Overuse of opiates?? Opinions? - page 6
would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea,... Read More
Aug 10, '04Quote from fab4fanLOL...how old are you? Was that intentional? Please don't tell me you're too young to know the "Fab Four." I can't handle another reminder of my age today! :chuckle
I was taught all of those misconeptions back in the dark ages when I was a student.
21. Nope, wasn't intentional, just a mistake.
Aug 10, '04Let me be the first to say I believe in pain management. The key word is management. I've given conscious sedation to countless people, 8 hours a day, 5 days a week for well over10 years. I'm known for the fact that people are pain free during my procedures. I think what I said was, we've allowed the mentality of entitlement to go beyond what it was meant to do. Living a life as a legitimate junkie is ruining more than the patients life, it ruins those around them too. I'm talking about abusers, life time of seekers. Pain is a bodily function. Wake up, it is a signal that something is not quite right in the body. My dad died of complications of septicemia...he had rheumatoid arthritis for 20 years, was sure he wanted to pain free, took depomedrol IM for years (Through Dr.R. Kaye, Standford University Hospital), and it destroyed his inflammatory responses, while it kept him pain free. So a massive infection took his life, without even a whisper to let us know how severe it was....pain management is the key. I am not in favor of pain, but it is a reality. Keeping people in a pain free state can mean so dependent, or so out of it, they really are not themselves, and they are not without dangers of pain medications. Management to a level of reasonable, with the hope of either eliminating the source of the pain (thus the real answer), or providing a way to live safely, exploring the alternatives. That's what pain evals do... they look at the whole person, body, mind and soul.
Aug 10, '04well deepbreathe, now that your sentiments are more clarified, i agree with you.
if the risks of meds are going to outweigh the benefits then yes, people should get used to living with a pain rating of 3 or less...that's reasonable.
i am also sorry about your father.....as with taking any steroids, these risks are well known of masking s/s of infection.
wishing you peace.
Aug 19, '04oh, Lord, the concept of pain management is becoming a big issue...I know when I am having pain, from spastic bowel or dental issues, the run of the mill Lortab or Vicodan doesn't work. That's just me.....a lot of people are the same way....what works for most doesn't work for them. For chronic pain issues, they don't become addicted once the magic bullet has been found. I can receive 100mg of Demeral and 75mg phenergan and walk and talk without difficulty, but it numbs the pain....but I don't want it afterward. Some of these people have legitimate pain and should be treated aggressively, and the nurses should talk to them, because the pain may be referred pain and not from what we think.
Aug 19, '04Reply to Rapheal: As a Staff Development Educator, I am discouraged that nurses and MDs continue to be misinformed about Demerol, which is VERY over- and misused, as in the example you gave.
Many hospitals have eliminated it from their Formulary or have severely limited it's use, because toxic byproducts build up in the body. And there are many other meds more appropriate. Demerol 50 mg is not more effective than 2 Tylenol, and research has shown Phenergan to be basically ineffective an a potentiator in a 25 mg dose.
And the action of Demerol only lasts 2-3 hrs., so ordering it q4 does the pt. a disservice. Pts. who complain that this regimen is ineffective are CORRECT. They are not drug seekers. Instead of letting the MD get away with ordering this outmoded regimen, nurses should take the opportunity to educate them that other narcotics, with or without NSAIDS, given ATC rather than prn, are much more effective.
You can consult McCaffery & Pasero's book on Pain Mgmt. for specifics.
Aug 19, '04I have an elderly resident on 100mcg duragesic changed every 2 days instead of 3, oxycontin 80mg every eight hours, and two vicodin every six for breakthrough pain, and she takes this around the clock, she also takes ambien every night. Her dx is left shoulder replacement! She s a frail lady and doe not even seem phased by the medication. She actually says she needs more!! I think that the doctor has allowed this woman to become addicted to these drugs because they keep increasing them and of course she will build up a tolerance!
Aug 22, '04I have a different perspective, I think. I believe everyone should get adequate or even more than adequate pain management, and if it means we enable some junkies, oh well. My job is to care for people after surgery, not treat addictions. That can wait until they leave the hospital. I'm always generous with pain meds and an advocate to the MD re: pain management. I guess I'd rather feed an addict, or give someone a touch more than was needed (assuming it doesn't harm them) than have any patient of mine have treatable pain. I had a professor once who said "There is enough morphine in the world that no one should have to be in pain." There are exceptions to that rule, but really, what use is modern medicine if people still suffer needlessly?
I have not had much of an issue with frequent flyers and vague complaints when I worked med-surg. I don't know why - my patients were almost always post-op or had gallstones or some other extremely legitimate source of pain. The drug abusers had a legitimate source of pain too, it's just that a.) their pain was harder to treat and b.) they played the system for drugs.
I remember a guy, a very successful ex-addict on methadone, who had an enormous debridement for necrotizing fascitis. Huge pieces of his thighs removed, skin grafts and harvest sites all over. The guy had a PCA, scheduled MSContin, methadone, and a 20-mg morphine bolus for dressing changes. Yowee. He still screamed during those dressing changes, too, and I don't think he was acting.
I know that because I am in the ICU, I have a freer rein than some of you. On my vented patients, it doen't matter if I give enough narc to suppress resp drive (unless they are weaning). Even if the patient isn't vented, they are monitored, so I feel confident that I won't walk in and find an obtunded patent breathing at 4/min. When I pick up a shift on my old surgical floor, I'm more careful, because I may only see my patients once every couple of hours when it's busy. They could be dead by then.
In the ICU, someone being an addict is the absolute least of their troubles and anyone sick enough enough to be there probably needs something to take the edge off. We do terrible things to ICU patients - intubate them, trach them, place PEGs and G-Js, allow interns to stab them repeatedly for central lines and art lines. Nurses always believe they are undersedated, and some are generous with their interpretations of the doc's sedation orders.Last edit by apaisRN on Aug 22, '04
Aug 25, '04I have been a nurse for a long time but apparently not as long as you to see patients in pain and to be deeming them all "junkies" and "drug seekers". It is impossible to know for sure what a patients pain is and people all deal with it in different ways-you know that. I know that there are the drug seekers out there that ruin it for the pts truly in pain, but you have to remember that addiction is a disease too. If anyone is to blame-it's the doc's that start all this in the first place. Please try to remember that addiction is not a moral deficit. Alot of the people you work beside may have been through the same thing(yes, nurses too). Please don't be so harsh.
Aug 25, '04Quote from RN Rotten NurseSounds to me like the only problem here is a judgemental one. Who are you to say who exactly are the drug seekers and who are in pain? Can YOU tell by looking at them? Well, Hats off to you. You have more nursing skills than I. Remeber who will be judged in the end.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?
Aug 25, '04Quote from fab4fanYou sound like an excellent nurse and able to view patients the way they ought to be with no judgement. I can't believe some of the responses from nurses that have absolutley no compassion. Keep up the good work!!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.
Aug 25, '04Quote from fab4fanDear heavens, this post made me want to cry. I am so sorry for what you went through! (((((HUG)))))
You hit it right on the money!!! I agree with every thing you have said. I have been a patient myself and looked at by nurses and could tell that they just think your " another drug seeker" . It really is too bad that so many nurses are still so narrow minded that they believe they have the power to see inside someone and know their pain. Thanks for that post. You have said it all.
Aug 25, '04Quote from 3rdShiftGuyMoia, thanks for sharing your story. Gives a nurse much to think about.
I refuse to get defensive. Your pain and you are not the type of patient I was talking about. I can't say I've seen anyone talking about using pain medicine to feel superior, but your perspective is entirely different and I will quietly dismiss myself from this discussion.
I will only say there is a difference between venting one's frustration and actually acting on that frustration by not believing a patient leaving them suffering when they say they are suffering. I'm not that kind of nurse, but as I said I refuse to defend myself or my venting.
Even if you are not "venting" where a pt can actually hear you, you still relay a demeaning message to that patient. You can tell when a nurse is doubtful of you and it's too bad for those poor patients in pain that are afraid to ask you for any relief.
Aug 26, '04Quote from jlallenbaughI have been a nurse for a long time but apparently not as long as you to see patients in pain and to be deeming them all "junkies" and "drug seekers". It is impossible to know for sure what a patients pain is and people all deal with it in different ways-you know that. I know that there are the drug seekers out there that ruin it for the pts truly in pain, but you have to remember that addiction is a disease too. If anyone is to blame-it's the doc's that start all this in the first place. Please try to remember that addiction is not a moral deficit. Alot of the people you work beside may have been through the same thing(yes, nurses too). Please don't be so harsh.
Addiction may be a disease
but the question here is
Is it my job to feed an addiction