As a GP trainee, I find opioid prescribing a particular challenge. This is especially the case for patients with chronic pain, where the distinction between analgesia and addiction can become increasingly blurred. It can be extremely difficult to maintain a therapeutic relationship with a patient who is dependent on the painkillers that they are being prescribed.
In her book Painkiller Addict: From Wreckage to Redemption, author Cathryn Kemp chronicles her own descent into fentanyl addiction, and her harrowing journey through recovery.
Previously a successful journalist, Kemp was diagnosed with idiopathic pancreatitis, and spent more than 2 years in and out of hospital. She was eventually discharged to the care of her GP with chronic abdominal pain and a prescription for fentanyl lozenges. Kemp initially adhered to the prescribed dose of eight lozenges per day, until a difficult break-up triggered her to think ‘one more won’t hurt …’
This book provides a brutally honest account of Kemp’s escalating use of fentanyl, peaking at 60 lozenges every day. It is a vivid depiction of how addiction insidiously grows to dominate every realm of a person’s life, and how the ravages of withdrawal are a terrifying, ever-present threat. Kemp says, ‘there never seems to be the feeling that I’ve had enough. I am always wanting the next lozenge. The craving follows me around all the time, like a lost puppy.’
Kemp describes an increasingly fraught relationship with her GP, whom she calls her ‘dealer’. Her GP attempts to limit the lozenge prescription on many occasions, giving the reader a unique insight into the patient perspective of the classic ‘drug-seeking’ interaction: ‘I nod with a compliant smile. He signs my prescriptions. I’ll do anything, agree to anything, as long as he carries on signing.’
Painkiller Addict: From Wreckage to Redemption provides a gripping and realistic narrative of prescription medication addiction, and I was left with a much better understanding of why those addicted to painkillers behave as they do.