Perception Versus Reality in a Brain Addicted to Opioids

My story begins 8 years ago on Labor Day weekend. I had just begun a new job and all the new employees had gotten together for some drinks and a night out on the town. Already one to take substances too far before my problem with opioids, I got so intoxicated from alcohol that after getting separated from our group, I ate at restaurant alone and then could not find the money that was in my back pocket. Subsequently, I ran out of the restaurant to evade the police and in the process jumped over a 20-foot ledge. The next day I discovered I had sustained a notoriously difficult to heal injury called a Lisfranc injury. My only solace came from knowing I would be getting powerful prescriptions that would likely make me feel really good. I had a known affinity for opioids from prior dental procedures. I had been able to stop the opioids after the dental work, but the much larger prescription I received after surgery proved to be my downfall.

After getting two prescriptions of 80 tablets from the surgeon, I was cut off abruptly. However, after taking several tablets daily for months, I was already dependent and addicted in the sense that I was using the medicine in risky situations, despite adverse effects and taking more than I had planned to. Over two days I was able to get through the physical withdrawal, but I still had a deep psychological craving to get more. My pain rebounded and was now the worst it had been since the initial injury. I tried getting refills from my PCP, but he only gave a small amount and said that's all he could do for me. After going through this small amount very quickly, I didn't know where to turn.

Then, it dawned on me. A couple of weeks ago, an acquaintance from high school foolishly posted that he had oxycodone-acetaminophen for sale on social media and asked for direct messages if anybody wanted any. Even more foolishly, I reached out to him to see if the offer was still available. It was. This began a 4-year downward spiral of illicitly buying prescription opioids and visiting various pain clinics and physicians—sometimes in different states, other times in different countries because I lived in a border state.

During this time, I did try to stop several times and tried to manage my pain with physical therapy, both on my own and with a therapist. I was actually successful at getting off the opioids and getting my pain to a manageable level about eight months after the initial surgery. However, I went on a snowmobiling trip and my addicted brain told me that "I needed to pick up some opioids for the trip just in case my pain came back." Which in hindsight, I know wasn't true—the pain wasn't that bad—I just wanted to get high again.

The trip was a disaster. I took a large amount of opioids before the day we planned to go in the backcountry in deep powder with a private guide. I was such a mess. I kept nodding off while driving and veering off the planned course leading to the snowmobile getting stuck. While digging the sled out after one of these episodes, I felt a "crack" and sharp pain in the foot that had the surgery. On my next orthopedic follow-up I learned that I had broken all the hardware that was placed in that foot. After the salvage surgery, I was never able to get the pain under control and began to lose hope.

I had considered trying an ultrasound-guided stem cell injection and other interventional procedures such as nerve ablation—but the addicted part of my brain was overriding and telling me "I couldn't afford it and that the opioids were still working." In reality, I could have afforded it and in hindsight this would have been a much better course of action as the opioids were in fact having very little effect, if not making...