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Addiction to Pain Medications (transcript)
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NARRATOR:

"SECOND OPINION” IS BROUGHT TO YOU BY BLUE CROSS/BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS/BLUE SHIELD -- LIVE FEARLESS.

NARRATOR:

"SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

 

PETER SALGO:

THIS IS "SECOND OPINION." I'M YOUR HOST, DR. PETER SALGO. THIS WEEK, MYTH OR MEDICINE -- "TAKING PAIN MEDICATION LEADS TO ADDICTION."

 

DR. GLORIA BACIEWICZ:

ADDICTION INCLUDES A COMPULSION TO USE THE DRUG, A CRAVING TO USE THE DRUG.

 

PETER SALGO:

AND SPECIAL GUEST JENNIFER MATESA IS HERE TO SHARE HER STORY ABOUT THE DARKNESS OF ADDICTION AND HER STRUGGLE TO RECOVERY. SHE'S HERE FOR A SECOND OPINION.

 

JENNIFER MATESA:

I BEGAN TO BE AFRAID OF THE PAIN, SO I -- I WOULD USE IT TO DEAL WITH MY FEAR OF THE PAIN. I WOULD, I WOULD -- AND I WAS USING OTHER MEDICATIONS AS WELL.

 

PETER SALGO:

THANKS SO MUCH FOR BEING HERE, JENNIFER. NICE OF YOU TO JOIN US. I KNOW YOU'VE GOT A LOT TO TELL US, AND WE'RE GOING TO HEAR YOUR STORY IN SOME DETAIL, AND I'D LIKE TO INTRODUCE YOU TO YOUR "SECOND OPINION" PANELISTS TOO, 'CAUSE THEY'RE HERE TO HELP YOU, AND LATER ON, YOU'LL BE ABLE TO GET A SECOND OPINION FROM BOTH OF THEM. FIRST, PRIMARY CARE DOCTOR LOU PAPA FROM THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. AND DR. LOUIS BAXTER SR. FROM THE PROFESSIONAL ASSISTANCE PROGRAM OF NEW JERSEY AND THOMAS JEFFERSON SCHOOL OF MEDICINE. GENTLEMEN, THANK YOU BOTH VERY MUCH FOR BEING HERE. SO, JENNIFER, I WANT TO GO BACK IN TIME WITH YOU, BACK WHEN YOU WERE 20 YEARS OLD, BEING TREATED FOR MIGRAINES. WHAT MEDICATION WERE THEY GIVING YOU AT THAT TIME?


JENNIFER MATESA:


I DIDN'T START TO GET TREATED UNTIL MY MID-20s. BUT AT THAT TIME, THEY WERE GIVING ME STADOL. THEY STARTED WITH STADOL.

 

PETER SALGO:

AND WHAT KIND OF MEDICINE WAS STADOL?

 

JENNIFER MATESA:

STADOL IS AN AGONIST-ANTAGONIST OPIOID, I THINK.

 

PETER SALGO:

THAT'S A LOT OF GIBBERISH. IT'S A NARCOTIC WITH SOME OTHER PROPERTIES.

JENNIFER MATESA:

IT'S A REALLY STRONG PAINKILLER, AND YOU TAKE IT IN YOUR NOSE. YOU SPRAY IT IN YOUR NOSE, AND I WOULD -- IT WOULD KNOCK ME OUT. THEY TOLD ME TO USE TWO SPRAYS, AND I WOULD GET TO ONE AND I WOULD BE KNOCKED OUT.

 

PETER SALGO:

OKAY, AND YOU USED THIS. WAS IT EFFECTIVE FOR YOU?

 

JENNIFER MATESA:

IT WAS EFFECTIVE TO THE EXTENT THAT IT KNOCKED ME OUT. I MEAN, I WAS IN SUCH TERRIBLE PAIN, AND IT WAS REALLY HARD FOR ME TO EVEN SLEEP.

 

PETER SALGO:

AND WHAT HAPPENED WITH THE STADOL OVER TIME?

 

JENNIFER MATESA:

OVER TIME I STARTED USING IT MORE AND MORE.

 

PETER SALGO:

WHY? DID YOU HAVE MORE PAIN, OR WHY WERE YOU USING IT?

 

JENNIFER MATESA:

I BEGAN TO BE AFRAID OF THE PAIN, SO I -- I WOULD USE IT TO DEAL WITH MY FEAR OF THE PAIN. I WOULD, I WOULD -- AND I WAS USING OTHER MEDICATIONS AS WELL.

 

PETER SALGO:

WHICH MEDICATIONS?

 

JENNIFER MATESA:

WELL, ANTIDEPRESSANTS AND OTHER KINDS OF PROPHYLACTIC MEDICATIONS TO TRY TO PREVENT THE MIGRAINES. AND I JUST SAW IT AS A KIND OF PREVENTATIVE.

 

PETER SALGO:

SO YOU WERE USING STADOL A LOT MORE THAN THE DOCTOR WHO PRESCRIBED IT THOUGHT YOU WERE USING IT.

 

JENNIFER MATESA:

RIGHT.

 

PETER SALGO:

SO YOU OBVIOUSLY HAD TO GO BACK FOR MORE PRESCRIPTIONS EARLY.

 

JENNIFER MATESA:

YES, I DID, YEAH, I RAN OUT A COUPLE OF TIMES, TOO EARLY.

 

PETER SALGO:

AND THEN WHAT HAPPENED?

 

JENNIFER MATESA:

SHE CUT ME OFF, AND SHE KIND OF -- SHE GOT ANNOYED AND -- AND ACTED LIKE IT WAS A REAL PROBLEM. AND I DIDN'T KNOW WHAT KIND OF PROBLEM.

 

PETER SALGO:

GENTLEMEN, IS THIS A REAL PROBLEM? SHE'S ON A FAIRLY POWERFUL DRUG, SHE'S STARTING TO USE IT MORE AND MORE, GOES BACK FOR MORE SCRIPTS, AND THEN HER DOCTOR SAYS, "ENOUGH." IS THAT A REAL PROBLEM?

 

DR. LOU PAPA:

YES, IT IS A REAL PROBLEM IT'S A REAL PROBLEM BECAUSE THE PHYSICIANS AREN'T UNDERSTANDING WHAT'S GOING ON. WHEN WE HAVE CASES OF PATIENTS' BECOMING MORE TOLERANT WITH MEDICATIONS, AND THEY BEGIN TO USE MORE AND MORE AND MORE, FOR REASONS OF TRYING TO SOLVE THE PAIN OR FOR FEAR OF EXPERIENCING THE PAIN, A LOT OF OUR COLLEAGUES THINK THAT IT'S WILLFUL MISCONDUCT, OR BAD BEHAVIOR.

 

PETER SALGO:

OR THE TERM THAT WE HEAR, LOU, IS, "IT'S DRUG-SEEKING BEHAVIOR." YOU HEARD THAT PHRASE, I'M SURE.

 

JENNIFER MATESA:

YES, SHE ACTED LIKE I WAS A DRUG SEEKER.

 

PETER SALGO:

WAS SHE A DRUG SEEKER, LOU? SHE'S USING IT A LOT MORE THAN HER DOCTOR PRESCR--

 

DR. LOU PAPA:

WELL, ONE OF THE THINGS YOU WORRY ABOUT WHEN YOU'RE MANAGING ANYBODY'S PAIN, ESPECIALLY IF YOU'RE USING POWERFUL DRUGS LIKE THAT, IS YOU NEED TO WATCH FOR ONE OF THE COMPLICATIONS OF THAT, WHICH IS ADDICTION OR OVERUSE OF THE DRUG, 'CAUSE IT HAS ITS DANGERS IN OVERUSING IT.

 

PETER SALGO:

 

ALL RIGHT, SO YOU WERE USING THE STADOL, THE OTHER DRUGS, USING IT MORE THAN THE DOCTOR PRESCRIBED. SHE CUT YOU OFF. THEN YOU GOT PREGNANT. AND FOR THE PAIN THEY PRESCRIBED WHAT, TYLENOL NUMBER 3.

 

JENNIFER MATESA:

YEAH.

 

PETER SALGO:

AND THAT'S A NARCOTIC TOO, IN ADDITION TO THE TYLENOL. TELL ME ABOUT HOW YOU USED THAT.

 

JENNIFER MATESA:

WELL, DURING MY PREGNANCY, I HAD VERY LITTLE PAIN, ESPECIALLY IN THE SECOND TRIMESTER, AND SO I WAS ABLE TO REALLY LIMIT -- AND I WANTED TO LIMIT MY INTAKE OF ANY DRUG DURING MY PREGNANCY, SO I REALLY ONLY USED IT ONCE OR TWICE A WEEK, BUT AFTER MY 31-HOUR LABOR... [ CHUCKLES ] AND MY HORMONES WENT BONKERS AND MY MIGRAINES GOT HORRIBLE AFTER MY LABOR, AND SO IT WAS VERY HARD FOR ME TO LIMIT MY INTAKE OF THAT DRUG AFTER.

 

PETER SALGO:

BUT AFTER YOU DELIVERED THE BABY, WHEN, PRESUMABLY, THE PAIN OF LABOR AND THE PAIN OF DELIVERY, THINGS HAVE SETTLED DOWN, WHAT HAPPENED WITH THAT TYLENOL NUMBER 3? WHAT WERE YOU DOING WITH IT?


JENNIFER MATESA :

I WAS STILL TAKING IT EVERY DAY -- MY PHYSICIAN REFILLED MY PRESCRIPTIONS, AND I RELIED ON IT, BECAUSE I WAS AFR-- I HAD AN INFANT BABY; I'D MOVED TO LONDON; I HAD TO FUNCTION. I HAD TO GET OUT OF BED EVERY MORNING AND DO WHAT I NEEDED TO DO.

 

PETER SALGO:

 

I NEED TO KNOW ONE DEFINITION -- WHEN YOU SAY YOU RELIED ON IT, WHAT DO YOU MEAN BY THAT?

 

JENNIFER MATESA:

I MEAN THAT IN THE MORNINGS, WHEN I WOULD WAKE UP WITH A HEADACHE OR ANY KIND OF PAIN AND A LOAD OF THINGS TO DO, IT WAS REALLY HARD FOR ME TO GET OUT OF BED, AND I DIDN'T UNDERSTAND AT THAT TIME THAT I WAS HAVING DEPRESSION. AND I USED IT TO GET OUT OF BED. I USED IT TO ENABLE MYSELF TO DO WHAT I NEEDED TO DO.

 

PETER SALGO:

NOW, THERE ARE SOME BUZZ WORDS IN HERE, RIGHT? IT WASN'T JUST THE PAIN. YOU USED IT TO GET OUT OF BED. SHE WAS USING IT TO ENABLE HERSELF. ARE YOUR ANTENNAE GOING UP AT THIS POINT?

 

DR. LOUIS BAXTER SR.:

YES, ABSOLUTELY, AND I'M WONDERING IF YOU WERE USING IT IN THE MORNING AT SOME POINT TO AVOID EVEN HAVING ANY PAIN, FOR FEAR OF PAIN.

 

JENNIFER MATESA:

SURE, YEAH. I USED IT WHEN I HAD PAIN, AND I USED IT WHEN I DIDN'T HAVE PAIN, SO I WOULDN'T HAVE PAIN AND SO I WOULD HAVE ENERGY TO DO WHAT I NEEDED TO DO.

 

PETER SALGO:

 

IS JENNIFER BECOMING ADDICTED?

 

DR. LOUIS BAXTER:

I BELIEVE THAT AT THIS POINT SHE IS, AND WHAT SHE'S DOING NOW, USING SMALL DOSES, OR RELATIVELY SMALL DOSES, IS JUST MAINTAINING, SO THAT SHE DOESN'T HAVE TO GET INTO THE THROES OF WITHDRAWAL.

 

PETER SALGO:

BUT HOW WOULD YOU DEFINE ADDICTION? I MEAN, THIS IS A VERY LOADED TERM.

 

DR. LOUIS BAXTER SR.:

 

MM-HMM.

 

PETER SALGO:

IS SHE DEPENDENT ON THE DRUG? IS SHE ADDICTED TO THE DRUG? IS THERE A DIFFERENCE?

 

DR. LOUS BAXTER SR.: THERE IS A DEFINITE DIFFERENCE.

 

PETER SALGO:

WHAT'S THE DIFFERENCE?

 

DR. LOUIS BAXTER SR.:

AND THE DIFFERENCE IS THAT WITH ADDICTION, YOU HAVE CERTAIN BEHAVIORS. WITH A PHYSIOLOGIC DEPENDENCE, ANYONE THAT TAKES ANY PSYCHOACTIVE SUBSTANCE FOR ANY LENGTH OF TIME -- FOR TWO WEEKS OR SO -- IF THEY STOP, THEY'RE GOING TO HAVE A PHYSICAL WITHDRAWAL. BUT THE DIFFERENCE BETWEEN DEPENDENCE AND ADDICTION IS THE BEHAVIORAL PIECES THAT WE SEE.

 

PETER SALGO:

WHO BECOMES ADDICTED TO DRUGS? I MEAN, THE TYPICAL PICTURE THAT YOU SEE IN A HOLLYWOOD MOVIE IS SOME STREET PERSON SHOOTING HEROIN. SHE DOESN'T LOOK LIKE A STREET PERSON TO ME. HOW COULD SHE BE AN ADDICT?

 

DR. LOU PAPA:

 

IT'S ALL WALKS OF LIFE. I MEAN, YOU CAN SEE IT – WE DON'T HAVE A GREAT WAY OF PREDICTING WHO'S GOING TO BE ADDICTED, BUT WE DO HAVE SOME RISK FACTORS THAT CAN GIVE US AN IDEA WHO HAS A GREATER CHANCE OF BECOMING ADDICTED.

 

PETER SALGO:

 

OKAY.

 

DR. LOUIS BAXTER SR.:

AND THERE'S ALSO A LOT OF EVIDENCE THAT IT IS FAMILIAL, AND SO WE SEE, IN MANY CASES, THAT PEOPLE WHO ACTUALLY HAVE ADDICTION, IF YOU TAKE AN ADDICTION HISTORY AND CHECK OUT SOME OF THE FAMILY MEMBERS, YOU'LL FIND THAT IT'S THERE.

 

PETER SALGO:

NOW, I KNOW, WE SPOKE, THAT AFTER A WHILE, YOUR DOCTOR GOT WORRIED ABOUT THE TYLENOL NUMBER 3.

 

JENNIFER MATESA :

NO, I WENT TO MY DOCTOR AND SAID, "I THINK MY PAIN IS WORSE THAN THIS DRUG IS ABLE TO TAKE CARE OF." BECAUSE MY MIGRAINES HAD INCREASED IN FREQUENCY, AND SO HE SENT ME TO A HEADACHE DOCTOR.

 

PETER SALGO:

AND EVENTUALLY TO A PAIN CLINIC, RIGHT?

 

JENNIFER MATESA:

 

EVENTUALLY.

 

PETER SALGO:

 

YOU ALSO DEVELOPED FIBROMYALGIA ALONG THE WAY, WHICH GAVE YOU PAIN.

 

JENNIFER MATESA:

RIGHT, RIGHT.

 

PETER SALGO:

AND I JUST WANT TO READ SOME OF THE DRUGS YOU WERE ON, THAT THEY GAVE YOU ALONG THE WAY. VICODIN, HYDROCODONE, MORPHINE, OXYCONTIN, AND THEN FENTANYL. FENTANYL IS A POWERFUL, POWERFUL NARCOTIC. AND YET YOU HAD A JOB. YOU WERE KEEPING HOUSE.

 

JENNIFER MATESA:

I DID.

 

PETER SALGO:

WHAT WERE YOU TELLING YOURSELF AT THE TIME ABOUT BEING AN ADDICT?

 

JENNIFER MATESA:

I -- I COULDN'T FIGURE OUT WHETHER I WAS AN ADDICT OR NOT. I WAS TELLING MYSELF THAT I HAD TWO NEUROLOGICAL PROBLEMS THAT REQUIRED ME TO TAKE THIS MEDICATION, MY DOCTOR SAID, MAYBE FOR THE REST OF MY LIFE. AND I ALSO KNEW THAT IT WAS INTERFERING -- IT HAD BEEN, FOR A LONG TIME, INTERFERING WITH MY ABILITY TO UNDERSTAND WHY I HAD TO TAKE IT ALL THE TIME, WHY I WAS SO TEMPTED TO TAKE IT MORE OFTEN THAN I WAS SUPPOSED TO TAKE IT, AND IN DIFFERENT WAYS.

 

PETER SALGO:

DID YOU TELL YOUR HUSBAND, YOUR FAMILY, THAT YOU WERE USING THESE PAINKILLERS THIS WAY?

 

JENNIFER MATESA:

UH...NO. I DIDN'T. NO, I TRIED TO HIDE THAT FROM PEOPLE.

 

PETER SALGO:

WHY?

 

JENNIFER MATESA:

BECAUSE I WAS ASHAMED OF MY NEED TO TAKE THEM. ALSO, I LIED BECAUSE THAT'S JUST A FEATURE OF ADDICTION.

 

PETER SALGO:

OKAY, BUT THAT'S WITH SORT OF THE "RETROSPECTROSCOPE." YOU LOOK BACK AT THAT NOW

JENNIFER MATESA:

IT'S A CARDINAL FEATURE OF ADDICTION. BUT BACK THEN, I WAS THINKING, "GOD, I CAN'T BE HONEST ABOUT THIS, BECAUSE --" AND I ALSO DIDN'T UNDERSTAND WHAT WAS HAPPENING TO ME

 

PETER SALGO:

SO THEN YOU RAN OUT OF FENTANYL. AND WHAT HAPPENED?

 

JENNIFER MATESA:

YES, ONCE, IN 2005. WELL, I WENT INTO A TERRIBLE WITHDRAWAL. IT WAS JUST APOCALYPTIC, EPIC WITHDRAWAL. I COULDN'T FUNCTION. I WAS KICKING, SWEATING, YAWNING, SNEEZING, GOOSE FLESH, THE WHOLE BIT.

 

PETER SALGO:

 

SO YOU MENTIONED WITHDRAWAL.

 

DR. LOUIS BAXTER SR.:

YES

 

DR:?:

SHE'S HAVING WITHDRAWAL WHEN THE FENTANYL IS GONE. IS SHE NOW AN ADDICT? WELL, SHE WAS AN ADDICT ONCE THAT SHE STARTED HAVING BEHAVIORS LIKE LYING AND HIDING --

 

PETER SALGO:

 

OKAY, SO THOSE ARE -- THE WORD WE WOULD USE IN MEDICINE -- PATHOGNOMONIC. THEY WERE TYPICAL.

 

DR. LOUIS BAXTER SR.:

PATHOGNOMONIC, YES. AND MEETING DIAGNOSTIC CRITERIA. SOME OF THOSE BIOPSYCHOSOCIAL THINGS THAT WE SEE IN FOLKS THAT HAVE ADDICTION ARE NOT READILY SEEN IN PEOPLE WHO ARE PHYSIOLOGICALLY DEPENDENT, AND THAT'S WHAT MAKES THE DIFFERENCE.

 

PETER SALGO:

 

MM-HMM, SO YOU HAD THIS WITHDRAWAL. YOU SAID TO YOURSELF WHAT, AT THAT TIME?

 

JENNIFER MATESA:

I SAID TO MYSELF, "I CAN'T CONTINUE THIS WAY. YOU KNOW, IF THIS HAPPENS AGAIN, I'M GOING TO HAVE TO GO INTO DETOX."

 

PETER SALGO:

SO AT THAT POINT, SOMEWHERE IN YOUR BRAIN, SOMETHING WAS SAYING, "YOU'RE AN ADDICT. YOU NEED HELP."

 

JENNIFER MATESA:

OH, SOMETHING IN MY BRAIN HAD BEEN SAYING THAT FOR A LONG, LONG TIME.

 

PETER SALGO:

 

OKAY, THEN YOU HAD ANOTHER LIFE EVENT WITH YOUR DAD -- WHAT HAPPENED THERE?

 

JENNIFER MATESA :

WELL, MY DAD WAS DIAGNOSED WITH CANCER IN JANUARY OF 2007 AND HE DIED WITHIN A MONTH.

 

PETER SALGO:

OKAY, AND WHAT DID THAT DO TO YOU?

 

JENNIFER MATESA:

AND HE WAS UNABLE TO BE TREATED BECAUSE OF HIS CIRRHOSIS. AND I WATCHED HIM DIE REALLY QUICKLY, AND ONE TUMOR – THEY NEVER FOUND THE PRIMARY, BUT ONE TUMOR ATE THROUGH HIS ARM BONE, AND THEY TREATED HIM WITH A QUARTER OF THE AMOUNT OF FENTANYL THAT I WAS BEING TREATED WITH. AND I THOUGHT TO MYSELF, "GOD, YOU KNOW, THIS GUY HAS DEVASTATING TERMINAL CANCER, AND HE'S BEING TREATED WITH A QUARTER THE AMOUNT THAT I'VE GOT, YOU KNOW, I'VE GOT TO DO SOMETHING ABOUT THIS."

 

PETER SALGO:

 

SO RIGHT THEN A MOMENT OF RECKONING?

 

JENNIFER MATESA :

YEAH, YEAH.

 

PETER SALGO:

OKAY, I MEAN, SOME ADDICTS SAY THEY HIT BOTTOM, BUT IT SOUNDS TO ME AS IF THIS LIFE EVENT SAID TO YOU, "THE TIME HAS COME."

 

JENNIFER MATESA:

WELL, THERE WERE OTHER LIFE EVENTS TOO, BUT THAT WAS ONE OF THEM.

 

PETER SALGO:

ALL RIGHT, I DO WANT TO HEAR MORE OF YOUR STORY. GENTLEMEN, I'D LIKE YOU TO STAY RIGHT WHERE YOU ARE. WE'RE GOING TO BE RIGHT BACK, AND WE'RE GOING TO GET YOUR SECOND OPINION TOO IN THE SECOND HALF OF OUR SHOW, BUT FIRST, HERE IS THIS WEEK'S "MYTH OR MEDICINE."

 

NARRATOR:

PAIN IS AN UNCOMFORTABLE SENSATION THAT SIGNALS SOMETHING MAY BE WRONG IN YOUR BODY. SOMETIMES PAIN IS UNBEARABLE AND REQUIRES MEDICAL INTERVENTION IN THE FORM OF PRESCRIPTION MEDICATION OR PAINKILLERS. BUT THESE MEDICATIONS COME WITH POTENTIAL RISKS. PATIENTS OFTEN FEAR THAT THEY'LL BECOME DEPENDENT. PAIN MEDICATIONS LEAD TO ADDICTION, RIGHT? IS THAT MYTH OR MEDICINE?

 

DR. GLORIA BACIEWICZ :

"PAIN MEDICATIONS LEAD TO ADDICTION." THAT IS A MYTH, AND I AM GOING TO TELL YOU WHY. I AM DR. GLORIA BACIEWICZ I AM AN ADDICTION PSYCHIATRIST, AND I AM THE DIVISION CHIEF OF THE ADDICTION PSYCHIATRY DIVISION AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. THE CHANCE OF DEVELOPING ADDICTION TO APPROPRIATELY PRESCRIBED PAIN MEDICATIONS WHEN GIVEN FOR SEVERE PAIN IS QUITE LOW. THE VAST MAJORITY OF PATIENTS CAN TAKE OPIOIDS SAFELY FOR SERIOUS PAIN. IF YOU MISUSE OPIOID MEDICINES BY TAKING THE PAIN MEDICINES WHEN YOU ARE NOT IN PAIN OR MAYBE JUST TO GET HIGH, OR MAYBE TAKING SOMEONE ELSE'S MEDICATIONS, THEN YOU CAN INCREASE YOUR CHANCES FOR DEVELOPING AN ADDICTION TO THESE MEDICATIONS.

 

NARRATOR:

IF I EXPERIENCE WITHDRAWAL AFTER STOPPING PAIN MEDICATIONS, AM I ADDICTED?

DR. GLORIA BACIEWICZ:

 

PHYSICAL DEPENDENCE IS OFTEN CONFUSED WITH ADDITION TO PAIN MEDICATIONS. PHYSICAL DEPENDENCE IS A NORMAL PHENOMENON THAT OCCURS WHEN THE BRAIN IS EXPOSED ON A CONTINUOUS BASIS TO OPIOID MEDICATIONS. WHEN A PERSON BECOMES PHYSICALLY DEPENDENT ON THE OPIOIDS, THEY WILL EXPERIENCE UNCOMFORTABLE WITHDRAWAL SYMPTOMS IF THEY SUDDENLY STOP TAKING THE OPIOIDS. ADDICTION IS DIFFERENT. ADDICTION INCLUDES A COMPULSION TO USE THE DRUG, A CRAVING TO USE THE DRUG, AND CONTINUOUS USE DESPITE HARMFUL CONSEQUENCES. AND THAT'S MEDICINE.

 

NARRATOR:

NOT SURE IF IT'S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE'LL GET TO WORK AND GET YOU A SECOND OPINION.

 

PETER SALGO:

AND WE'RE BACK. JENNIFER, YOU'RE STILL WITH US. JENNIFER, A RECOVERING ADDICT. A MOTHER, BUSINESSWOMAN, WHO WAS ADDICTED TO NARCOTICS, REALLY. YOU KNEW YOU WERE AN ADDICT. WHY COULDN'T YOU JUST SAY TO YOURSELF, "THAT'S IT -- I'M GOING TO STOP"?

 

JENNIFER MATESA:

WELL, EVENTUALLY I DID DO THAT. THAT'S EXACTLY WHAT I DID.

 

PETER SALGO:

BUT YOU DIDN'T DO IT ALONE. YOU NEEDED HELP.

 

JENNIFER MATESA:

YEAH, THAT'S RIGHT. I NEEDED TO ASK FOR HELP, AND I NEEDED TO -- BUT EVERYONE ASKS FOR HELP ON THEIR OWN, RIGHT? LIKE, IT WAS ME WHO WENT INTO THE SUBOXONE DOCTOR'S OFFICE AND SAID, "LOOK, I CAN'T DO THIS BY MYSELF -- WILL YOU HELP ME?"

 

PETER SALGO:

I WANT TO GO THERE TOO, BUT, LOU, WE WERE TALKING ABOUT THIS -- YOU ASKED WHAT HER FATHER DIED OF. WHAT DID YOUR FATHER DIE OF?

 

JENNIFER MATESA:

WELL, HE DIED OF CANCER. THE DEATH CERTIFICATE SAYS, "CANCER," RIGHT, BUT --

 

PETER SALGO:

BUT HE HAD CIRRHOSIS.

 

JENNIFER MATESA:

BUT HE HAD CIRRHOSIS, AND THE ONCOLOGIST STOOD IN FRONT OF ME AND SAID, "WE CAN'T TREAT HIM WITH CHEMO BECAUSE HIS CIRRHOSIS PREVENTS THAT."

 

PETER SALGO:

BUT WAS YOUR DAD AN ALCOHOLIC?

 

JENNIFER MATESA :

HE WAS AN ALCOHOLIC, YEAH.

 

PETER SALGO:

SO SOMETHING IN YOUR FAMILY -- THERE WAS A FAMILY HISTORY OF ADDICTIVE BEHAVIOR,  AT THE VERY LEAST.

 

JENNIFER MATESA:

I HAVE ALCOHOLISM AND ADDICTION ON BOTH SIDES OF MY FAMILY.

 

PETER SALGO:

LOU, IS THIS COMMON?

 

DR. LOUIS BAXTER:

THIS IS VERY COMMON. AND IT IS EXACTLY WHAT WE SEE WITH OTHER CHRONIC MEDICAL ILLNESSES. THAT'S THE ISSUE, AND THAT'S THE POINT THAT I THINK WE REALLY NEED TO TRY TO EDUCATE NOT ONLY PEOPLE AND PATIENTS, BUT ALSO OTHER PRACTITIONERS, THAT ADDICTION IS A CHRONIC MEDICAL ILLNESS, JUST LIKE DIABETES AND HYPERTENSION, AND THAT THERE ARE CERTAIN GENETIC PREDISPOSITIONS. AND JUST AS A DIABETIC CANNOT WILL THEMSELVES INTO A EUGLYCEMIC STATE --

 

PETER SALGO:

MEANING NORMAL SUGAR.

 

 

DR. LOUIS BAXTER SR.:

INTO NORMAL SUGAR – AN ADDICT CANNOT WILL THEMSELVES INTO RECOVERY.

 

PETER SALGO:

SO "JUST STOP," "JUST SAY NO," THAT DOESN'T MAKE GENETIC SENSE.

 

DR.?:

IT DOESN'T MAKE GENETIC SENSE.

 

JENNIFER MATESA :

I WANT TO SAY ALSO THAT THE DOCTORS HAD ASKED MY FATHER TO QUIT DRINKING FOR A WHILE, UNTIL HIS LIVER ENZYMES WOULD RETURN TO NORMAL. DAD WAS NOT THE KIND OF ALCOHOLIC THAT I THOUGHT OF AS AN ALCOHOLIC. HE DIDN'T -- HE BROUGHT HOME HIS PAYCHECKS, HE WAS RESPONSIBLE TO HIS FAMILY, HE LOVED US, YOU KNOW. HE WASN'T THROWING THINGS AROUND AND DESTROYING THINGS. SO -- BUT HE DID HAVE AN ILLNESS THAT DESTROYED HIS BODY.

 

DR. LOU PAPA:

HE HAD HEALTH CONSEQUENCES OF THAT ABUSE.

 

PETER SALGO:

BUT AGAIN, THERE'S A STRONG GENETIC COMPONENT HERE.

 

DR. LOUIS BAXTER SR:

ABSOLUTELY.

 

PETER SALGO:

AND AGAINST YOUR GENES, SOMETIMES MERE WILL POWER IS NOT ENOUGH.

 

DR BAXTER?:

IT ABSOLUTELY IS NOT ENOUGH. AND SO WE NEED TO RECOGNIZE THAT A PERSON -- FIRST WE HAVE TO MAKE THE DIAGNOSIS, NOT THAT A PERSON IS JUST A BAD PERSON OR A HELL RAISER, IF YOU WILL, BUT RATHER THAT A PERSON IS SUFFERING FROM A DIAGNOSABLE AND TREATABLE DISEASE.

 

DR.LOU PAPA:

IT'S A COMPLICATED DISEASE. I MEAN, I THINK IT'S SOMETHING THAT REQUIRES COMPREHENSIVE CARE. IT'S REALLY DIFFICULT, AS A PHYSICIAN, ESPECIALLY BACK THEN, TO MANAGE THAT ON YOUR OWN. YOU REALLY NEED THE PATIENT TO GET TO THE POINT.

 

PETER SALGO:

AND YOU DID GO FOR HELP, AND YOU MENTIONED YOU GOT A DRUG CALLED SUBOXONE. WHAT WAS THAT LIKE AND WHAT WAS THAT ABOUT?

 

JENNIFER MATESA:

WELL, I WAS ON SUCH A HIGH LEVEL OF PAINKILLERS THAT I COULD NEVER HAVE QUIT THEM ON MY OWN, SO I WENT TO A DOCTOR WHO PRESCRIBED ME SUBOXONE, WHICH IS ANOTHER OPIOID DRUG, BUT IT HAS A LONGER HALF-LIFE. SO THAT IT ALLOWED ME TO TAPER DOWN.

 

PETER SALGO:

SO WHEN YOU SAY IT HAS AS LONGER HALF-LIFE, IT WAS EFFECTIVE ORALLY, YOU COULD TAKE IT AS A PILL, AND IT LASTED A LONG TIME, SO YOU DIDN'T HAVE TO POP PILLS ALL DAY LONG.

 

JENNIFER MATESA :

RIGHT, EXACTLY, WHICH WAS A HABIT THAT REALLY HAD GOTTEN INTO ME, BY THE WAY. IF I WAS REQUIRED TO TAKE PILLS ALL THE TIME, IT REINFORCED THAT DRUG-TAKING BEHAVIOR. "DO I NEED SOMETHING NOW? HOW AM I FEELING," ALL THE TIME. IT WAS REALLY HARD TO BREAK THAT.

 

PETER SALGO:

AND YOU MENTIONED TO ME THAT YOU DID SOMETHING INTERESTING -- YOU DETOXED AT HOME WITH SUBOXONE. HOW DID THAT GO?

 

JENNIFER MATESA:

WELL, I DETOXED AT HOME BECAUSE I DIDN'T WANT TO LEAVE MY SON FOR A MONTH TO GO INTO REHAB, BUT THE DOCTOR OVERSAW ME. WEEK BY WEEK, I WOULD HAVE TO COME INTO HIS OFFICE. AND IT WAS EFFECTIVE, AS LONG AS I WAS VERY RESPONSIBLE, AND HE TOLD ME THAT I WAS ONE OF THE MOST RESPONSIBLE PATIENTS HE'D SEEN.

 

PETER SALGO:

AND HOW DID IT FEEL WHILE YOU WERE DETOXING WITH THE SUBOXONE?

 

JENNIFER MATESA :

IT WAS DIFFICULT.

 

PETER SALGO:

HOW SO?

 

JENNIFER MATESA :

WELL, ONCE -- BECAUSE YOUR BODY IS DEPENDENT ON THE DRUG, BECAUSE YOUR PSYCHE IS DEPENDENT ON THE DRUG, BECAUSE YOU'RE GETTING LESS AND LESS OF IT ALL THE TIME, AND YOU KNOW THAT ONE DAY YOU'RE GOING TO HIT ZERO -- I TELL PEOPLE WHO WRITE IN TO MY BLOG, YOU KNOW, "ONE DAY YOU HAVE TO PLAN TO HIT ZERO." ZERO MILLIGRAMS, AND YOU CAN'T HAVE ANY MORE. YOU HAVE TO PLAN FOR THAT DAY.

 

PETER SALGO:

NOT A LOT OF PEOPLE BACK WHEN I WAS IN THE HOUSE OFFICER STAGE WERE BLOGGING ABOUT THEIR DETOX. DO YOU SEE A LOT OF THAT?

 

DR.:

YES, THERE IS A LOT OF THAT GOING ON, AND ANY SUPPORT THAT CAN BE PROVIDED, I THINK, IS VERY GOOD. INDIVIDUALS NEED TO KNOW THAT THEY'RE NOT THE ONLY ONES THAT HAVE HAD THE PROBLEM AND THAT THEY ARE NOT DESTINED TO GO THROUGH THIS ALONE. THERE IS PLENTY OF SUPPORT.

 

PETER SALGO:

SO SHE WAS AT HOME TAKING SUBOXONE. IS THAT AN ADEQUATE DETOX PROGRAM? WHAT IS A SUCCESSFUL PROGRAM? WHAT DOES THAT LOOK LIKE?

 

DR. LOU PAPA:


WELL, LET ME TELL YOU FIRST WHAT A FULL TREATMENT PROGRAM LOOKS LIKE, BECAUSE WHAT THAT IS IS DETOXIFICATION – GETTING THE MEDICATION OUT OF THE SYSTEM – WHETHER COLD TURKEY OR WITH USE OF OTHER MEDICINES. THEN THERE HAS TO BE REHABILITATION, WHICH IS TRAINING AND EDUCATING THE INDIVIDUAL ABOUT THEIR DISEASE, WHY THEY HAVE TRIGGERS, HOW NOT TO USE. AND THEN THE LAST PHASE IS MAINTENANCE, AND THAT'S CONTINUING ON DOING THOSE THINGS THAT THEY HAVE BEEN TAUGHT. AND WHEN YOU COMPARE THAT WITH HOW WE TREAT OTHER CHRONIC MEDICAL ILLNESSES, SUCH AS DIABETES, IF A PERSON COMES INTO THE EMERGENCY ROOM, BLOOD SUGAR IS OVER 300, THE FIRST THING WE DO IS DETOX THEM. WE PUT A LINE IN, DRIP INSULIN IN. AT THAT POINT, WE DON'T SAY, "SEE YOU LATER, BE SUGAR FREE." WHAT WE DO IS THAT WE REHABILITATE THEM. WE TEACH THEM ABOUT THEIR DISEASE --

 

PETER SALGO:

YOU INTEGRATE THEM BACK INTO THE SYSTEM.

 

DR: 

THAT'S RIGHT. WE TEACH THEM HOW TO EAT, HOW TO MEASURE THEIR SUGARS AND WHAT TO DO, AND AT THAT POINT WE FOLLOW THEM FOR THE REST OF THEIR LIVES.

 

PETER SALGO:

JENNIFER, WHAT'S GOING ON WITH YOU? FOR ONE THING, ARE YOU BEING FOLLOWED? AND FOR ANOTHER, IF YOU HAVE PAIN, WHAT CAN YOU TAKE FOR IT NOW?

 

JENNIFER MATESA:

WELL, I DO HAVE PAIN. I STILL HAVE MIGRAINE AND FIBROMYALGIA, AND I TAKE IMITREX AND MAXALT, WHICH ARE OF THE CLASS OF DRUGS KNOWN AS TRIPTANS THAT SQUEEZE THE BLOOD VESSELS WHEN THE MIGRAINE FLARES ON THE SIDE OF MY HEAD. AND I TAKE A MODERATE DOSE OF GABAPENTIN EVERY DAY FOR MY FIBROMYALGIA. BUT I ALSO DO A GREAT MANY OTHER THINGS -- I EXERCISE REALLY VIGOROUSLY; I EAT REASONABLY, AS REASONABLY AS I CAN; I TRY TO MAINTAIN REALLY GOOD HEALTH. PROTECTING MY SLEEP IS A REALLY CRITICAL THING FOR FIBROMYALGIA. I MEDITATE. I TRY TO ENJOY MYSELF, WHICH IS NOT SOMETHING I DID WHEN I WAS LIVING UNDER ALL THESE EXPECTATIONS, TRYING TO GET EVERYTHING DONE. SO I REALLY THINK THAT THOSE WERE THINGS THAT I NEEDED TO LEARN.

 

PETER SALGO:

SO LET ME ASK A LOADED QUESTION -- RIGHT NOW, IS JENNIFER CURED?

 

DR. LOU PAPA:

WELL, YOU'RE NEVER REALLY CURED OF DIABETES. YOU CONTROL IT.

 

DR. LOUIS BAXTER SR: AND SHE IS NOT CURED.

 

PETER SALGO:

DO YOU CONSIDER YOURSELF CURED? OR HOW DO YOU DESCRIBE YOURSELF?

 

JENNIFER MATESA:

NO, I DON'T THINK I AM CURED. I THINK THAT THIS IS – THE ACTIVE ILLNESS IS IN REMISSION. I MEAN, WHEN YOU HAVE CANCER, EVEN WHEN THEY SAY YOU'RE CANCER-FREE, YOU ALWAYS THINK IT MIGHT COME BACK, RIGHT? HAVE YOU GOTTEN EVERY SINGLE LAST CELL OUT OF YOUR BODY? WE HAVE CANCER CELLS FLOATING IN OUR BODY ALL THE TIME. SO, NO, I DON'T THINK OF MYSELF AS CURED, BUT I TRY TO LIVE TODAY TO THE BEST OF MY ABILITY.

 

PETER SALGO:

NOW, JENNIFER, THIS IS YOUR PART OF THE BROADCAST. WE HAVE TWO PEOPLE HERE WHO ARE GOING TO GIVE YOU A SECOND OPINION -- IT'S YOUR MOMENT TO ASK ANY QUESTION YOU'D LIKE. FIRE AWAY.

 

JENNIFER MATESA:

SO YOU BROUGHT UP THE TOPIC OF DIABETES -- THAT'S A REALLY INTERESTING ANALOGY AND ONE THAT'S USED OFTEN. AND WE'RE TALKING ABOUT ADDICTION AS A CHRONIC ILLNESS. FIBROMYALGIA IS CHRONIC. MIGRAINE IS CHRONIC. WHAT IF I CAME TO YOU AND SAID -- AND YOU SAID, "OKAY, YOU HAVE MIGRAINE AND FIBROMYALGIA. AND HERE ARE THE DRUGS YOU NEED TO TAKE." AND WHAT IF I SAID I WANTED TO BE AS DRUG-FREE AS POSSIBLE?

 

DR. LOU PAPA:

 

WELL, I MEAN, THAT'S A THING WE RUN IN FRONT OF PRIMARY CARE ALL THE TIME. YOU WILL TRY, EVEN WITH DIABETICS, DEPENDING ON THE TYPE OF DIABETIC, YOU HAVE A TRIAL PERIOD -- AS LONG AS THERE'S GOOD FOLLOW-UP, YOU HAVE AN ENGAGED PATIENT, MAKING THEM AWARE THAT WE NEED TO LEAVE THOSE OTHER OPTIONS OPEN.

 

DR. LOUIS BAXTER SR:

I WOULD ACTUALLY HAVE YOU ENGAGE IN THE OTHER ACTIVITIES -- I WOULD MAKE SURE THAT YOU ARE HAVING GOOD SLEEP HYGIENE, ARE YOU HAVING GOOD EXERCISE REGIMES, ARE YOU MEDITATING? YOU KNOW, THERE ARE OTHER AVENUES TO MANAGE PAIN OTHER THAN MEDICATIONS. ACUPUNCTURE IS ONE.

 

PETER SALGO:

YOU KNOW, WHEN I WAS YOUNGER, ALL OF THESE ANSWERS WOULD HAVE SOUNDED LIKE SO MUCH PSYCHOBABBLE. HAVING SEEN ENOUGH PATIENTS LIKE YOU, IT'S NOT. IT MAKES A LOT OF SENSE. SO, JENNIFER, I WANT TO THANK YOU FOR BEING HERE AND SHARING YOUR STORY WITH US. I KNOW IT'S NOT THE EASIEST STORY TO SHARE WITH ALL OF AMERICA. PANEL, I WANT TO THANK YOU TWO FOR BEING HERE AS WELL AND GIVING US YOUR INSIGHTS ON THIS CASE. AND I WANT TO KNOW WHAT YOU THINK ABOUT TODAY'S DISCUSSION AND JENNIFER'S SECOND OPINION BY TWEETING US OR COMMENTING ON OUR FACEBOOK PAGE. AND NOW, FOR THE LAST WORD ON ADDICTION TO PAIN MEDICATIONS, HERE'S THIS WEEK'S "SECOND OPINION 5."

 

 

DR. JOHN MARKMAN:

HELLO, I'M DR. JOHN MARKMAN, AND I'M HERE TO SHARE FIVE SIGNS OF OPIOID PAIN MEDICATION ABUSE. THE FIRST SIGN IS THAT YOU TAKE THE MEDICATION TO IMPROVE YOUR MOOD OR TO TAKE THE EDGE OFF RATHER THAN TO LOWER THE INTENSITY OF PAIN IN A PARTICULAR PART OF YOUR BODY. TO PUT IT ANOTHER WAY, YOU TAKE PAIN MEDICATION TO FEEL HIGH OR TO RELAX OR EVEN TO FALL ASLEEP. THE NEXT THING TO LOOK FOR IS TAMPERING WITH THE PILLS, SUCH AS CRUSHING OR CHEWING, TO RELEASE THE MEDICATION MORE QUICKLY. ANOTHER SIGN TO BE ON THE LOOKOUT FOR IS IF YOUR PAIN MEDICATION ACTUALLY INTERFERES WITH WORK ACTIVITIES, RATHER THAN MAKING THEM EASIER TO DO. ARE YOU SO SLEEPY OR INATTENTIVE THAT YOU CANNOT MEET THE RESPONSIBILITIES OF CARING FOR A CHILD OR OPERATING YOUR MACHINE OR PAYING ATTENTION WHEN DRIVING? ONE MORE SIGN OF OUT-OF-CONTROL PAIN MEDICATION USE IS TO CONTINUE TO TAKE PAIN MEDICATION AFTER THE INITIAL REASON FOR THE PRESCRIPTION -- LIKE A BROKEN ANKLE OR A DENTAL INFECTION -- HAS HEALED. IN THAT CASE, FINDING WAYS TO GET PAIN MEDICATIONS FROM FRIENDS OR FAMILY OR ANOTHER TYPE OF DOCTOR OFTEN BECOMES A FOCUS. LASTLY, IF YOU FIND YOURSELF TAKING MORE PAIN MEDICATION THAN PRESCRIBED OR FEEL LIKE YOU'RE TAKING ADDITIONAL DOSES OF MEDICATION JUST TO AVOID SYMPTOMS OF WITHDRAWAL, SUCH AS ABDOMINAL CRAMPING OR FEELING ANTSY, RATHER THAN FOR PAIN  RELIEF, THAT IS A WARNING SIGN. AND THAT'S YOUR "SECOND OPINION 5."

 

 

PETER SALGO:

THANK YOU SO MUCH FOR WATCHING, AND REMEMBER, YOU CAN GET MORE SECOND OPINIONSAND PATIENT STORIES ON OURWEBSITE AT secondopinion-tv.org. NOW, SEND US YOUR SHOW IDEAS. SHARE YOUR OWN STORY, AND MAYBE WE'LL INVITE YOU TO BE ON THE SHOW WITH US. YOU CAN CONTINUE THIS CONVERSATION ON FACEBOOK AND TWITTER, WHERE WE ARE LIVE EVERY DAY WITH BREAKING HEALTH NEWS. I'M DR. PETER SALGO. AND I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

 

NARRATOR:

"SECOND OPINION" IS BROUGHT TO YOU BY BLUE CROSS/BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS/BLUE SHIELD -- LIVE FEARLESS. "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.