In 2016 a recovering opioid addict underwent hip surgery in Michigan and was given 50 oxycodone pills to deal with the pain. Instead she died of an overdose.

The hospital where she received her surgery didn’t know of her addiction or recent stay at a substance use disorder treatment clinic because of privacy laws designed to protect recovering addicts from discrimination.

In balancing the two concerns, the system failed. A new law has been proposed to correct this, but that leaves a broader question: what does a recovering addict do about pain, especially surgical pain?

Even when the surgical team knows the patient is a recovering addict, sometimes anesthesia that includes opioids are used.

That’s what happened with another patient in Massachusetts. The surgeon, James Shenko, and the anesthesiologist discussed it beforehand. The patient had been on Suboxone – a maintenance/recovery drug containing buprenorphine that stops the opioid craving but (at proper doses) doesn’t cause a euphoric “high” – and there’s evidence that patients on Suboxone can handle opioid anesthesia.

But the patient was no longer taking it, and came out of surgery begging for opioids for the pain. With reservations, Shenko gave them to him, reasoning that if he didn’t, the patient would find opioids elsewhere and self-medicate.

Shenko’s reasoning was sound. The patient later died of a heroin overdose. The new law wouldn’t have prevented that tragedy.

We don’t use anesthesia or pain killers (only) because we’re wimps, but because tissues heal better when there is less pain. Inadequate pain prevention can cause chronic pain. There are other painkillers, and other ways to control pain , but opioids, even though they are addictive, do work, at least in the short term. Over time, users develop tolerance and need to take stronger doses or switch to stronger drugs.

Shenko now believes that in such situations doctors should consult an addiction specialist. Such a specialist could evaluate if a renewed maintenance prescription was necessary post-surgery, or a further stay in a “sober living environment” or rehab clinic.

Others say that we need to moderate out expectations. To an extent, we have become wimps. We demand that pain be completely eliminated. Selwyn O. Rogers Jr. of University of Chicago Medicine wrote that doctors need “to prepare the patient to expect some discomfort, realize that complete relief of all pain is impossible, and that the cost of trying” – which can include addiction and death – “is not worth it.”