“What is your current pain level on a scale from 0 to 10?” This is the first thing I remember the nurse asking me after my surgery. I don’t know how many times I was asked this, not because it was so many, but because of the anesthesia. I guess I told the nurse multiple times that the surgery was going to cost a lot of money because I didn’t have insurance. Apparently, it was on my mind.

Still, though, I know I was asked a few times. I figured they were concerned because I had told the anesthesiologist that I didn’t want any opiates when he told me he was going to give me something to help me relax right before I went into the operating room.

I had surgery on my hand to pin four of my metatarsals back to my hand bone above the wrist. The only explanation I’ll share is church basketball, the embarrassing details are not the story. The morning after my surgery, I was awakened by a phone call. It was the hospital checking on me and this time I know for sure, the very first thing they asked was if my pain was being adequately managed.

Now I don’t know at this point if I would have been given opiates depending on my answer; I hope not. In my initial consultation, my surgeon had not recommended opiates and I had told him I wouldn’t have taken them even if he had. He asked if I had had issues with opiates to which I affirmed and expounded on a little.

The facility and staff seemed very on board with my decision to avoid opiates. The pain questions are just part of their jobs. My friend in the nursing field was required to administer fentanyl to patients who were barely conscious if they answered ten to the question, “What is your current level of pain?” He hated the rules but followed them.

I imagine these caregivers genuinely care, but the procedures and rules are largely a result of something called HCAHPS. HCAHPS is a survey that links economic rewards and penalties to hospitals. Three of the questions focus on pain: During this hospital stay, did you need medicine for pain? During this hospital stay, how often was your pain well controlled? During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

A patient’s perspective on how their pain was managed is a large part of these “reviews” and are directly tied to financial incentives. Sometimes the best intentions have unintended consequences. It’s not the cause of the opioid epidemic, but doctors admit to over-prescribing to avoid penalties. I did some research and doctors claim most of their negative reviews are from drug seekers, which I totally understand.

The most negative and angry comment I’ve ever seen about my column was from a woman who felt I was somehow threatening her supply by saying I wish medical marijuana would have been an alternative option to opiates. I believe her visceral reaction and name calling was a direct result of her addiction. She wanted to make sure everyone knew she had legitimate pain and her drugs came from a doctor.

I don’t highlight this so I can get the last word; I’m making a point. Because her drugs were prescribed by a doctor and because she had legitimate pain, she believed that disqualified her from being a drug addict. She very clearly stated that distinction between her and myself, and therein lies the problem. I’ve been there. I was this type of drug addict for years before I became a criminal. People trust doctors and yet it’s really the patient’s decision. Before I broke the law by doctor shopping, I would manipulate the doctor into giving me what my body craved.

The pins drilled into my bones and sticking out of my hand have caused some pain, but pain is really subjective. If I have to put it on a scale from one to ten, I can only use personal experience. If I put this up to the hurt I felt in prison when my 5-year-old son told me over the phone he had forgotten what I looked like or the pain I felt when I thought about missing the next several years of him growing up, then this pain doesn’t even register on that scale.

I know that’s not everyone’s experience with painkillers, but it was mine and not unlike many others. I think the potentially catastrophic results far outweigh the benefits of making sure people are not uncomfortable.