Hey Dawn, It's not a lecture about the evils of opiates, It's simply about using breakthrough meds when used in conjunction with LA meds correctly.
I can say that at the PM clinic that finally got my pain under control, one of the nurses from that hospital was going through at the same time. She had RA too, pretty severe where her arms were deformed to the point of arms so twisted inward the palms of her hands pointed outward. After titrating the right LA med, I saw her workng in the hospital about a month later, palms turned in and keeping up with the kids on the psych wing.
In her case, LA meds were the answer. It's much harder to bring a flair under control than it is to keep pain in check, that's the basic idea behind LA meds. When it becomes a quality of life issue, it's not a hard decsion, even knowing all the possible negitive consequnces and experincing many, the negative media, the freinds and family that know what you need to do and what helped their 3rd cousins husbands dog.
LA meds can be the right answer for some people. Just something to think about. Rheumy's aren't notorious for pain managment though, you may need to find a PM doc that can manage both the pain and the RA. They are out there.
Good luck, No lectures

Dave