pain in the ed - page 13

i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick. our er uses the pixis and... Read More

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    Just curious what exactly is your problem with methadone. It has been shown to be beneficial for long term chronic pain. Why would you want to deprive your patients of adequet pain management. Just curious.

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    Well I think there are better alternatives than methadone, but that's not my issue here;

    In Phoenix, we have methadone clinics around town, that deal ONLY w/ methadone administration and treatment...

    I will not allow anyone on methadone in my LTC for a simple reason. I do not want the "spill-overs" from the methadone clinic to come to the LTC looking for their methadone (once word gets out that we now have it), after their (methadone) clinic has closed, and they overslept...

    When I worked ER, we had many of these "spill-overs," and a nursing home is not an ER (And many hospitals and walk-in clinics in town do NOT have methadone either)

    I worked inpatient chemical dependency a few years back; Methadone is oftentimes necessary for Heroine (and OXY) detox...It can be EVIL and is VERY addicting. It used to be ONLY for detox.
    And Oxycontin was mainly for hospice.

    I work prn in a pain clinic, and there are MANY safer alternatives...Usually non-narcotic as well...

    Last edit by hogan4736 on Jan 13, '04
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    I cannot adquately respond to your statement because since it is your view, I would end up attacking you and that's not what this is about.

    I will only say that your "policy" is soo wrong it obsurd. This line of thinking is dangerous, is causing needless suffering, and should not be allowed.

    You've stated your opinion, there's mine.

    Last edit by MD Terminator on Jan 13, '04
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    That's the problem w/ this board sometimes Dave, a difference of opinion is seen as hostile by some of the mods...I would love to debate the issue here, don't hold back

    That being said, I take issue w/ you thinking that our policy is absurd...

    There are several "nursing homes" in Phoenix that are nothing more than drug homes. True story. Research "Desert Sky Nursing Home" in SW Phoenix. I used to be a charge nurse there. They used to be a clean nursing home. They began to accept patients on methadone. I quit.

    Fast forward 4 years, the police are there EVERY OTHER day, there are residents cheeking their pills, selling them in front of the building, getting arrested, OVERDOSING (from repeated cheeking and subsequent triple self dosing). The problems at that ONE facility are too much. Half the population at any given time are admitted for "cellulitis secondary to spider bites :roll

    I know nursing homes are changing, but that is rediculous, and we won't have it at ours...I am not doubting pain, I am refusing the secondary element I have seen that comes w/ methadone.

    Methadone administration belongs in a closely MD supervised facility. That is NOT a nursing homes. Besides, like I said, many ERs that I have worked don't even stock methadone in the pharmacy (of the hospital)

    Many pharmacies around the country are not filling oxy and methadone RXs...Call it what you will, but we have a problem w/ oxy and methadone overprescrition in this country. I have a 21 y/o friend that was in a rear-end MVA, diagnosed w/ a cervical strain. SHE WAS PRESCRIBED OXYCONTIN!!!!!!!!!!!!!!

    Dave, THAT is a crime. Too many docs are turning the other way, and making oxy and methadone FIRST line drugs for muscle strains! I TAKE ISSUE w/ THAT!!

    Last edit by hogan4736 on Jan 13, '04
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    Yes we have a problem with Oxycontin over-prescribing. Methadone? No. A good portion of docs have never heard of it being used for pain.

    One could also say we over write Norvasc, Atenlol, or Clonidine.

    People have chronic conditions. People need medication long term. We agressive treat hypertension, so why not pain?

    It is in NO WAY criminial to prescribe enough medication to ease someones suffering. Not in the least.

    Just a question. You say that Methadone is sooo addictive? Since when do people get addicted to pain meds when they're taking them for pain? I've never sceen it happen. Leading pain specialists haven't sceen it happen. Do you have a special insight that we're all missing?

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    well let's get some straight facts....a narc, is a narc, is a narc - they all have the potential for addiction in even those who are not "predisposed" psychologically or emotionally...there is a physical addiction that accompanies them unlike some other meds.... so therefore methadone, just like percocet, just like heroin CAN be a matter of fact a good friend of mine had a pretty extensive surg for which they placed her on oxycontin for 2 wks - when she stopped taking it (as prescribed) she went through withdraw - you cannot go through withdraw IF the med doesn't have the ability to cause physical dependence.

    as for "caring" going out of nursing....let me tell you about a pt that we tried to be caring for.... known drug abuser...chronic back pain -on large doses of multiple different narc's and muscle relaxers...comes to the ed 3 days in a row - on day 3 the doctor medicates him (by injection) for his pain and refers him to a pain clinic and discusses w/ him the concern that he may have an addiction issue and that seeking help for that may alleviate -to some degree - his pain... pt promptly states to the nurses and the doctors that he knows he is addicted to pain meds and that we are sons of b$^ches for not giving him a script to carry him through the week - he went further to threaten us outside of work.... and let's make clear - THIS happens VERY OFTEN...
    so angelbear- not only did we care for this pt's pain, but his well-being and his future - where did it get us?!?!?!?

    as nurses we have a responsibility to treat pain - NO ONE has debated that issue... but you need to deal w/ reality as well - and there are drug seekers.... that CANNOT be debated -
    we also have a responsibility to speak to that issue.
    Last edit by athomas91 on Jan 13, '04
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    You are correct noone here is debating the fact that there are true drug seekers out there that only want the stuff for a high I agree. What I am saying is that if that is the case then make a referral. Also please stop saying physically addicted when speaking of people in true pain they are not physically addicted they are tolerant or physically dependant. Furthermore those in LTC deserve and have a right to adequet pain management even if that means methadone or oxycontin. If security is your concern #1 dont make it known the drug is there and #2 GET SECURITY LTC has drugs and people know it be it darvocet, vicodin etc... all are narcs HELLO SECURITY!!! Our elderly and our incapacitated deserve pain care just like everyone else. As for the care in health care if it was there so many healthcare providers would not lack knowledge concerning pain management and EVERY patients right to it. Thank you
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    i cannot speak for others - but when i speak of physical dependence - i am referring to the actual physical dependence of the body of a narcotic- as the receptors adapt to a narcotic- yet the body continues w/ pain - it makes more receptors - this builds what is known as tolerance - it also causes an actual physical response if those receptors that are in need of filling are left w/o med -
  9. 0
    Originally posted by angelbear
    ... Furthermore those in LTC deserve and have a right to adequet pain management even if that means methadone or oxycontin. If security is your concern #1 dont make it known the drug is there and #2 GET SECURITY LTC has drugs and people know it be it darvocet, vicodin etc... all are narcs HELLO SECURITY!!!
    1) I nor anyone else is telling people that the drug is there. Read my earlier example regarding "Desert Sky Nursing Home." The PATIENTS tell other prospective PATIENTS after discharge...Come on...

    2) Get security" Please...we have enough budget constraints with low census, complicated patients, and frequent call offs...I can just hear administration now...I can't even get us a Pyxis (sp?)

    3) I am NOT saying these people aren't in pain...

    How about my other issue here...Why does my 21 year old, healthy female friend get prescribed Oxycontin AS A FIRST LINE analgesic? NO ONE explained to her the highly addictive nature of the drug. NO ONE prescribed her motrin (a first line med for a muscle strain). Instead she gets one of the most powerful painkillers on the market (can you say the doctor is in the manufacturer's back pocket???? but that's another thread)

    So dave, I'll say that many drugs are overprescribed in this country...Are they in other countries? I work w/ an ER nurse from India (just moved here). When I asked her the state of pain management in an ER in India, she laughs at our culture. she tells me (yes, this is only one person) that meds like oxy and percocet are RARELY prescribed, Motrin and Darvocet are more commonly used, and she has NEVER seen a kid on Ritalin (a whole 'nother thread). The attitudes of many of our "conditions" is unbelieved in India...

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    You have a good grasp on what happens Thomas. However in my expeirence, and from the information I've gathered from many studies... Physical addiction is not all that common when taking a narcotic for pain. Even more rare, is psycological addiction.

    Dependence is common. It doesn't mean people are addicted. It means they need a little more medication to do the job.


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