Accidental Pill Pusher - page 2

Accidental Pill Pusher In the early 80’s nursing education about pain management took a turn. Gone were the days of observing the patient for non-verbal signs of pain or of watching the clock to... Read More

  1. by   BostonFNP
    Quote from Dohardthings
    I hope you read the whole article and not just what was quoted, because there is sooo much more. Also most pain scripts are not "recycled", they are stolen from someone who rightfully was using all of it.
    I did read it all. The article highlights a number of concerns in inappropriate prescribing that need to be addressed so that those that truly need the medication can safely get it.

    Can you cite your source that most of the prescription drugs on the street are "stolen"? In my clinic, like most every clinic I know, patients have to sign a contract that they can secure there medication and they know that they can not have replacement for stolen meds.
  2. by   LovingLife123
    This article shows me that nurses do not understand addiction either by most of these comments. It's not the simple, oh it started with a pain medicine prescription for a toothache. The problem of addiction is much deeper. By placing the problem squarely on the pills, it's leading to much bigger problems.

    Everybody thinks, lets just stop prescribing. Hold the doctors responsible for this mess. No, that's not the answer. The addicts simply then turn to the street and start up on Heroin. I saw this happen to a community I used to live in. Our government patted themselves on the back for shutting down three doctors. The Heroin epidemic is now in full swing. Needle exchange stations have popped up. HIV is on the rise...... because nobody wants to take the actual time to understand and try to fix addiction.

    Meanwhile those with chronic pain are ostracized. Cancer is not the only painful condition out there.

    I strongly encourage nurses to attend an NA meeting. I did years ago and it opened my eyes. These people have problems that started way before taking a Percocet. Most were addicted cited to something else, the percocets were just cheaper. Their addictions often weren't any type of drugs, nonetheless they were an addiction. Pills were easier and cheaper.

    We need to fix why these people don't find everyday life satisfying. I feel that is a societal issue as well as the message is given everywhere that our lives have to be fulfilling and meaningful. People compare their lives to what they see from their friends on social media. They get depressed when they think they don't have as much or don't have the perfect life that all their coworkers and former classmates have. There's too much to put into words on here. But you can see where I'm going.

    We are not the pill pushers. The doctors did not create this. Acute care is not the place to fix this. I'm not treating the pain I see on my unit with an ibuprofen. And while I explain to each patient that their pain will not fully be gone even with narcotics, I do my best to get it under control.

    I'm tired of the evening news doing shows on it every night. Those people understand the least and the pendulum is getting ready to fly in the wrong direction 100% with people who are in horrible pain getting a Tylenol and ibuprofen which is laughable, to say the least. I've never had a Tylenol do anything for pain. It helps with fever. Too many ibuprofen will destroy your stomach.

    Let's actually deal with the problem. It's going to take a lot of money and work, but let's actually get the government and mental health professionals to deal and fix the problem.

    I'm not going to at my level, nor do I want to. I don't have the resources nor do I have the time at the acute care level to do it. I'm treating their pain by the number I'm told.
  3. by   ItsThatJenGirl
    I have a condition that causes me a lot of pain - headaches mostly (Chiari Malformation). My day to day pain level is about a 4. I recently saw a new neurologist, and he prescribed me some meds for my breakthrough pain days (anything over a 7 or so I medicate). It did nothing for the headache I'd had for 5 months. I went back to him and told him that I had had Vicodin in the past with good results. He told me that there was a policy in place in their practice that they didn't prescribe narcotics. Not only was I made to feel like a drug seeker, but I was totally let down by my healthcare partner. He didn't offer me any other solutions (like seeing a pain doctor). He told me there was nothing else he could do for me.

    Luckily my primary care provider stepped in and gave me the prescription I needed. 20 pills will last me about year give or take. She's happy to help me manage my pain in a responsible way - working with me.

    In an effort to reverse the opioid epidemic, I fear there are many cases like mine. Being in near constant pain and then being treated like a drug addict can be so demoralizing.
  4. by   Dohardthings
    Quote from BostonFNP
    Can you cite your source that most of the prescription drugs on the street are "stolen"?
    Fueled by accessibility and high demand, medication theft-coined "pharmaceutical diversion" by the U.S. Drug Enforcement Administration-has escalated in recent years. The National Drug Intelligence Center reported that $184 million in prescription drug thefts occurred in 2010-a 350 percent increase since 2007. Particularly vulnerable are older adults, who may fall victim to unscrupulous caregivers or family members, or even to strangers hunting for an easy target.

    Article after article talking about drug diversion. Plus, being related to pain pill addicts, I know how they get them. Easier to swipe someone else's pills then go through the charade of doctor shopping.
  5. by   traumaRUs
    Great article. Chronic pain and acute pain require two different kinds of pain management.
  6. by   BostonFNP
    Quote from Dohardthings
    Fueled by accessibility and high demand, medication theft-coined "pharmaceutical diversion" by the U.S. Drug Enforcement Administration-has escalated in recent years. The National Drug Intelligence Center reported that $184 million in prescription drug thefts occurred in 2010-a 350 percent increase since 2007. Particularly vulnerable are older adults, who may fall victim to unscrupulous caregivers or family members, or even to strangers hunting for an easy target.

    Article after article talking about drug diversion. Plus, being related to pain pill addicts, I know how they get them. Easier to swipe someone else's pills then go through the charade of doctor shopping.
    Drug diversion is far more encompassing than theft of a script. Statistically the majority of diversion comes from family members and friends.

    From the NDIC:
    "NSDUH data show that among individuals aged 12 or older who used prescription opioid pain relievers nonmedically in the past year, 56.5 percent reported that they acquired these drugs from a friend or relative for free. Additionally, 81 percent of those who acquired the pain relievers from a friend or relative indicated that the drugs originally were acquired from one doctor. NSDUH data also show that 18.1 percent acquired the drugs directly from one doctor, 8.9 percent bought the drugs from a friend or family member, and 5.2 percent stole them from a friend or family member."

    As a prescriber, these data are troubling to me. I don't seen any evidence here that "stolen" scripts are the majority of diverted pills.
  7. by   BostonFNP
    Quote from ItsThatJenGirl
    Luckily my primary care provider stepped in and gave me the prescription I needed. 20 pills will last me about year give or take. She's happy to help me manage my pain in a responsible way - working with me.
    This is an example of appropriate prescribing. Any reasonable plan to address the opioid epidemic shouldn't have any effect on this practice, though I have concerns it will. I hope nothing changes for you.
  8. by   wernicke
    It's paradoxical, but I think de-stigmatizing meds for mental illness such as SSRIs will help here. So many people with addictions are self-medicating. I knew someone whose son had an addiction problem, it started when oxycodone post op all but cured his severe anxiety, and so he kept taking it just to get relief from the anxiety. Over time, this led to dependence and then addiction that, as tolerance built, evolved to a heroin addiction. Thankfully, he got the help he needed. Had there been less stigma in asking for help, he could have been put on the Prozac that keeps him mentally well now long before he was exposed to the oxycodone.

    It does stink that pain has to be tolerated to some extent. I think information can help patients, letting them know the risks and the benefits. I have a rare neuro/endo condition that opiates could've exacerbated the heck out of. It's too rare for there to be enough data, but any risk was too much for me. Hence, I skipped them after major abdominal surgery. Toradol was a godsend, and so was thinking of what would've happened had the other condition relapsed. Pain didn't seem so bad when the alternative was a free, one-way trip back to 2011 when I was the sickest I'd ever get from anything. I was the one really insistent on trying to do it without narcotics, but had it been the other way 'round, and had I not known the rationale behind it, I think it'd have been tougher to take. So we need to be clearer communicators.

    Also, some non-pharmacological pain management techniques really, really work. A close family friend taught me one that he sort of discovered by accident himself but works better than anything else I've tried: press fingertips against each other, all at once. I suspect the sensitivity of the fingertips plus the fact that pressure and pain are sensed by the same nerves may "trick" the brain into prioritizing that sensory data. It really does cut the pain. Doesn't cure, but noticeably helps.
  9. by   macawake
    Quote from jeastridge
    In its place came the pain scale that we use today and the altogether new approach, "A patient's pain is what they say it is." Unspoken was the undercurrent that pain is the enemy to be removed completely whenever possible.
    Well, I think that most people agree that pain negatively effects quality of life and as nurses we know that it has many physiologically detrimental effects on the human body. So yes, I agree with thinking of pain as an enemy. It's only really useful in the ultra-short term when it signals to us that we should pull away from/stop doing whatever's causing the pain in order to protect us from sustaining further injury. Beyond that, it's just one huge stressor on the body.

    Quote from jeastridge
    Studies show that initial dependency often happens after surgery for orthopedic problems, wisdom teeth or other "routine" procedures.
    Could you provide links to those studies?

    Quote from jeastridge
    I tried to point out in my article that chronic pain is a separate category and that there are no easy fixes--no one size fits all--when it comes to pain management. I hope that I was clear in pointing out that one of our primary concerns as nurses is for us to begin to shift our teaching--especially with acute pain--so that narcotics become second line drugs instead the go-to answer for short term pain management.
    Quote from jeastridge
    Teach better.

    We can start now with modifying how we teach our patients about narcotic use for post operative pain and chronic pain. Simply taking time to discuss non-narcotic pain relief legitimatizes it and helps it be the first line of defense when pain begins. NSAIDs, Tylenol, ice, heat, distraction, music, topical analgesics are all part of our arsenal of tools for addressing pain. The simple expectation that narcotics are a second choice can open doors for patients who are looking to manage their pain in ways that don't promote dependency.
    (my bold)

    While I have no doubt that you are well-intentioned I always worry when I read posts like yours, describing the problematic "opioid epidemic" and suggesting that the solution to it can be found in the acute care setting, and in how we manage postsurgical pain. I think that this fear (sometimes bordering on hysteria/moral panic in my opinion) of causing addiction negatively affects many patients, both individuals who suffer from chronic pain and patients who have recently had surgery.

    There's nothing wrong with a multimodal approach to pain treatment for postsurgical patients (the same goes for chronic pain) and I'm not saying that many of your suggestions don't have merit. They do. But opioids often (almost always, unless the surgery is very minor) have to be the first choice in the immediate period following surgery. You will not cure the opioid epidemic in the acute care setting. It's not the time nor the place.

    Pain isn't "innocent", it isn't a mere nuisance that we can stoically suffer through without any ill effects.

    Undertreated postsurgical pain results in needless suffering for the patient. The sustained stress response that is the result of undertreated pain causes elevated catecholamines, cortisol and increased catabolism. That is not beneficial. It increases anxiety, leads to poor sleep, limits mobility, increases risk of thrombosis, pulmonary morbidity (both pneumonia and embolus), suppresses the immune system, delays wound healing and increases the risk of infection and also increases the risk of the pain becoming chronic (persistent postsurgical pain).

    Please don't let your fear of opioids make you undertreat your patient's pain. It will hurt them.

    Before I became a nurse I've had half a dozen surgeries, several of them traumas. Fortunately I had nurses and physicians who weren't in the least bit scared of opioids and they treated my postsurgical pain to as close to zero as they could come. That allowed me to heal and do my physiotherapy and recover fully with no sequelae. I never needed opioids for much more than a week after any surgery and sometimes just days, but they would have treated me for as long as it was necessary. I'm glad I had knowledgeable healthcare professionals.

    These days, I make sure that my patients are as pain-free as I can make them.




    "Old-ish" but still relevant:

    Improving the Quality of Care Through Pain Assessment and Management - Patient Safety and Quality - NCBI Bookshelf

    Understanding the physiological effects of unrelieved pain | Practice | Nursing Times
  10. by   Dohardthings
    Quote from macawake

    These days, I make sure that my patients are as pain-free as I can make them.
    Super love your post.

    I have had 28 surgeries. I have adverse reactions to everything but Dilaudid. And do you know when the last time I have had Dilaudid? Yea, neither do I because it has been years. But I know what it is like to have pain so rough that I passed out, my body compensated, but I sure and heck wasn't recovering. Pain is subjective, period. Opioid addiction stems from mental health deficiencies and not supporting the healthy growth of our youth. We need to spend the money and time towards mental health.

    Pain Management in the Critically Ill

    Discovery of Unexpected Pain in Intubated and Sedated Patients

    https://www.aacn.org/docs/cemedia/C1533.pdf

    Knowledge and Attitude about Pain and Pain Management among Critical Care Nurses in a Tertiary Hospital | Insight Medical Publishing
  11. by   HH_RN13
    I agree that opioids pose a big risk to people and we as nurses must educate our patients about every medication they are taking and the risks and benefits of each one. And it shouldn't stop at opioids. Too many cases I've seen of patients with liver failure and major Gi bleeding due being in a lot of pain and using Tylenol and ibuprofen with little relief, thinking that taking more pills would provide better relief only to end up still in pain and in the hospital needing a new liver or multiple transfusions to keep them alive. For each pain there should be a solution, but some providers are too quick to brush off people with real pain and label them as drug seekers, refuse to give them appropriate treatment and leaving them to rely on self medicating. Opioids just like any other drug have risks and benefits. And it's not all size fits all. Some people require opioid to get the relief they need and to function, others could be managed with something less potent. The opioid crisis has created fearful patients, doctors, and nurses - which in turn does not benefit anyone. I see on the news all the time huge pain clinics being raided and closed because careless money hungry doctors and drug dealers misuse the medication that has the potential to help so many who are in real pain. I guess my point is that I agree with you that we need to provide better education to our patients about ALL medications they are taking, but education must also be provided to doctors to better understand how to treat pain. I have many patients who have opioids prescribed to them for years, and they use it only when the pain is above 7. And I also had several patients who took opioids round the clock for weeks after surgeries or small procedures, thinking there was no problem. I take my time to teach them all on alternative pain relief measures. what I notice most of the time is that those who become addicted are with mental health issues, anxiety, and underlying depression. As a previous poster mentioned, better mental health system may help solve the problem much better than labeling opioids as the problem in itself.
  12. by   jeastridge
    Quote from LovingLife123
    This article shows me that nurses do not understand addiction either by most of these comments. It's not the simple, oh it started with a pain medicine prescription for a toothache. The problem of addiction is much deeper. By placing the problem squarely on the pills, it's leading to much bigger problems.

    Everybody thinks, lets just stop prescribing. Hold the doctors responsible for this mess. No, that's not the answer. The addicts simply then turn to the street and start up on Heroin. I saw this happen to a community I used to live in. Our government patted themselves on the back for shutting down three doctors. The Heroin epidemic is now in full swing. Needle exchange stations have popped up. HIV is on the rise...... because nobody wants to take the actual time to understand and try to fix addiction.

    Meanwhile those with chronic pain are ostracized. Cancer is not the only painful condition out there.

    I strongly encourage nurses to attend an NA meeting. I did years ago and it opened my eyes. These people have problems that started way before taking a Percocet. Most were addicted cited to something else, the percocets were just cheaper. Their addictions often weren't any type of drugs, nonetheless they were an addiction. Pills were easier and cheaper.

    We need to fix why these people don't find everyday life satisfying. I feel that is a societal issue as well as the message is given everywhere that our lives have to be fulfilling and meaningful. People compare their lives to what they see from their friends on social media. They get depressed when they think they don't have as much or don't have the perfect life that all their coworkers and former classmates have. There's too much to put into words on here. But you can see where I'm going.

    We are not the pill pushers. The doctors did not create this. Acute care is not the place to fix this. I'm not treating the pain I see on my unit with an ibuprofen. And while I explain to each patient that their pain will not fully be gone even with narcotics, I do my best to get it under control.

    I'm tired of the evening news doing shows on it every night. Those people understand the least and the pendulum is getting ready to fly in the wrong direction 100% with people who are in horrible pain getting a Tylenol and ibuprofen which is laughable, to say the least. I've never had a Tylenol do anything for pain. It helps with fever. Too many ibuprofen will destroy your stomach.

    Let's actually deal with the problem. It's going to take a lot of money and work, but let's actually get the government and mental health professionals to deal and fix the problem.

    I'm not going to at my level, nor do I want to. I don't have the resources nor do I have the time at the acute care level to do it. I'm treating their pain by the number I'm told.
    You do a good job of pointing out what a multi-faceted problem this is. It encompasses all of society--not just nurses or health care providers. But we all have a part to play in reversing directions. Together, we can make a positive impact and help our friends, family and patients who are addicted or who are at risk. We must work together. Joy
  13. by   jeastridge
    Quote from ItsThatJenGirl
    I have a condition that causes me a lot of pain - headaches mostly (Chiari Malformation). My day to day pain level is about a 4. I recently saw a new neurologist, and he prescribed me some meds for my breakthrough pain days (anything over a 7 or so I medicate). It did nothing for the headache I'd had for 5 months. I went back to him and told him that I had had Vicodin in the past with good results. He told me that there was a policy in place in their practice that they didn't prescribe narcotics. Not only was I made to feel like a drug seeker, but I was totally let down by my healthcare partner. He didn't offer me any other solutions (like seeing a pain doctor). He told me there was nothing else he could do for me.

    Luckily my primary care provider stepped in and gave me the prescription I needed. 20 pills will last me about year give or take. She's happy to help me manage my pain in a responsible way - working with me.

    In an effort to reverse the opioid epidemic, I fear there are many cases like mine. Being in near constant pain and then being treated like a drug addict can be so demoralizing.

    Thank you for sharing so personally. Your post highlights the need for all of us to keep working together. The answer is not simple and does not involve a uniform approach. I hope that all of us can see that and continue moving forward together with compassion and hope. I wish you the best! Joy

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