Editor’s note: This post is not intended as medical advice. Always consult a medical professional or physician before treatment of any kind.
On the way home from the hospital after my second C-section, my husband, newborn, and I stopped at the pharmacy to drop off the prescription my doctor had given to me. It was for 60 Percocet. As a person who was experiencing minimal recovery pain, I knew the number was extreme. But as an opioid addict, I was elated.
I wasn’t the only new mother in the U.S. sent home from her C-section with an excessive number of opioids, though. According to a new study published just last month, 75 percent of women who used prescribed opioids after their C-sections did not use all of their pills, and of those, 63 percent stored their remaining pills in an unlocked location.
But those leftover pills are part of what’s contributed to the opioid crisis that’s now sweeping the country. According to a government study, 71 percent of people who abused pain medication did so with pills that were not prescribed to them. And while that’s not how I personally began abusing prescription pills, asking friends for their pills or even stealing from them is certainly how I supplemented my supply.
But there’s one doctor who’s on a crusade to make sure unused opioids no longer exist in the homes of new mothers — by never sending them home in the first place. And, with the help of a new drug, he claims to have a 100 percent success rate.
For the last seven months, Texas OB-GYN Dr. Richard Chudacoff has been treating his patients who receive C-sections with EXPAREL, an injectable, nonnarcotic medication that minimizes or even eliminates pain completely — and they’ve been amazed by their speedy and pain-free recovery.
EXPAREL works by targeting the muscle pain directly. Opioids, however, work very differently; they stop pain signals in the brain all together.
Dr. Chudacoff tells me that after he successfully delivers a baby via C-section, he begins suturing the mother’s womb back together. It’s at this point, right during the surgery, that he administers the EXPAREL. He makes multiple injections in a circular motion around the incision site to numb it fully. Because it’s in a targeted area, this is called a local anesthetic.
The key to EXPAREL’s success is due to a long-acting agent called bupivacaine. This specially-formulated ingredient slowly releases over time, controlling pain in a single dose. One application of EXPAREL usually controls pain for 72-96 hours, which allows for more healing. A typical analgesic, or pain reliever, however, only works for about 4-6 hours. The long-lasting effect of just one dosage is exceptionally helpful, since the doctor doesn’t need to use IV medications or any other restraint that inhibits a patient’s ability to get out of bed in order to extend pain control.
EXPAREL starts controlling pain during surgery, even before a patient is aware they’re having any pain. However, should EXPAREL not provide enough relief, it’s not incompatible with opioids; so if you still need them to manage your pain, you can safely take them.
“My goal isn’t to totally eliminate a patient’s pain,” Dr. Chudacoff explains. “I want to make their pain manageable. We all experience pain. As someone who’s getting older, I often wake up feeling like a three on a range from one to 10. The day after I play golf, I might even be a five!”
But Dr. Chudacoff’s patients do seem to be pain-free, or at least managing their pain well enough to make opioids unnecessary. So far, none of his patients who have used EXPAREL have requested prescription pain medications afterwards — Ibuprofen and Acetaminophen have been more than sufficient.
In addition to experiencing less pain, new moms who’ve used EXPAREL report faster than usual recoveries — not only his prior C-section patients, but even his patients who deliver vaginally. I spent days recovering from each of my C-sections; Dr. Chudacoff’s patients only take hours. Typically, three hours after surgery, the new mothers are out of bed. And, usually by six hours post-delivery, they have eaten. In fact, the average hospital stay for one of Dr. Chudacoff’s patients who delivers via C-section is only 1.2 days. According to the American College of Obstetrics and Gynecologists, most women who deliver via C-section typically stay in the hospital between two and four days. He even had one patient who felt good enough to grocery shopping two days after delivering her son!
Keely, who recently underwent a C-section performed by Dr. Chudacoff, says that prior to giving birth, she was worried. She had heard too many stories from friends and relatives about difficult and painful recoveries from C-sections. However, she was pleasantly surprised after Dr. Chudacoff delivered her son. Acetaminophen and Ibuprofen were sufficient to help with her pain. She didn’t need opioids in the hospital let alone a prescription to take home.
One of the hardest parts about recovering from a C-section is that you’re expected to take care of someone else even though you’re often unable to care for yourself. In the excitement and overwhelming need of a newborn, it’s easy to forget that we’re talking about a serious, major surgery. My husband took one look behind the curtain my doctor hung below my neck and exclaimed, “your insides are outside!” Doctors literally remove a woman’s organs before they can deliver a child, so they need to replace them before suturing her, layer by layer, back together.
Climbing steps, going to the bathroom, even something as simple as walking can be daunting and painful. You’re also in an incredibly vulnerable emotional state having just given birth. And yet, you need to care for a newborn who is incapable of doing a single thing for themselves (other than pooping, or crying, or being frustrating). The faster a woman can feel like herself again, the faster she can feel like a mother to her new child.
“I don’t know why this isn’t standard of care,” Dr. Chudacoff tells me during our conversation, and, frankly, I agree with him. Especially since there doesn’t seem to be much downside to EXPAREL — the most common side effects are nausea, constipation, and vomiting, but those are also common side effects of opioids.
As I mentioned, this story is personal to me — I became addicted to opioids about six months after my first son was born. My general practitioner prescribed them because I had a legitimate pain problem. However, I soon realized that in addition to alleviating my pain, the pills also eased my untreated postpartum depression and anxiety. But almost immediately, I began taking Percocet every day, regardless of my pain level.
Within weeks, I was addicted. Within months, I was doctor shopping to obtain multiple, concurrent prescriptions of opioids.
All told, my addiction lasted for two and a half years. When I found out I was pregnant with my second son, I immediately stopped myself — that very day — from taking opioids and other prescription pills like benzodiazepines (Xanax). And, for the months that I nursed him, I didn’t take anything that interfered with breastfeeding. But as soon as he weaned, I went right back to my habit.
Why might someone abuse opioids? According to the National Institute of Drug Abuse, opioids produce pleasurable feelings because the drugs affect the reward areas of brain regions. I liked taking them because they tamped down most of my feelings, masking my depression and lessening my anxiety. They didn’t make me feel drunk or high; I still felt like I was in control; I was just a softer, happier version of myself.
Every time I’ve written about my addiction, I’ve received messages from other women saying I’m not just sharing my story; I’m also sharing theirs. They also began using opioids to manage a pain problem. They also were self-medicating for an untreated mental health problem. And many of them are also mothers.
At least two of the women who’ve reached out to me began abusing opioids they were initially prescribed after their C-sections. *Laura (not her real name) told me that the pills gave her the “oomph” she needed to visit her twins in the NICU and go home to care for her other children. They gave her a “power” that she had never experienced before.
*Megan (also not her real name) said that when she used Percocet for her C-section “it was the first time I ever truly felt happy and stress free. I even thought it was ok to take other’s prescriptions because I once had my own. At the time I didn’t realize I was taking a drug and getting high. Once I found out what I was doing, I was horrified, but it was too late, I was already hooked.”
The irony here, is that opioid abuse can also cause depression, inadvertently exacerbating the very problem someone might be self-medicating for.
But this story isn’t just personal to me; it’s personal to Dr. Chudacoff, too — one of his close relatives is addicted to heroin. Just like many people, though, her first interaction with opioids wasn’t with heroin, it was with prescription pills. Pills prescribed to someone else. She began abusing drugs at 15 when a high-school friend shared opioids with her that he had stolen. At least 80 percent of heroin users did not begin their addiction by starting with heroin, Healthline reports — they graduated to it after abusing pills. And, once people use heroin, they are more likely to continue to abuse it, because it’s cheaper and easier to get than prescription pills.
It’s also far more addictive.
Of course, the best way to avoid addiction is to never use an addictive substance to begin with. If you don’t feel like you need opioids for pain relief, don’t take them. Don’t even fill the prescription. In a recent study, most women used opioids for eight days after their C-section surgeries. The longer you use opioids, even for only ten days, the more likely you are to abuse them.
And while there are certainly factors that increase your odds of abusing substances like having a family history of substance abuse or having a mental health problem, there is often no way of knowing how someone’s brain chemistry will react to a certain substance.
I was 33 when I became addicted to opioids. It was the first time in my life I had ever been addicted to anything. Although I had smoked cigarettes on occasion in college, I was never addicted to nicotine. I didn’t even drink coffee. Yet, opioids felt like the puzzle piece I didn’t know I was missing. For the first time, I finally understood how it might feel impossible to live without something.
There are a plethora of causes that have contributed to the opioid epidemic. The crisis has even gotten so bad that President Trump recently declared it a national emergency.
We all know that opioids should be prescribed sparingly. However, that doesn’t mean doctors who prescribe them or patients who use them should be vilified. Sometimes opioids really are the best way to manage pain — and in those cases, it’s totally okay and even necessary to use them. Using opioids isn’t necessarily a recipe for disaster; it just means that you need to be vigilant and check in with yourself that you’re using them when necessary for pain relief.
Addiction can affect anyone, regardless of age, gender, sexuality, or socioeconomic status. As I found out, it can even affect moms.
If you’re currently abusing opioids or any other prescription pills, please know that you’re not alone. Please know that help is available. I found help and got better — you can, too.