drugs

  1. what do all you nurses think about methadone. we have a new doc on rehab. we have always given percocet, darvocet and tyl #3 for most pain complaints prn. if not relieved the old doc might order demerol prn im. this new doc automatically put her pts on mssr routinely--not prn.with percocet prn. the pts appear to be in no painbefore or after med given. some cannot wake up for therapy but still insist on having their med. now she has changed to methadone routinely with percocet in between. some on like 30mg tid. plus percocet every 4 hrs. most of us have no respect for this new doc because of various reasons. what are your thoughts????/
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  2. 7 Comments

  3. by   frustratedRN
    ive seen methadone used for pain control where i work. not sure why tho.
    more effective and longer lasting than mo4?
    i dont know that much about it.
    why not just ask the doc why they are oredering methadone rather than the old standby's.
    i have no problems asking questions like that and i tell them that im not questioning their orders, its just an fyi thing.
    im seeing more pain meds as scheduled meds these days but that doesnt mean i give them. many patients dont want those because they arent in any pain. i ask them and give them the choice and if they are sleeping (like most of them at 2am) i wont wake them up to give it.
    if you feel like your patient is being overmedicated then its up to you to hold the meds or at least get clarification from the doc.
  4. by   P_RN
    My experience has been that folks who want/ demand their meds....make it hard for the real pain patients to get an even break. Methadone has kind of a reputation preceding it, doesn't it? It was used for years to get people off of the street drugs..heroin etc.

    Methadone is a good, reliable and very inexpensive opiod medication. It is given on a routine basis by many pain management specialists to give some of their patients the first pain free days they have had in a long time. Methadone used as an analgesic may be dispensed by any pharmacy. Only Methadone used in narcotic rehab is limited to centers that specialize in this.

    Please don't blame the med or the prescriber. The tabs come in 5 & 10 mg. Mostly I have seen 10-20 as the equianalgesic dose for Oxycodone 5mg.

    What type of patient are we talking about? Are they ortho? CVA? Narcotic Rehab?

    P
  5. by   WriteStuff

    Hi Tiger,
    I was a little confused after reading your post.....only because I needed more information. What kind of "rehab" unit or facility are we talking about? What is "mssr?" I'm an old War Horse in the profession, so don't be too "amazed" at my questions.
    Just curious.....what happened to the "old" doc? And how long has the "new" doc been on the scene?
    I'll take a stab at answering your post based on the possibility that you are talking about a post-op ortho kind of rehab unit..........
    My experience tells me that such patients, depending on the kind of surgery i.e., hip vs. knee, etc. and their general overall conditon requires I.M. narcotic pain relief for the first 24-48 hours (possibly longer, depending on the surgery and patient) - but usually no longer than that. After that, pain relief is pretty well accomplished with some kind of p.o. analgesic such as Vicodin, Percocet, Percodan, Tylenol with Codeine, etc. Correct me if I'm wrong (anybody with more experience than I)......but what seems "peculiar" is using Methadone for pain relief for this kind of setting. I've used it in Oncology many times, for a variety of reasons, but never in an Ortho setting.
    I also thought, as I read your post, how we as Nurses have a tendency to be "speculative" about new members of the staff, be it Nurses, Doctors, or otherwise, until we see the "newbies" in action for a period of time. It sounds like you liked the "old" doc and were used to his/her way of doing things.
    Suggestion: Take your genuine concerns to your Unit Manager, or whoever is in Charge and hash things over a bit.

    Bonnie Creighton,RN
  6. by   Dplear
    Methadone is given quite frequently to kids with CF for pain control. It is very effective and cost efficient.
  7. by   tiger
    hi. thanks for all of your responses. i work on inpatient rehab in the hospital. some of these pts. are going home in a couple of days and are still on methadone + taking their percocet every four hours. doesn't matter the dx. whoever complains the most gets the highest dose. and yes i did like the old doc but not just because i was used to his ways but because his ways were to see and speak to the pt. daily. to actually look at wounds, bedsores, and actually assess the pt. to respond to pages timely and address concerns made by nursing, pts. family. he was treated unfairly by admin. and so he left. can't blame him but ooooh what we are left with for the most part. the one doc that comes now does so in the middle of the night-doesn't even speak to the pts. once he wrote a progress note that pt was stable, no complaints, blah, blah... the pt had been discharged that a.m. then he tried to have a p.a come to handle our unit but we do not except them. boy was he ticked. you have to catch them when they are around and remind them that the pt has staples that need to come out or that they need to include on the dc instructions a follow up for pt going home on coumadin to have pt drawn. or that the pt still has g-tube, has been on reg diet for weeks and is going home tom. shouldn't the docs know these things and be responsible to check them?? guess all that is nurses responsibility too. but half the time you tell them and they still write nothing. yes, i miss the old doc...
  8. by   nur20
    I HAVE WORKED IN DRUG REHAB CLINICS DISPENSING METHADONE AND PERSONALLY I WOULDN'T RECOMMEND METHADONE AS AN ANALGESIC. WITHDRAWAL FROM METHADONE IS ALMOST AS BAD AS HEROINE WITHDRAWAL. THE DOSE HAS TO BE LOWERED A LITTLE EACH TIME UNTIL IT IS DOWN TO '0' TO WEAN A PATIENT FROM IT. THEY CAN,T JUST STOP IT. VERY FEW CASES IV'E SEEN THAT CAN'T BE MANAGED WITH THE OTHER MEDS MENTIONED :
  9. by   aimeee
    Just had a pain control inservice this morning and methadone was one of the big topics. It seems like a very odd choice to be used for rehab. Wouldn't these be mostly folks that you would be expecting to wean off pain meds after a relatively short time?

    According to what we were told today it takes three days for Methadone to be fully loaded. A much better choice for people with chronic pain, rather than acute, because of this. Also, since it does take a few days to really be effective, you need something short acting, like MS-IR, for breakthru pain. It is the only one of the four big guns (ms-contin, oxycontin, duragesic, methadone) that is truly LONG acting. And it is CHEAP CHEAP CHEAP (especially compared to duragesic which just went up in price by 23%!)

    I'm a little confused by your reference to MSSR. I would think that would be Morphine Sulfate Sustained Release (MS-Contin, in other words.) Is this Dr. using both?

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