Overuse of opiates?? Opinions?

leslie :-D · Aug 7, 2004

I agree with the whole pain issue. Somehow, we as a society have become accustomed to the idea that pain free is the best way to be. The problem with that is that it really means anesthesized.

i'll stop your post right there.

narcotics are not only an appropriate intervention for severe pain but often are the only intervention....to be used, not abused.

in this day and age, no one should have to be in pain.

many of us are quite familiar with supplementary therapies to assist in relieving pain.

and many of us are also familiar with the infamous med-seekers.

these are 2 different ballgames completely.

and of course, pain free IS the best way to be.

am i missing a major point here?

fab4fan · Aug 7, 2004

Not to mention that pts. with chronic pain issues often require phenomenal amounts of pain medication to get relief. Would you say the same thing about a pt who needed a higher than usual nitro infusion to relieve his chest pain? Would you say, "This is ridiculous!"?

Look at the level of relief, not the dose. Instead of assuming that the pt is a seeker, why not ask why his pain can't be managed effectively? Imagine how horrible it must be to be totally dependent on someone else to relieve your pain.

This is a topic that frustrates me to no end. I will never forget the rotten treatment I got from an ED nurse (and let me state that I am a former ED nurse, so there's no axe to grind here) who treated me like something lower than dirt beneath her feet because I said I had a horrible H/A.

Well, well, well. Amazing how solicitous she became when the ED doc dx me with a potentially fatal neuro disorder. Spent several days in ICU.

Guess my pain was real, after all.

As for me, I'd rather give someone the benefit of the doubt than let a judgemental attitude potentially harm a pt.

fab4fan · Aug 7, 2004

i'll stop your post right there.
narcotics are not only an appropriate intervention for severe pain but often are the only intervention....to be used, not abused.
in this day and age, no one should have to be in pain.
many of us are quite familiar with supplementary therapies to assist in relieving pain.
and many of us are also familiar with the infamous med-seekers.
these are 2 different ballgames completely.
and of course, pain free IS the best way to be.
am i missing a major point here?

Eh, no. Any med can be misued...people misuse laxatives, diuretics, tylenol.

Some of these attitudes seem a bit dated (given all of the info that is out there on pain mgmt.) and puritanical. The purpose of pain mgmt. is not detox; it's finding the best comb. of meds/therapies to control the pain. Many times that includes the use of narcs.

UM Review RN, ASN, RN · Aug 8, 2004

i mean, 100mg of demerol every hour?

i believe the max daily dose of meperidine is 600 mg, or no more than 48 hours of therapy before d/c, else the patient runs the risk of neurotoxicity.

indeed, i once had the honor of calling a doc in the wee hours and informing him that his prescribed dose of demerol was too high and i wasn't going to give it, on the advice of our pharmacist.

doc transferred the patient off to another unit. patient got the med as prescribed--and went into convulsions later that weekend.

but on the normal shift, i have to agree with tom--i try not to judge. i came to that philosophy because of a patient who was in excruciating pain for over a week while test after test came up negative--except the last one. turns out the patient had a large kidney stone that had been somehow blocked on other tests, and finally was seen on the last (it was so long ago, i don't recall the exact test). by this time, i was giving the pain meds, but not much sympathy, until i saw that report. pt subsequently got relief when the stone was removed, and i learned a very valuable lesson.

i'm sure there are drug addicts and malingerers out there, but i'm not super and i don't know it all, so as long as the med and the dose is safe for that patient, i'll just give the meds.

RN Rotten Nurse · Aug 8, 2004

I think one of the BIG problems I see is that we are nurses are so damn judgemental. If a patient has standing orders for narcs and states a specified pain level the nurse gives the drug, there is no judgement call orders are orders. If the person is an addict that is the DOCTORS fault! Why would we as nurses say something like a few addicts ruin it for everyone!!! We despense medication ordered by doctors, if a doctor orders narcs for an addict them I give the drug if I start looking for addicts I see one in every patient and quality of care suffers. Why would I give the addict the power to lower my overall nursing care? If he talks the doc into narcs then he has a problem, but it's not my problem. Pain is little understood and poorly treated in general and I feel nurses should be more open in general to pain management. If you serve a few addicts to help 1 patient in genuine pain who looks OK to you then I say good job. What is it that makes drug seekers soo important to nurses that we alter our care based on our perception of how patients like the meds? Bottom line, it is the person who is in pain that is important not the drug seeker. If everyone gets their ordered meds every time we would have happy patients and happy addicts and less stress on ourselves trying to find the difference.

I believe it is OUR problem. It is societies problem as well. I'll tell you why it bothers me to dope up our drug seekers. First of all, many if not most of them are unemployed. Most are usually on medicaid and other forms of government assistance. Everytime I cater to a drug seekers request for demerol and such I'm thinking--ok, the government is going to take even more out of my paycheck so I can pay for this loser's drug habit yet I won't be able to pay for my child's college tuition. Do you really not see a problem here?

fab4fan · Aug 8, 2004

Do you feel the same level of indignation at other Medicaid recipients such as non-compliant diabetics, smokers who get CA, chronic heart pts. who continue to smoke and eat the wrong diet, etc?

Even an addict is entitled to pain relief, and that may include the use of narcotics. This is not my opinion, it is in all the current literature on pain mgmt. (Surely you don't suggest that a "seeker" should have surgery/broken bones/sickle cell crisis and just "suck it up.")

I mentioned in a previous post that I'd had a bad exp in the ED with a judgemental nurse. Because I had been in the ED before with migraines, she immediately labeled me and blew me off. Thank God the ED doc didn't, or I may not have lived.

Unless someone is gifted with the ability to see inside a pt's body and know for a certainty that his pain is real, IMO it's better to give the pt the benefit of the doubt.

And we ALL pay taxes for things we don't agree with. That's life in an imperfect world.

Jay-Jay, RN · Aug 8, 2004

As a migrane sufferer, I can certainly appreciate stories re. having pain ignored and being thought a drug seeker (though this hasn't happened to me...I have a terrific G.P. and my migranes rarely get bad enough to need more than Tylenol #3.)

HOWEVER, recently I experienced the flip side of the coin.

We had a patient who had fallen on broken glass, and suffered a deep puncture wound to her backside, which became infected. She kept complaining of unrelieved pain, and asking the nurses to intervene with the doctors for more pain meds. She was a very good manipulator, and had most of us fooled. The docs were fooled too, and gave her pretty much whatever she wanted.

She died of an unintentional drug overdose.

The other side of the coin, people. I still feel like **** about it, and wish we could have done something to prevent it happening.

NiteShiftNut · Aug 8, 2004

i guess since i'm the one who originally posted this, i should clarify---i was not talking about every patient with pain meds ordered..............i was actually doing nothing more than venting after a long frustrating night of dealing with a known addict. i have decided to adopt the "i could give 2 ****'* and a **** less attitude" if the doc knows that the patient is merely a drug seeker and they still choose to enable their habit-wonderful!!!! if everyone just wants to jump on the bandwagon and get stoned out of their minds for the rest of their miserable lives-wonderful!!! dole it out baby!!!! i say the more miserable unemployed crack addicts the better. it's job security. i give up. i have to pick my battles, and i'm tired of this one. i will serve up the high with a smile on my face and a skip in my step from now on--and besides--it's just easier to give em what they want.

KarafromPhilly · Aug 9, 2004

HOWERVER, recently I experienced the flip side of the coin.

We had a patient who had fallen on broken glass, and suffered a deep puncture wound to her backside, which became infected. She kept complaining of unrelieved pain, and asking the nurses to intervene with the doctors for more pain meds. She was a very good manipulator, and had most of us fooled. The docs were fooled too, and gave her pretty much whatever she wanted.

She died of an unintentional drug overdose.

The other side of the coin, people. I still feel like **** about it, and wish we could have done something to prevent it happening.

Something like...assessing the patient? I must be missing something here--??

**canoehead, BSN, RN** · Aug 9, 2004

I have also seen a patient claim a pain level of 10/10 when shaken from a stupor like sleep with resps 6/minute. At that point do we medicate her (pain is what the patient says it is, and she says "Yeah" when I ask her if she needs more meds) or do I make a judgement that she's going to kill herself if I do what she requests.

kids · Aug 9, 2004

I believe it is OUR problem. It is societies problem as well. I'll tell you why it bothers me to dope up our drug seekers. First of all, many if not most of them are unemployed. Most are usually on medicaid and other forms of government assistance. Everytime I cater to a drug seekers request for demerol and such I'm thinking--ok, the government is going to take even more out of my paycheck so I can pay for this loser's drug habit yet I won't be able to pay for my child's college tuition. Do you really not see a problem here?

This is the EXACT reason I won't so much as go to the dentist without a recent x-ray showing the titanium screws and rods that hold my spine togather. God forbid I have something happen (root canal, broken ankle, surgery) that my maintainance meds aren't enough to treat the pain.

I did want to point out that because the Social Security Admin works with individual states many people receiving disability also receive Medicaid. And if anyone thinks it is easy to get SSD they are sadly mistaken as several disabled members of this board can attest to.

Jay-Jay, RN · Aug 9, 2004

Something like...assessing the patient? I must be missing something here--??

I want to clarify: this was a home care patient. I did do an assessment on her, before sending her off to the doctor with a note. On the note, I gave vitals (pulse was elevated, BP was not, she was diaphoretic.... something going on, but acute pain? Chronic pain? I wasn't sure!) So, I asked the doc to CALL ME. He/she didn't bother. If he/she had, I would have said, "Look, maybe you know this patient's history better than I do. I think she MAY be a drug seeker, but I'm not sure." Instead, the doctor just gave her what she asked for.

The last time I saw her, I could tell she had too much medication on board, but she (supposedly) was just about to leave to go to see her doctor, and wanted me to hurry up with my visit so she could leave. I decided to let the MD look after it. Afterwards, I wondered if she had actually kept the appointment. I think two of her nurses called 911 before finally getting her admitted to hospital. The first time she refused to go. By the second time, it was too late. Unfortunately, there is only so much the nurse can do to help someone who does not want to be helped.