can cause one of three things to happen.
• The patient may need more anesthesia to fall asleep and stay asleep. The American Society of Anesthesiologists recently published a study saying that those who smoked marijuana before surgery needed nearly 50 percent more anesthesia than non-users. The amount might fluctuate depending on frequency and duration of use.
• The patient might experience more post-surgical pain than non-users. This might require more narcotic pain relief, which can lead to other problems with those medications.
• Other complications are that marijuana smoking is linked to risk for other lung problems, lowering of blood pressure, and increased heart rate. All of these can be dangerous during surgery.
For these and other reasons, abstaining from marijuana use is strongly recommended.
Those in recovery — short-term, long-term
For those in recovery, there are special issues to consider. While some may still fear stigma from the medical profession, doctors have been updating their education about addiction, prescribing, and the benefits of recovery. The doctor-patient confidentiality is still sacrosanct — so there is a promise of your recovery remaining private from public view.
The above issues about self-disclosure to doctors (surgeons and anesthesiologists) are also important for those in recovery.
Be sure that family, friends, and group members know you are going in for surgery. You don’t need to share the details of the diagnosis but need the emotional and spiritual support they can provide.
A trusted family member (or friend, who lives with you) should be in charge of giving you any post-surgical pain medications that you might require. If your doctors know your history and know that you prefer non-narcotic pain meds, it is easier and safer when someone else is in charge of distributing the medications.
If you live alone, they may be able to get you admitted to a rehab facility for a couple of days, if insurance will cover it. If not, see if you can get a recovering friend from your home group to stay with you for a few days.
Have a few members of your home group stop by every evening and you can host a meeting. It will help you maintain recovery during a high-risk period. It can also reduce your pain levels. Fellowship and community reduce stress-related pain.
Practice meditation several times a day. Have recovery-orientated reading material available during your surgical recovery. Recovery-orientated DVDs or streaming content also can also help pass the time.
Go to more frequent meetings, about three to seven times a week, before surgery, and go when you get mobile post-surgery. Have extra sponsor contact pre- and post-surgery.
Do not be afraid of prescription meds that a doctor, who understands your disease, prescribes. It is appropriate to ask if there are non-narcotic meds available, but if you need them, it is not a relapse.
Father Edward Reading, Ph.D., LCADC, is assistant director of the Professional Assistance Program of N.J., president of Matt Talbot Institute of Addiction Studies, president of the International Coalition of Addiction Studies Educators, a member, of the National Association of Alcohol and Drug Counselors, an associate member of the American Society for Addiction Medicine, and a board member of Catholic Charities in the Paterson Diocese.
