For Michiganders in opioid recovery, surgery brings a new pain dilemma

An increasing number of patients are in recovery, assisted by drugs that help break those addictions
Doctors worry that drugs used to control surgery pain will trigger a relapse
A new study highlights a need for better guidance

The pain shot through her abdomen and wracked her body.

After 42 hours of labor and an emergency c-section, Allison Herrst was scared. She couldn’t walk and couldn’t sit or stand without help.

Worst of all: Herrst couldn’t pick up her 6-pound baby boy — a “tiny peanut,” named Davis. Even getting a drink of water seemed impossible against a wall of pain, she said.

“I wanted to be a mother, but I was just …” she paused, looking for the word… “incapacitated.”

It was 2020, and Herrst had been nearly seven years clean after an addiction to pain pills. But when it was time to leave the hospital with Davis, a discharging hospital doctor had refused to prescribe her painkillers.

“He said ‘you’re an addict,’ and that was it,” she recalled.

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At her Ypsilanti home two days after her C-section, “it was like my insides had been ripped open.”

A growing number of Americans are turning to medications to beat addictions to pain pills and other opioids. Others, like Herrst, have gone cold turkey.

Now, their doctors face a complex dilemma: how to manage patients’ pain without derailing efforts to stay sober.

A new study, led by a Michigan anesthesiologist and pain management doctor, highlights a growing gap between what doctors know and what patients — specifically patients who battle addiction — need.

It’s a gap in knowledge at the “intersection of surgery and (addiction) recovery,” said Dr. Mark Bicket, the lead author of the study.

Bicket’s work focused on a subset of people in recovery: Those who use medications such as methadone, buprenorphine or naltrexone to help beat back addiction.

Most of the patients in recovery in the study were on one of two medications: methadone and buprenorphine. Both reduce cravings and withdrawal symptoms. Methadone is typically dispensed in special clinics; buprenorphine can be dispensed in doctor’s offices and is also known by brand names like Suboxone and Sublocade. Naltrexone is also used to treat alcohol use disorder.

“We want to be really careful balancing pain control with potential relapse,” he said.

Bicket and his colleagues believed the numbers of these patients is increasing — as is the need to know how to properly manage their pain.

But by how much? they wondered. They turned to a database of 8.1 million surgeries across the US for the answer.

In 2022, nearly 241 in every 100,000 surgeries involved a patient on medications for opioid use disorder — an increase from about 154 for every 100,000 surgeries six years earlier, Bickett and his team found.

The results of the study were published this month in the peer-reviewed medical journal Anesthesiology.

Precisely how many Michiganders now use medications for recovery isn’t immediately clear, but Bicket and another University of Michigan research team behind a 2024 study found that about 26,000 people in the state each month had filled a prescription for buprenorphine at least once.

Drug-assisted recovery

Kicking addiction is hard.

Dr. Glenn Dregansky, a longtime family physician and an addiction specialist, says he’s now 22 years sober from his addiction to, among other things, painkillers. (Bryan Gutierrez for Bridge Michigan)

While some people may quit cold-turkey, others turn to medications for opioid use disorder — “MOUD” in recovery vernacular.

Yet when these patients needed surgery — to repair a shoulder or hip, for example — there are conflicting medical guidelines about how to handle their pain, Bicket told Bridge Michigan.

Doctors are unclear to what extent should patients continue recovery medications before and after surgery, and the optimal level of painkillers that won’t tip the scales into relapse.

As the number of patients in recovery increases — both those on medications and those who have quit cold turkey, doctors need more clarity on the best ways to control pain without opioids, he said.

Confusion, pain

That confusion has led some doctors to simply refuse to prescribe painkillers — in spite of guidelines from the American Society of Addiction Medicine, said Dr. Glenn Dregansky, a long-time family doctor and former chair of the Michigan Academy of Family Physicians.

He’s also in recovery, himself, and he’s a certified specialist in addiction medicine and prescribes buprenorphine for his patients.

Dregansky remembers one of his patients — a man using medications to assist in recovery — whose chest had taken a blunt force in a motorcycle accident. The man’s doctor had refused him painkillers.

“He was wide awake with his chest torn apart, on a ventilator — which is painful, in itself — and he was in agony,” Dregansky said.

People in recovery are wary of medical care for the same reason, said Herrst, now a southeast Michigan certified peer recovery coach and master social worker.

“There’s a fear: ‘What do I do if I ever need surgery?’” said Herrst, who also is the executive director of the Wayne-based Recovery Action Network of Michigan. “It’s tricky.”

No ‘one-size-fits-all’ answer

Herrst was released from the hospital with her newborn and instructions to use over-the-counter painkillers, such as Motrin.

Ultimately, her husband, Mike, convinced her to call her ob-gyn, who prescribed her opioid painkillers.

A woman plays a game at a table with a man and a young male child. — Allison Herrst, 41, her husband Mike Herrst, 32, and son, Davis, 5, play a game of dinosaur monopoly at the kitchen table in their Ypsilanti home. (Emily Elconin for Bridge Michigan)

But there was a plan. The doctor, Herrst, and Herrst’s sponsor in a recovery program agreed that Herrst’s husband would keep the medication, doling it out only as directed.

It worked. Less than two weeks later, she stopped using the opioid pain killers.

“It helped to have someone check in on me,” she said.

Three years later, it was a different story.

Herrst underwent surgery again, this time for nasal reconstruction and a biopsy to rule out cancer.

She was worried about the biopsy. She’d been trying to have another baby.

“Life was not going well, and then there’s this (drug-induced) euphoria in the hospital.”

This time, she said, the painkillers “gave me the urge to use again.”

Herrst demanded pain pills when she saw an ear-nose-throat doctor as a follow-up. The doctor refused.

Looking back, that doctor might have just saved her life, Herrst said. It would have been a short trip to relapse, she said: “I think about where I was physically, mentally and emotionally. I wasn’t in a good place.”

Hers is a cautionary tale, said Dregansky, the addiction specialist, now sober for 22 years.

Guidance is important, Dregansky said, but it also must accommodate different patients and ever-changing circumstances, Dregansky said.

“This really isn’t going to be one size-fits-all,” he said.

Bicket agreed, hoping that the new data will raise awareness about the need for guidelines as well as communication between doctors, patients and their loved ones for a “clear plan” around pain management.

“Our sense is that’s not happening right now,” Bicket said.

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