prescription drug addiction

Nurses General Nursing

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Noticed a Facebook "trending topic" this evening (early morning?) about neonatal abstinence syndrome and it talked about prescription drug abuse. Thought it was an interesting article.

Researchers say the increase coincides with the increase in opioid use in rural communities and rising prescription pill overdose rates.

Honestly, I would be happy if I never had to give IV dilaudid.

I have told all my docs and nurse friends, if I end up in the hospital, NO IV NARCS. I had auditory hallucinations when I had PO oxycodone after a knee surgery. I can only imagine that dilaudid would probably kill me.

If it's ordered, the patient asks, and vitals support the safe delivery of it, give it. One and done. There is no need to over-think this one.

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Specializes in PICU, Pediatrics, Trauma.
The addiction pretty often starts as acute management when narcs and other drugs with high addiction potential are given for no good enough reason.

The thing is, pain relief 30-40% (i.e. to 4/10 from 7/10, 10/10 being extremity amputation "as it is") is what considered by experts to be "adequate" in majority of cases. The people, though, expect and want 0/10, 10 being whatever hurts them now. That is simply not possible without narcs. So, a 17 y/o given given 30 pills of Norco5 to begin with for sprained ankle. Norco is hydrocodone. She feels 1) wonderful feeling of being OK in all capiral letter, and 2) no pain at all, so instead of RICE she goes back to her busy life and uses not yet healed joint, which thus never heals.

The PT/OT plus some Motrin would be more than adequate, but the nearest PT clinic is in 30 miles and works 9 to 5. The patient has a job, the employer won't let her get off early, won't find light duty, will just throw her out. School is of no help. And, yeah, her mom's insurance doesn't cover PT for dependants.

To cope with all that at once, she is given 30 of "nerve pills" (Xanax). And then things just go underhill from there.

Yep! Good example of how it begins. Especially for anyone depressed, has high

stress/anxiety or in general, an unhappy life...the immediate relief from all these discomforts is difficult to deny. It's like you are blocking a source of pain (emotional/mental as well as physical) and then the person has to willingly go right back to that pain.

Having said that, I am NOT suggesting we give Meds for these problems, just saying that is what it is like for people. Life is hard, then you die! There is no getting around the pain/discomforts of life. We all need to learn to cope in healthy ways as best as possible, but when someone gives you an "easy" out of that work, many want

the path of least resistance and the quick fix. (No pun intended)

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Specializes in PICU, Pediatrics, Trauma.
Obligatory not a nurse yet.

I have Chiari Malformation. I always have a headache - usually I can handle them with zero meds, but sometimes I can't. I can't get my PCP to give me a prescription for pain meds to have on hand for the bad days to save my life. He thinks that Advil or Aleve should be sufficient. It's not, not on the bad days - I can't move, speak or see on the bad days - and that lasts about three days at a time. A 'script for 30 vicodin would last me at least a year and give me some of my life back, but I'm refused that comfort and control over my own pain. And it makes me feel like I'm a drug seeker, which is a really, really bad feeling.

It sucks.

I understand and respect the need to be cautious, but I think sometimes that caution negatively impacts patients.

Yes, yes, and yes. It seems that pendulum swings too far in many cases. I would switch doctors. Or, why not suggest a contract with your doctor? 30 per year certainly shouldn't be

cause for concern with a legitimate cause. Too bad there isn't some way to have him/her experience that pain for even 5 mins....

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Prescription drug addiction.

On topic

It happens a lot.

I went to in for an ulnar surgery on my elbow because it was causing problems.

I got a lot of refills on hydrocodone. I was even explained that it was about money. That it was my choice that if I want that much.

In nursing it's notorious.

I've known people who have actually lost teeth due to this.

Prescription drug addiction.

It's real, know the symptoms.

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Methadone; no high and excellent pain medication. I wish they would give it to everyone who needs pain meds...especially the kids. My own niece was in an accident; I found out 10 years later she was a heroin addict (talk about skeletons). Chasing that high from the first Percocet. I know the kids need to take responsibility, but why start in the first place?

I found out because my sister finally called me and asked my advice whether my niece should go on methadone or suboxone. I said neither one...why replace a drug with a drug; she should go into a rehab. That was 10 years ago, and my niece still pulls the marionette puppet strings wrapped around my sister's throat due to her misplaced guilt of how she failed her only daughter.:banghead:

People hear methadone and automatically think addict, but that's not what methadone was/is intended for originally. They give the addicts methadone for maintenance because the methadone doesn't have a high (has long half-life too).

As far as psych patients; most of them don't run out of their meds, they feel so good they stop taking their meds or can't afford them (leastwise in the psych ward I worked at for over 3 years). Then they have an event and end up in the ER.

They're usually evaluated and sent to a psych ward on a 48/72 hour involuntary hold for eval.

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Methadone must be managed VERY carefully, it has a long half-life, and the prescriber must wean up quite slowly. It cannot (or should not) be prescribed casually.

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Specializes in POST PARTUM/NURSERY/L&D/WOMENS SERVICES.

"Why did I go through this whole story? My "new " PCP (I was her first repeat patient) that I had to go to because of my pain meds when I was discharged recently sent me this e-mail...."I know you still have terrible pain but "we" need to dc your pain meds with the opiate crisis they way it is." REALLY? What does a drug addict have to do with my pain"

YES! That...

I was recently diagnosed with esophageal cancer, secondary to grade D esophagitis...I have horrifying pain in the right side of my chest that pierces from front to back. I don't have it all the time, but when I do it is awful.

Upon d/c from the hospital I was given 30 tabs and told to follow up with primary care for refills.

After 2 weeks...yes 30 tablets lasted me 14 days...not abuse in any way shape or form, I requested a refill. My idiot family doctor who could not possible know the pain I have, states to me that I can have 1 5/325 tablet a day for 30 days, and there will be no refills, makes me sign a pain contract and states if I violate the rules I will never get pain meds from him again!

Are you freakin kidding me? When I went to the pharmacy with the script the pharmacist asked if he was retarded...I stated of course....

Good thing I know many street pharmacists...which is unfortunate that we are forced to seek help from shady sources when we have a legitimate problem...

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Interesting article! I am originally from a city that is having an opioid crisis (slightly different as it is mostly affecting people using street drugs but worth mentioning as some of these users became addicted to these drugs after being prescribed legal narcotics). I live/work in a different city now, but find that my patients have many of the same fears about taking opioids in this setting as the last, believing that it will lead to addiction.

Opioids are necessary medications for some conditions (i.e. intractable pain), beneficial in others (i.e. major surgery, fractures), and questionable in others (i.e. wisdom teeth removal). However, pain is subjective and if a someone is writhing in pain post wisdom-tooth removal, I would hope that their health care provider would prescribe adequate analgesic.

Furthermore, if a patient wants to explore and try alternative methods of pain control, I will support them. I work as a bedside nurse in an acute care surgical setting so this doesn't happen too often, but when it does I will advocate for alternative methods and connect the patient with appropriate supportive resources (i.e. spiritual care, music therapy). However, I will attempt to have as open and honest a dialogue as possible with these patients to ensure that it is not misinformation that is preventing them from taking opioids (which are often an important part of my current population's post-surgical recovery) and I will communicate my patient's wishes with the rest of the health care team.

The suggestions in this article as a means of addressing this issue are definitely important. I too believe there should be more education provided to the public about opioid use and misuse. There should also be more education to providers (tolerance vs addiction being a big part of this education) so that patients who need opioid analgesics aren't wrongfully denied them. In addition, I think there should also be more checks and balances (i.e. a national opioid dispensary system) to prevent addicted patients from using multiple providers and filling their prescriptions at multiple pharmacies. This would then promote identification of at-risk or drug-addicted patients. There should also be more resources for them to seek the help and support they need (i.e. on-line support as an aspect of a multi-faceted approach to reach remote rural patients.)

Hopefully, we can all agree that the last thing any of these patients need is to be stigmatized as that helps no one. To some extent, I believe we all need to feel a shared sense of responsibility for these issues as drug-addiction and dependency often have multi-factorial causes that are rooted in social and economic disparities.

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Methadone must be managed VERY carefully, it has a long half-life, and the prescriber must wean up quite slowly. It cannot (or should not) be prescribed casually.

I did say it has a long half life. Small does for a few days isn't going to hook the person and for those who need 24/7 pain management it's a God send. I think the government (who are the ones making all these ridiculous laws governing people with chronic pain) would look at it a little differently when approached with the methadone idea.

Weaning off of methadone is like weaning off of any narcotic; easy does it...with methadone it takes a little bit longer.

I would rather the short term tooth pulls, sprains, etc... be treated short term with small doses of methadone then be given Vicodin/Percocet that would put them in the sky if they are opioid naïve. That's where a majority of addiction with young people starts IMO. If there was no high, I believe not only would it save the person from knowing the so called ecstasy of escape (I've heard comments like, makes my tummy all warm, I love that feeling it gives me; from young and old), but the healing process could be more focused on.

Also, couldn't agree more with increasing doses of methadone to find the right dose. Most careful...in long term, chronic pain patients.

Either way, if you get hooked/dependent (from your own fault or having to stay on the meds for a long time) you have to give something to pay the piper. I believe the average half life of methadone is 26 to 32 hours depending on the person. Can also be shorter or longer for same reason. All weaning off of any controlled substance II should be monitored and controlled with other meds for comfort measures and safety.

As with anything, education is key.

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Specializes in allergy and asthma, urgent care.
I did say it has a long half life. Small does for a few days isn't going to hook the person and for those who need 24/7 pain management it's a God send. I think the government (who are the ones making all these ridiculous laws governing people with chronic pain) would look at it a little differently when approached with the methadone idea.

Weaning off of methadone is like weaning off of any narcotic; easy does it...with methadone it takes a little bit longer.

I would rather the short term tooth pulls, sprains, etc... be treated short term with small doses of methadone then be given Vicodin/Percocet that would put them in the sky if they are opioid naïve. That's where a majority of addiction with young people starts IMO. If there was no high, I believe not only would it save the person from knowing the so called ecstasy of escape (I've heard comments like, makes my tummy all warm, I love that feeling it gives me; from young and old), but the healing process could be more focused on.

Also, couldn't agree more with increasing doses of methadone to find the right dose. Most careful...in long term, chronic pain patients.

Either way, if you get hooked/dependent (from your own fault or having to stay on the meds for a long time) you have to give something to pay the piper. I believe the average half life of methadone is 26 to 32 hours depending on the person. Can also be shorter or longer for same reason. All weaning off of any controlled substance II should be monitored and controlled with other meds for comfort measures and safety.

As with anything, education is key.

I agree with ladySolo. Methadone can be very dangerous and should not be prescribed as a first or even second line pain treatment. Too little and the pain isn't controlled. Too much and you can die. Some patients do feel a rush from methadone,and can start taking higher and higher doses to find that rush. It can be very helpful for pain, but I feel it should only be prescribed by a knowledgeable pain specialist,and only after other treatments have failed.

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Specializes in Adult Internal Medicine.

I would rather the short term tooth pulls, sprains, etc... be treated short term with small doses of methadone then be given Vicodin/Percocet that would put them in the sky if they are opioid naïve.

Methadone for acute episodic pain? Have you ever prescribed methadone? That doesn't make any pharmacokinetic sense let alone all the other headaches and dangerous therapeutic index.

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Specializes in Pediatric Hematology/Oncology.

Not all opioids are created equal.

Here is a case study regarding one beleaguered cancer patient's struggle with SQ morphine: Morphine-induced hallucinations - resolution with switching to oxycodone: a case report and review of the literature

tl;dr

Interestingly enough, once he switched to PO oxycodone, his whole world changed around.

I work with kids with cancer. We do a lot of immunotherapies for neuroblastoma that require a continuous morphine infusion be started 30 minutes prior to starting the immunotherapy infusion. For the kids that get a little weird, nauseated, or itchy, they get a low-dose naloxone infusion. Rarely are there problems with this and the naloxone is quite effective. If there is a kid who has absolute intolerance to morphine, they will (they must) try a different opioid (an NSAID won't cut it with the immunotherapy; also it's counter to what the immunotherapy does).

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