My husband began suffering from back pain about two years ago. It was unbearable for him, he could not sit or lie down; the only way to temporarily alleviate it was by walking (he ended up losing his job, but that's another story). He went to two different orthopedists who told him the same thing- they didn't see anything wrong. He was turned down by the HMO for an MRI (yet another story- fricking hmo's...) but they took numerous xrays and swore that it was nothing. After suffering for four months and crying every night, with me having to help him bathe and dress and sit and stand and walk and even wipe his butt on the toilet for him because he couldn't reach his arms backwards, they finally began a trial of epidurals. After a lumbar puncture and three epidurals, still nothing. This whole time he was on Vicodin and Percocet, alternating between the two at the doctor's whimsy. They would give him a prescription for, say, twenty pills PRN that were supposed to be taken 1-2 q4 AS NEEDED. He would run out in three days-4 days, max. Sometimes he was taking two pills q4 all day long trying to maintain even a smidge of relief, and let me tell you, those pills barely took the edge off. Even though he was medicated fully, he would still be grimacing with every breath and sweating like a dog when he moved. Excruciating pain. I would call the office and beg them for another prescription or a refill and they would be SHOCKED and in DISBELIEF that he was running out so fast. Oh, sir, those are PRN- you only take them when you absolutely HAVE to. Hello, people, didn't we take a lecture in school on therapeutic med levels????? It was horrible. Once they refused to give him any more because they said they could get in legal trouble (snicker) and claimed he was addicted to the medication and not in actual pain. Well, I took two hours to get him up and dressed and we hobbled his weeping ass right on in the office and made them look him in the eye and dared them to deny him medication one more time. It never happened again, thank God. However, he suffered immense pain making that trip and it was, in my opinion, completely unnecessary. Now, he never claimed to have 'lost' the pills- we told them straight out he had taken every last one of them. Only when we petitioned the HMO did he get an MRI and guess what? Oh, now we see it, haha, whoops, you have a degenerative disc condition and no cartilidge between four of your lumbar vertebrae and whoops, what's that sliver of bone poking out there into your spinal column? Didn't see that on the X-Ray, haha, sorry. I am a nurse. I am there to ensure that my patients are pain free and comfortable, or at least as comfortable as possible, while they are in my care. I don't care if they even have a history of poly-drug abuse; they wouldn't be hospitalized if there wasn't something wrong. While they are in my charge, drug hx be damned, because I will medicate at the first time I see even a hint of pain. I will not wait until my patient is crying before I take action. Proactive medication does wonders. Easier to maintain a therapeutic level in the bloodstream, enables patients to participate in physical activity more easily, helps them to HEAL FASTER because being in pain wreaks havoc on your immune system. My LAST concern is contributing to an addiction; it is a concern, but not the most important one. In my opinion, anyway. :>P
Oh, something else I thought of. I have a friend who's father just died of lung cancer. He had a number of bottles of all types of pain relief, Ativan patches, you name it, in the medicine cabinet. She walked in to the bathroom one morning and caught her sister, who had snuck in the house unannounced, stealing pills from each bottle and sticking them in her pants pocket. Having someone steal your medication is not that far fetched- you'd be amazed how people are when it comes to pain pills. It seems sometimes there are no boundaries to be crossed. I dated a guy who used to skim heavy-duty sleeping pills from his ex-girlfriend. It's not uncommon. Also, I thought of this. I don't know where you work, but I work at a charity hospital that caters to the homeless, underpriveleged, and indigent population. They frequently recieve a free prescription on their way out of the hospital, only to be robbed by other homeless people or whatever out on the street. Guess who shows up the next day? They're not ALL lying. Not ALL of them. How do WE know which are telling the truth? To a grand degree, we must simply assume that they are telling the truth. If you think about it, it's not really farfetched. If someone will steal PRESCRIPTION glasses from another man off the street, glasses in a PERSONALLY DETERMINED PRESCRIPTION for that person, what makes us think that the pills won't go like lightning? Just something to think about. I mean, we send moms home with boxes of formula for their babies and they SELL IT to buy food. There are very poor people out there, and some of them, unfortunately, have to choose the lesser of the two evils in order to survive.
And one last thing... If my patient DOES have a history of drug abuse, you know what? The first thing I'm thinking of is TOLERANCE. If they frequently do heroin or crack, what's a measly vicodin going to do if they are genuinely in pain? Under medical supervision, of course, they should be getting almost liberal amounts of pain medication, unlike a four foot tall grandmother who hasn't done a drug in her life, you see what I'm saying? It may sound sort of harsh, but addiction isn't my problem- it's theirs. If they truly are addicted, they need treatment, but if they truly are in pain, they need medication FIRST, treatment later.