Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

A reader had some questions about my interview with Dr. Scanlan, a physician who conducts opiate detox in the Florida pill-mill hot-zone:

It would have been helpful if Dr. Scanlan had addressed those opiate addicts that became that way after dealing with chronic pain. If there is no long-term maintenance, how will they stay off of opiates? Maybe a different way to address that is how will they get pain relief? “Buprenorphine is now the 41st prescribed drug in the U.S.” Where is OxyContin, Fentanyl and morphine? Most opiate addicts became that way because of being prescribed pain medication for legitimate chronic painful conditions. Are they included the 5% of addicts that may need maintenance? Or are we just discussing the ‘recreational’ users?

These are good points. Many people do become addicted after seeking treatment for serious chronic pain conditions. For the last 15 years or so there has been a big push in the medical community to recognize pain as the Fifth Vital Sign, and to treat it aggressively with appropriate drugs. Along with treating more pain with more opioids comes the risk that more people will become addicted. Simple math.

I agree—those of us with chronic pain have to strategize about its treatment in order to avoid turning back to opioids. Speaking from my own experience, an important part of this strategy is recognizing that opioids are not the only solution for pain relief. They’re certainly not the best long-term solution for chronic nonmalignant pain.

If you have chronic pain and addiction, I’d like to ask, what have you done about your pain?

As for your other questions: Where are OxyContin, fentanyl and morphine in the list? Oxycodone in all its forms is quite high on the list, though not as high as hydrocodone, which is the top-prescribed drug in the U.S., bar none. Second on the 2009 list (the most recent) were cholesterol maintenance drugs, then amoxicillin (a trusty antibiotic). Codeine is also way up there, and lots of people get addicted via codeine cough syrup or Tylenol #3 for headache, for example. (I knew one professional person who always carried a bottle of codeine cough syrup in their bag—their way of dealing with stress.) See this Forbes piece for one explanation that includes good sources. …

Vicodin is being prescribed like a version of extra-strength Tylenol these days. People go in to have a tooth pulled or to have a wound stitched and are given 30 or 60 Vicodin. It used to be that they’d get 3-5 tablets, but physicians are so used to writing in counts of “30” or “60.” With that supply of a drug that strong on hand, the “addiction switch” (as I think of it) can get turned on within a matter of weeks. Then, when they beg but can no longer get any more refills from their doctor, they turn to other sources to keep the lights on.

A Florida corner-store pain clinic.

I’ve been told that, once you cross the Georgia-Florida border on I-95, the signs for places to score pills start appearing on the roadside, and they follow you all the way down the coast. It’s said that there are more “pain clinics” than McDonald’s restaurants in Broward County—and three times as many clinics as Starbucks outlets.

Dr. Scanlan’s patients, just like all addicts, have become addicted in all kinds of ways. In addition, he practices in this hotbed of pill-mills, some of which dispense painkillers without following good medical practice. These people may or may not be “recreational” users (from my experience, people who are taking 300-600mg of oxycodone each day are no longer engaged in “recreation”), but they’re still suffering from a problem they can’t control.

A Florida strip-mall pain clinic.

I don’t think Dr. Scanlan was talking about pain patients in particular as being in the five percent of addicted people who may need drug maintenance. Scanlan and others, such as Dr. Gabor Maté, some of whose patients live in extremely difficult circumstances—people from street conditions who continually relapse and can’t get sober-time not only because of the inherent power of the disease but also because of the corollary circumstances that go along with certain manifestations of it (homelessness; joblessness; criminality; needle-use; prostitution; etc.)—believe in drug-maintenance to help this set of people stop harming themselves first of all.

The way I understand Scanlan’s comment about drug-maintenance is, he thinks this option gets promoted (by greedy drug manufacturers and well-meaning but largely ignorant policy-makers who have little or no personal experience with addiction) as a “cure” for all addiction—when he many others know that there are non-drug solutions that are less costly to the individual’s physical health and also their wallet, and to society. He’s a living example, and he’s trying to bring that solution to the people who come to him asking for help.



  1. I have concerns that my wife is getting hydrocodone and morphine but understand that she is in great pain. I know that she never had a problem with drugs–she was a real alcoholic. But it gives me pause.

  2. what is it about the person that is helped by non drug therapy, kind of like people that quit smoking, who think that all people who need medication are either drug addicts or lazy

    I have been on maintainence for 15 years I wish I didn’t need it but am glad I have it.

    walk a mile in my shoes then you can get on your soap box, arrogant do-gooders

  3. Your insulting tone is interesting. So you’re part of the 5 percent who may need maintenance… so what? No one here is dissing you for choosing to use a drug.

    What I (and Dr. Scanlan) are questioning is the corporations making enormous amounts of money in the business of keeping the disease of addiction active in people who may not need or want maintenance.

    Stay well.

  4. Guinevere, I’m learning so much I wish I’d known earlier. I was on methadone for 8 years (chronic back pain) and have been off for 6 weeks now. I remember when methadone maintenance was considered just official sanctioning of drug use/abuse — and now its considered the way to go. Our whole culture, not just we as individuals, are much better at extremes than balance. Especially when big money enters the picture…

  5. Encephalitis destroyed my life. All my ambitions wiped out in a flash. Three young children lost their real mum. Their real mum is detroyed by chronic pain with the feeling of a sledgehammer embedded in her head…and that is still the case 15 years on.
    Help me live a life with happiness again..any one,can you help me?

    Opiates no longer help with the pain. Antidepressants for neurogenic pain are useless, the lethargy leads to long days acting like a zoombie. I’d like to laugh and be happy in the company of my family, children and now grandchildren, but I look at the clock prying the time will soon come when they go homw. What a terrible nanna I have become. My husband,who is he? Poor man. I’ve destryoyed everyones life not just my own. I cry and cry and ten more years of this is soul destroying, I would dearly love to escape but i’d break to many hearts, so I continue in a world that is lifeless.

    Help me….please?

  6. I know, from coming off of 120 mg of morphine a day, that clonidine, dicyclomine, a light benzo, and lots of fluids helped me get off CT several times. I have congenital kidney disease, which leaves me in a lot of pain most days. When it’s time to come off of these monsters, aka opiates, the above, especially the dicyclomine, which stops the muscle spasms in the stomach, thus no diarrhea, has been a winner for me. I hope this helps. Good luck to you all and God Bless!

  7. i started taking morphine through v.a. some 15 years ago. dependent yes. when i moved from fl. to in. the v.a. doc switched me from sustained to controled release and i went into shock. due to the behavior that came with the change of drug i have been given a very hard row to hoe. the morphine was pulled away from me at a rate that left me unable to take care of my self. i am 63 viet nam vet many problems physical mental. i didnt go into the doc and say start me on morphine. i am now withdrawing from the buprenorphine due to the g.i. problems that it has created. is there any help the v.a. will let me die and it sounds much better than what iam going through at the moment. better dead than to not be able to function.

  8. I have been back on oxycontin 80 mg. For almost 2 months now and I am 3 days short. I see my dr. Friday. Any suggestions on. How I am going to make it? The few extras are just ENUFF for 1 or a half of 1 day. Please help…I hurt so bad!

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