Addiction

Adriane just had dental surgery and the surgeon provided a prescription for Tylenol with codeine. When she told him that opioids were not better than over-the-counter (OTC) painkillers for dental pain, the surgeon argued, “But it’s such a weak opioid.” And then he said, almost to himself, “Well, I guess it does turn to morphine in the gut.”

Back when we were in training, more than 30 years ago, opioids were considered dangerous drugs that could cause addiction and life-threatening respiratory depression. Medical students were taught that opioids were very useful for end-of-life pain (especially for cancer, which can cause excruciating pain) and that they were important for a few days after surgery or a severe injury.