prescription drug addiction

Emergent, RN · Dec 15, 2016

My ER regularly has psych patients come in in crisis, out of meds, and needing refills.

KatieMI, BSN, MSN, RN · Dec 15, 2016

More money is thrown at and more lives are affected by our lifestyle.. We will destroy ourselves before anything else can.
However I don't see the relevancy of newborn narcotic withdrawal with my own acute pain mgmt. How many of these moms were hospitalized for unavoidable illness and injury needing acute pain mgmt? Is that what they're saying is the start of most of their addiction? Or did their issues start with seeking out drug use?
I'm not dismissing the overuse of narcotics and lack of alternative regimens but I'd like to know the profiles of these moms before denying myself reasonable pain mgmt.

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.

shedevilprincss · Dec 15, 2016

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.

YES! This.

elkpark · Dec 15, 2016

An ED is a horrible place for a patient in an acute mental health crisis, especially off their psych meds or needing an adjustment.

Agreed -- but it's a great place for someone who isn't in an acute mental health crisis, but is just looking to score some benzos and knows what to say to get them, because so many EDs will just give 'em a scrip to get them out of there.

DeeAngel · Dec 15, 2016

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.

Well keep that in mind if you have open heart surgery someday. I would never say never to IV narcs, there is a time and place for them and they work wonders. Now you have set your family up to be refusing pain medication when you're really in pain and perhaps can't express yourself. Good luck with that because a lot of us won't spend time trying to convince them otherwise.

verene, MSN · Dec 15, 2016

I think there is a time and a place for everything. Is there an opioid epidemic in this country? Very much yes, and I've had the unfortunate experience of working with and caring for individuals affected. We really, really need better access to treatment for those addicted. Once had a client asked for assistance in breaking her addiction - it took nearly 5 months to find a facility that would accept her insurance, AND accept that she had additional issues that needed to be managed and could adequately care for those other issues. Unfortunately many facilities and insurance providers will treat addition, OR mental health OR physical health, but are unable and unwilling to manage all 3, and all 3 issues exist together so much of the time.

However, I've also been in settings where use of opiods is completely appropriate, and to withhold such medication from our patients would be negligent at best; end-stage cancer, post-major surgery, severe chronic pain that cannot be alleviated by other means. Severe pain, can and should be managed. No patient needs to suffer. That being said education as to expectations is needed (no it won't take away 100% of your pain, but taking away 80% is going to feel a lot better) as well as educating about addiction - many patients fear to take any opioids at all for any reason, convinced that taking oxycodone for 3 days post-surgery for severe pain is going to turn them into a drug addict.

These are potent drugs that have the ability to make a huge difference in patient lives. Both for the better and for the worse depending on how they are used. I think it is on those of us working in health care to understand these drugs, know when they are an are not appropriate, and provide education on the pluses and negatives of use, as well as be willing to confront misuse and addition when we see it.

allnurses Guide · Dec 15, 2016

KatieMI . . . great points! :up:

I think we've gone a bit too far overboard with scaring the snot out of people regarding pain meds. There has to be a balance.

Farawyn · Dec 15, 2016

KatieMI . . . great points!
I think we've gone a bit too far overboard with scaring the snot out of people regarding pain meds. There has to be a balance.

Gurl.

ItsThatJenGirl, CNA · Dec 15, 2016

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.

JadedCPN, BSN, RN · Dec 15, 2016

KatieMI . . . great points!
I think we've gone a bit too far overboard with scaring the snot out of people regarding pain meds. There has to be a balance.

I definitely have witnessed this in my pediatric hospital setting over the years of working with post op kids. I can't count the number of times that I have had parents refuse narcotic medications of any sort for their little kid that is fresh out of surgery because they are afraid the patient will get addicted.

Like in most situations, education is key.

Horseshoe, BSN, RN · Dec 15, 2016

I'd like to know what the "no narcs" people would do if they ever had open heart surgery or stem to stern abdominal surgery. The pain after a surgery like that can be absolutely EXCRUCIATING. There is no safe amount of Tylenol or Toradol that can even take the edge off some kinds of surgery.

That said, it's one thing to request no narcs after a surgery, but there should be a special place in hell for a family member who would deny their vulnerable and powerless relative pain relief based on their own inflated beliefs about their personal pain tolerance or ignorance about a particular procedure or pain medicine protocol.

Horseshoe, BSN, RN · Dec 15, 2016

I can't count the number of times that I have had parents refuse narcotic medications of any sort for their little kid that is fresh out of surgery because they are afraid the patient will get addicted.

Oy vey. What do they think is going to happen, 4 year old Jimmy is going to get addicted and prostitute himself on the streets for his fix? This is truly a sign of media fear mongering.