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How to welcome back a colleague who is in recovery

February 15, 2018

About the Author

photo of Peter Grinspoon, MD

Peter Grinspoon, MD, Contributor

Dr. Peter Grinspoon is a primary care physician, educator, and cannabis specialist at Massachusetts General Hospital; an instructor at Harvard Medical School; and a certified health and wellness coach. He is the author of the forthcoming book Seeing … See Full Bio
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Eugen Ioanid
February 27, 2018

I am amazed that we ASSUME that Rx opioids are “gateway” drugs when heroine and fentanel (obtained by mail order from China as US Mail just can’t go through tons of mail and some who find it keep it for sale) are much too often the start drug with no gateway drug. So let’s stop blaming grandma for leaving around her unused pills, making them gateway for grandkids. The sutions to pain you offer: antidepressants and NDAIDs and Tylenol are extremely dangerous. But more important, middle aged people are not looking for a high, nor pain relief; THEY ONLY SEEK TO BE FUNCTIONAL AND GAINFULLY EMPLOYED. They do not look at drugs to make them happy. They want to be happy that they’ve got the job others depend on them to do DONE, period. Nothing is as effective as opioids in getting you to grin and bear it so that you can function and not be detoured by chronic pain. I won’t go into the physiology, but doses that do not leave abtunded do not block the sharpness of acute pain, only dial down chronic pain. The latter is what makes perseverance impossible while acute pain is deemed part of physical burden of effort. All the other pain suppressors weaken, dull and confuse the ability to follow through. Proof is that most opioid users suffering chronic pain stick to one dose indefinitely while users of the other drugs match and mix due to ineffectiveness or to full sideffects from these drugs. The trouble with opioids is that, over the long term, IN PEOPLE SEEKING ONLY TO CONQUER chronic pain enough to be functional, they block the pain and the job gets done but the warming offered by pain block results in inflammation, then fibrosis, permanent injury. But no antidepressant can cure the despair from inability of a mom or dad who fail to do what they feel must be done. Working with the relief from what you recommend leads to serious overdosing and/or side effects. The only gateway drugs are heroine, delivered to home-alone kids to the door by drug cartels and the fentynel delivered by the mailman from China. DEA is scapegpating MDs trying to give parents and grandparents enough relief so they can get the job done. We were not built to last past 40years old so they need opioids to get them by. But your analysis fails to note their critical duties done in pain made tolerable by opioids because you were blinded by the glare of reckless users for a high— a state whose dose requirement increases exponentially over time to where it causes respiratory arrest. But unlike the former, who must get it from the pharmacy, the latter get it delivered to the door on demand. Please don’t confuse the two, making the former suffer disability because you can’t think of anyway of controlling the illicit access of the latter.

Peter Grinspoon, MD
February 19, 2018


February 19, 2018

Wouldn’t a “good to see you, glad you’re back” greeting be appropriate in almost all cases?

Kenan Mirazli
February 15, 2018

Very helpful information! Thank you very much

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