Breaking the Stigma of Addiction

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Specializes in Eating disorders.

I have a question for those of you who currently work in ER/or admin. 
Can you give suggestions for recovering people with substance use disorder (& also current active addiction) who need to come to the ER for various reasons. 
Please no arguments on choice vs disease, clean vs mat treatment etc. Facts are that there are 21 million people with addiction and less than 10 % seek treatment partly due to not knowing how to take care of their medical needs when they are technically self harming with substances. But they still deserve our care without judgement as humans and medical professionals. 
I'm trying to help a recovery group when they seek care so as to not further the stigma that all they want is drugs when when in legitimate pain. I haven't been to any pain conferences or medical addiction seminars in years so I need ideas. 
Thank you in advance. 

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Specializes in Psych, Addictions, SOL (Student of Life).

This is a great question and great topic for discussion. As a nurse in recovery (18 years) who also suffers from Chronic Pain, I avoided Emergency rooms even when I really needed to be there because of tjhe raised eyebrows,and ugly comments from ER staff. Here are some non-opiode options for persons in recovery. Bear in mind a lot depends on how long the patient used and how long in recovery. Also important is the patient's willingness to try other options for pain management. 

Options include:

Acetaminophen (Tylenol) can be given PO, IV or rectally with supository. 

Traditional and non-traditional NSAIDS. such as ibuprofen, naproxen, and aspirin or brands like Advil, Motrin, and Aleve. Prescription-only NSAIDs include Naprelan, Anaprox and Voltaren now available as a topical OTC . Can be given orally or as sprays, gels or creams. 

Anti-convulsants (Gabapentin) can be used to address chronic pain as well as Acute pain from conditions like shingles.

Antidepressants such as Older tricyclic antidepressants like [coupon drug=imipramine]imipramine (Tofranil), nortriptyline (Pamelor), and amitriptyline (Elavil), and SNRIs (serotonin-norepinephrine reuptake inhibitors) like venlafaxine and duloxetine, have been shown to lessen pain caused by damaged nerves.

These antidepressants can also relieve any symptoms of depression that can exist with persistent pain, and help with difficulty sleeping too.

When it comes to chronic pain the patient should always get a consult with a pain management doctor. The patient should tell this professional if opiods is not a option. Most are willing to work with patients who wish to try non-opioid options. 

In cases where opioids may be the best option for relief of acute pain post injury/post surgery. The treating physican and nurses need to use tact and care in exolaining why these medications are needed and for how long.

Hope this helps

 

 

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The ED setting is changing more and more, especially in California. There's a program specifically oriented towards offering SUD services in the ED. This allows folks who are experiencing withdrawal to be treated with buprenorphine in the ED setting, and be connected to on-going MAT by a designated patient navigator. There's still a long way to go to influence medicine as a whole, but there is movement. Check out www.cabridge.org for more info. They are kicking off a nurse training series this month, focusing on acute based MAT.

CA BRIDGE - Nurse Training Flyer - 2021.pdf

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Specializes in Eating disorders.

Thank you! Great suggestions. I have a blog on addiction may I share your thoughts on there? 

http://samantha-waters.com/2021/03/08/hope-floats-in-the-desert/

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Hi Samantha, yes, please share these thoughts! It's a new yet simple approach that makes a lot of sense. Will you please omit the flyer pdf from any blog post? It's OK to reference cabridge.org.  Thank you! 

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