Managing Pain, Monitoring Addiction

Jocelyn Ligayo grew up in the Philippines, where controlled medications were rare and treated as something serious. When she moved to the United States at twenty and began working as a bedside nurse, one pattern kept catching her attention. Even a simple case of knee pain would come back with a prescription for oxycodone or hydrocodone, and she found herself asking why so many patients were being started on something so strong. She carried that question through nine years across the ICU, the ER, and med-surg floors, and then into a role in pain management, where she saw what the prescriptions did. Patients told her the medication had changed their behavior and strained their relationships with their families, and a close friend of hers became addicted. Her turning point was a young woman whose drug tests kept coming back negative, who returned every two weeks with the same story about lost or stolen pills, and who threatened Jocelyn's life the day the refills stopped. Jocelyn made a quiet decision about the kind of provider she wanted to be, and moved into primary care, serving people who are unhoused out of a rescue mission in Nevada. She arrived carrying the same assumptions many providers do, that homelessness came down to laziness and addiction came down to a choice. The stories she heard did not leave those assumptions intact. Most of the people in front of her had started using young, at a point in their lives when they felt no one was listening.