Story seduction and the opioid crisis

May 11, 2016

It was Saturday evening and Audrey G lay awkwardly on an emergency department stretcher in search of a comfortable position. She suffered from chronic hip pain, the unfortunate and unexpected effect of pelvic surgery. But her real chief complaint involved her drug-abusing husband, who that morning stole her recently filled bottle of oxycodone, an opioid pain medicine. Her story included the surgeon who doubted her pain and a year of failed therapies. Now only oxycodone touched the pain, or so she said, fighting back tears. The on-call physician didn’t know her and said to go to the ER.

Any decision that involves prescribing an opioid asks that I pivot in a space mined with judgment and peril. Studies show that four of five new heroin abusers began their habit by abusing painkillers, and opioid painkillers and heroin have a heavy hand in the 47,000 lives lost prematurely in a single year from drug overdoses.

To be an emergency physician requires, first and foremost, being a skilled story listener. Before I can fashion a response or formulate a plan, I must first understand the patient’s story. This isn’t earth-shattering news. Humans, a group that includes both physicians and patients, have been using stories for thousands of years to communicate, connect and forge relationships. Read the rest of this entry »