[HM2Viking]

MYRTLE BEACH, South Carolina: People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it.
The amount of five major prescription painkillers sold at retail establishments rose 88 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.
More than 200,000 pounds (90,720 kilograms) of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.
http://www.iht.com/articles/ap/2007/...ld-of-Pain.php

[rehab nurse]

Thanks for the article link. I just finished reading it.

I am a chronic pain patient. My lumbar spine has severe DDD and 5 herniations. My pain doctor suspects I now have at least one herniation in the thoracic spine, but my horrible insurance I am paying under COBRA at 1000 dollars a month refuses to pay.

It is very difficult for people in my area to find a physician willing to prescribe opiates long-term. There are just 5 clinics in a 3 county area, a very busy, sprawling urban area. Only 2 of those clinics have doctors willing to write long-term opiates. I go to one of them. I was lucky that I was initially referred to one of them from my surgeon.

I am only in my 30's. Due to my back issues and cancer, I take morphine every day. My pain on a good day is never less than a 4. Usually around a 6-7. My case is a bit more difficult because I suffer from different types of pain and it is caused by multiple factors.

This article stirs up my biggest fear, something I worry about every day. That one day I won't be able to have access to my doctor, who helps me control my pain. Not just with pills, but with other modalities. I am looking at a lifetime of severe pain due to a workplace injury. I have seen so many specialists, surgeons, and other doctors and none of them has a great prognosis for me.

It makes me so angry that people are able to acquire opiates and other controlled substances illegally. It really fires up the DEA and they in turn turn up the fire on the legitimate doctors who prescribe. I feel it too, in the increasing amount of "rules" I must abide by to obtain my medications. It truly is a sad situation in my area. I can't believe how hard it is to find a doctor willing to treat chronic pain here. There are so many drug abuse cases here, and so many of those are people who obtain their drugs illegally. And that makes it very hard for people like me, who suffer in pain 24/7, and who follow the "rules".

I have to submit to so many things which make me feel like a common criminal, but I have to do those things to continue to get treatment. I am one of the so-called "lucky" ones, I guess in that I found a caring physician who is willing to treat me. But that doesn't stop my anxiety about the future, perhaps when I get older, and I am scared to think about the dose I will be on then. It's high enough now, and as I get more tolerant over the next few decades, I can only imagine the raised eyebrows I will see. What happens to me when my doctor moves or retires? Will I have to be weaned off after decades of treatment? Will I find another physician willing to treat? Or will I suffer in agony?

Being in pain 24/7 really has increased my awareness of the suffering that continues in those who are afflicted with chronic pain and the battle for adequate treatment. I sometimes think to myself that it is harder for the legitimate people to be treated than those who obtain their drugs illegally. I guess I don't know.

Nurses out there, PLEASE take care of yourselves on the job. Especially all the younger folks out there, advocate for proper resources to lift and care for patients. Take care of your back, cause it's the only one you've got. I don't want anyone to end up like me. Pain has cost me my nursing career and my life as I knew it.

[Quickbeam]

I am not surprised by the article. I oversee driving and health issues for my state. We see a staggering number of incidents and accidents related to OxyContin, methadone & muscle relaxant use. I see the medical records of about 100K people a year. I am overwhelmed by the number of people for whom the first level of pain relief is OxyContin, with no medical follow up. I've lost count of the number of people who had simple, "fixable" health issues that only after their license was threatened, got proper care and no longer had pain. A bone chip in an ankle, for example.

I write this as someone who has had a chronic pain problem since my teens (JRA). I'm all for people being pain free. What I find with the pain clinics is that they never seem to caution people about driving and narcotic use. I can tell you that the old "oh if you really have pain it goes to the receptors and you are not excessively fatigued" is dead wrong for many many people.

[ERTraumaJunkie]

"In Appalachia, retail sales of hydrocodone — sold mostly as Vicodin — are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee."

Yep, I see that everyday. As a rural ER nurse in Tennessee, I contribute to the increasing number of prescription drug addicts everyday I work. I'm sorry, but I just don't think a pre-teen suffering from her first case of menstrual cramps should be given a Nubain/Phenergan injection and sent home with a RX of hydrocodone. I don't even want to think about what kind of pain management program she'll be on by the time she reaches adulthood.

Basically, in the ER I work in, if you ask for it, you get it. Come in obviously high...ask the ER doc for Xanax cause you're having marital stress and hydro's for your chronic back pain, you're going home with a script no matter how hard we nurses protest that the patient is already stoned!!!

I don't get it. And before I get blasted, I'm not talking about patients with legitimate pain issues. I'm talking about the patient that received a script for 12 Lortab 7.5mg yesterday for an ingrown toenail and comes back 24 hrs later for another script because he's out!! (That averages to 1 tablet every 2 hours in case you're wondering).

All of our doctors except for one old school doc, give the narcs out like candy. We have one migraine patient that has been in 96 times this year for headaches. 96 times!! She doesn't even pretend to be sick anymore. She comes in smiling and sometimes even cooks for us right before her visit. ***** When I have a severe headache with nausea and vomiting, I don't feel like cooking. She gets her daily shot of love (Nubain/Phenergan: our house special) and goes her merry way.

Many days it disgusts me. Especially when you consider that all of the teenage OD's we've seen this year have been on RX meds, no cocaine, no meth, no inhalants. We hand the scripts out like crazy and the kids are getting high out of mom and dad's medicine cabinets. And I'm contributing to it. Makes it really hard somedays.

Is there anything that can be done? The docs b*tch about the pt's demanding the drugs, but go ahead and write the scripts anyway, cause we're all about customer service and we don't want anyone unhappy. No one is unhappy. They're all stoned!

[Quickbeam]

I just don't think a pre-teen suffering from her first case of menstrual cramps should be given a Nubain/Phenergan injection and sent home with a RX of hydrocodone. I don't even want to think about what kind of pain management program she'll be on by the time she reaches adulthood.

I agree 100% and that's a better statement of the problem than my post. If you start people out with narcotics for minor pain issues, there is nothing left in the arsenal later.

[rehab nurse]

Originally Posted by Quickbeam

I am not surprised by the article. I oversee driving and health issues for my state. We see a staggering number of incidents and accidents related to OxyContin, methadone & muscle relaxant use. I see the medical records of about 100K people a year. I am overwhelmed by the number of people for whom the first level of pain relief is OxyContin, with no medical follow up. I've lost count of the number of people who had simple, "fixable" health issues that only after their license was threatened, got proper care and no longer had pain. A bone chip in an ankle, for example.

I write this as someone who has had a chronic pain problem since my teens (JRA). I'm all for people being pain free. What I find with the pain clinics is that they never seem to caution people about driving and narcotic use. I can tell you that the old "oh if you really have pain it goes to the receptors and you are not excessively fatigued" is dead wrong for many many people.

This surprises me. I too, when first put on a strong opiate, was told I could drive. I was put on fentanyl patch, after trying other combination types of meds for years. Anyway, I didn't agree that I could drive, nor did I. I don't want to hurt someone's family. I could never live with myself. This was a "nurse" giving info I thought, until my follow up visit, I found out she was a MA. The doc was livid when I told him what she told me.

However, I have been on opiates for years now, and have been tested so many times for impairment. I paid a lot of money to see whether or not I showed signs of impairment, and I got a clean bill of no problems. I still don't drive, though. The only time I notice (or anyone else notices, for that matter) a change to being fatigued is when my meds are adjusted. But usually within a few days I am fine. No one who is unaware of my status can tell I take opiates. I know some people won't believe this, but it's true. And believe me, I take all safety precautions possible.

Some people are okay, and in my state, you have to be seen by an addictionologist once a year who reviews your meds and your cognitive state to continue receiving opiates. You also have to go to the doctor once a month to be seen, meds counted, urine tests, etc. There are only a couple physicians in this huge urban area who prescribe long-term opiates.

It took 7 years for me to find an acceptable pain management regime, and it does include daily opiates. Believe me when I tell you I have tried every non-pharmalogical alternative possible before resorting to taking these meds.

I know from seeing records of pain patients that there are a TON of people who drive on strong opiates, and no one is told not to drive. That scares me to death. I choose not to drive, but I am not forced to. My doctor has given me permission to drive, as he sees no problem with my cognition, and he has tests that show I am alright. It is my choice not to drive. If something happened to a family or an individual due to my actions, I would be devastated. I know other people are not so lucky to have someone to drive them somewhere, and there are not a whole lot of public transportation or alternate transportation services available. But I know in this state, if they are following the rules, they have to be seen monthly, and go through all kinds of tests to make sure they are not abusing and are not a problem.

My doctor even said he wants me to go back to work, but I am applying for disability. I don't want to be on a floor working while on opiates, and that's my own choice. I know some who do, and they do absolutely fine, but they have managers who are accepting. There is no law in my state against nurses working while on opiates that are legally prescribed. If a nurse is able to still contribute to the needs of patients, and has been screened for impairment, I think that's their choice. I choose not to because of my own number of health issues, but it is still a decision I struggle with. I do miss nursing.

Anyway, I am just interested in how it is in your state and why patients don't need follow-up? Who prescribed these meds without following up on their patients every month?? That is frightening.

[rehab nurse]

Originally Posted by ERTraumaJunkie

"In Appalachia, retail sales of hydrocodone — sold mostly as Vicodin — are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee."

Yep, I see that everyday. As a rural ER nurse in Tennessee, I contribute to the increasing number of prescription drug addicts everyday I work. I'm sorry, but I just don't think a pre-teen suffering from her first case of menstrual cramps should be given a Nubain/Phenergan injection and sent home with a RX of hydrocodone. I don't even want to think about what kind of pain management program she'll be on by the time she reaches adulthood.

Basically, in the ER I work in, if you ask for it, you get it. Come in obviously high...ask the ER doc for Xanax cause you're having marital stress and hydro's for your chronic back pain, you're going home with a script no matter how hard we nurses protest that the patient is already stoned!!!

I don't get it. And before I get blasted, I'm not talking about patients with legitimate pain issues. I'm talking about the patient that received a script for 12 Lortab 7.5mg yesterday for an ingrown toenail and comes back 24 hrs later for another script because he's out!! (That averages to 1 tablet every 2 hours in case you're wondering).

All of our doctors except for one old school doc, give the narcs out like candy. We have one migraine patient that has been in 96 times this year for headaches. 96 times!! She doesn't even pretend to be sick anymore. She comes in smiling and sometimes even cooks for us right before her visit. ***** When I have a severe headache with nausea and vomiting, I don't feel like cooking. She gets her daily shot of love (Nubain/Phenergan: our house special) and goes her merry way.

Many days it disgusts me. Especially when you consider that all of the teenage OD's we've seen this year have been on RX meds, no cocaine, no meth, no inhalants. We hand the scripts out like crazy and the kids are getting high out of mom and dad's medicine cabinets. And I'm contributing to it. Makes it really hard somedays.

Is there anything that can be done? The docs b*tch about the pt's demanding the drugs, but go ahead and write the scripts anyway, cause we're all about customer service and we don't want anyone unhappy. No one is unhappy. They're all stoned!

Wow. I have always given ER nurses a hat's off. I could never handle that job. I don't think I'm smart enough, for one. But, I can understand your frustration of a teen coming in for "menstrual cramps" and getting Hydrocodone!!! WOW!!! When I first hurt my back, and had TWO severe herniated discs, with cord impingement and sciatica, I was started on Naprosyn. It took four years of PT, massage, accupuncture, moist heat, etc, before I could even move up on the scale...to Darvocet. Then another year after I had a back surgery to start on more potent opiates. I'm not saying this teen didn't hurt, cause I have been there, and suffered for years with endometriosis/PCOS, fiboids, etc, but I never got more than a NSAID for that. Or Toradol, which helped. I never got any type of opiate for those "female" problems.

I don't know why your docs gripe about handing out narcs "like candy" but then continue to do so. Maybe they're burnt out and are tired of hearing the pt's complain, but that's still not a good reason. With the DEA on doc's breathing down their necks, I am surprised they don't have more stringent guidelines.

I suffer from migraines as well, but I have never used opiates for it. I am not saying that other people, with various issues, like migraines/reproductive pain, do NOT deserve opiates, but I think that there needs to be strict follow-up, and they need to be evaluating the person's prescription records to make sure no doctor-shopping is going on. They certainly check my prescription history every month at the pain doctors. I feel like a criminal when I go there, but I understand it is these people abusing the system making the problems for me. I go along with it, only because the opiates give me a pain level of 4-5, rather than 10, and at least make me able to walk sometimes without having to use a w/c.

Pain has been a touchy subject. Until there is a way to objectively determine it, I think we will always have these problems. I can see it bothers you so much to have to feel like you're contributing to addicts. I don't know how you ER nurses do it. We've debated pain, esp chronic pain, on this forum before, and I never understood the ER nurses opinions until they told me what really goes on down there. I think they see so many abusers of the system that they get jaded sometimes. I can understand that. If I had to see it all the time too, I know I would. But you ER nurses are a special breed, and I know you work hard to help those of us who are really in pain.

I have always locked up my opiates and other controlled substances in a lock box. My kids are young, but I don't want them having access to it. They have no idea where I hide the box either. I had a friend, who is a MS patient in severe pain, who has a teenager. This teenager had a "DARE" drug program at school, and the teacher said, "All these drugs are very bad", and the boy went home, and flushed his dad's morphine down the toilet. He didn't get taught that some people need these medications for legit reasons. Everything was fine the next day, but my friend had a rough time until he could prove what happened. I remember when I had some Actiq suckers when I first had my cancer surgery, and the pharmacist warned me to lock them up. Apparently a child of a patient at that pharmacy got a hold of the sucker and died. I did lock them up, because I have always locked my opiates up.

It is such a battle going on. The amount of people in severe chronic pain will only grow as the baby boomers get older. I also know since the early 90's when the "pain" movement got larger, more physicians started prescribing, because of patients suing for lack of pain control. It is a frustrating battle.

And the makers of Oxycontin lying about the addictive nature of their drug to FDA, physicians, and patients didn't help matters. There have been so many deaths because of that medication, and it really has been one of the bigger problems in this area along with fentanyl. I don't know what the answer is. I just think the whole situation is a mess. I am glad Purdue Pharma was found out and will have to pay for the problems they caused.