Is current thinking on pain control creating drug addicts?

grandee3 · Dec 25, 2006

I think I failed to mention that I work in an LTAC, our length of stay can be anywhere from 10 days to 45 days. We get a lot of 30 something's who have old injuries from either work related or sometimes from their long addiction to pain meds, ie falls, broken bones etc.

They come to us a few days post op or post hospital for long term care. I know these pts can still experience some severe pain, but when they are c/o nausea and eating fried chicken at the same time and want a push of Phenegan, I have a problem with that. And then, they want the med pushed real fast and not diluted, to me that's a problem.

When I said they can go out to smoke, I am referring to a pt we had who took her Dem?phen push then went outside with her cig and was fould asleep in her wheelchair with a lit cig burning her gown! What would have happened it the pt was injured by setting herself on fire because she was medicated? What happens to that nurse in court? Does her license survive? Please, advise.

teeituptom, BSN, RN · Dec 25, 2006

The current treatments out there highly designed at creating and turning people into drug addicts.

Vicodin used to come in 2.5 mg tabs and 5 mg tabs. only a long time ago. Then increased it to 7.5 mgs, then to 10 mg tablets. They are now researching the feasibility of a 20 mg tablet.

We have turned drug addiction into a socially acceptable form of behaviour.

SK-222 · Dec 25, 2006

Being a chronic pain sufferer, this thread unfortunately hits home.

Unfortunately, I almost suffered my own recent death and eye-opening experience as the result of undertreatment. Full story at the link: Pain Relief Network » Blog Archive » Jessica’s Story

Reasons the DEA is evil:
Since the spinal injury (multiple fractured vertebrae) in 2001, I've suffered from chronic back pain. I'm miserable not being active and pushing the limits on a regular basis, but at the same time I need prescription medication just to get by, especially with my harshly severe pain. It sucks. I'm lucky to have an excellent doctor, but as with most physicians, there is an EVIL entity known as the DEA who threatens them and also ensures legit pain sufferers continue to suffer. Because of a small percentage of people who abuse/misuse prescription meds, the DEA (drug enforcement agency) threatens doctors, prescribing licenses, etc. In my opinion, the penalties should be harsher for not treating pain than accidentally giving meds to someone who will abuse them. Much like the rest of our fouled up healthcare system in the US, the DEA is nothing more than a huge flaw and joke. When it comes to voting on passing laws and such, if there is ever a senator or otherwise who is all for dismantling or striking down the DEA, they will certainly get my vote.
Another example many can relate to where the DEA has continued to screw up: There are idiot methamphetamine makers and users. They forgot there are people who suffer from chronic nasal allergies, eye irritation, etc., but once again, they sided with the druggies, making over-the-counter meds (such as Sudafed, etc that contains some key ingredient in making meth) making the OTC meds harder to get. Sure, the restrictions might make a black market for the druggies, but that also means the rest of us who are legit and occasionally took the tablet of our choice, get to jump through stupid hoops to get what works. Tylenol is more "dangerous" and can cause liver failure if taken too much at once, yet that's freely available. Benadryl allergy is something I used to take which was good for my sinuses. Just recently the formula changed and it's no longer effective. The DEA is good at constantly revealing their own flaws. Bottom line: the DEA DESTROYS LIVES.
Physical pain can be deadly...
The DEA and other related medical organizations have failed in countless ways. Putting this in layman's terms so all reading can understand; in my back I have discs that are herniated up through the bone, making sitting for long periods of time painful. Getting through a day at work often means I need to take meds to get by. As I type this, I've needed nothing for a couple of days; I'm doing good at the moment. Pain (at least for me) is a cycle with good and bad days. If I don't need anything, I don't take it. I have no problem cold-turkeying prescription narcotic pain meds when I have no pain, and I have NO withdrawal symptoms, etc., there's not a psychological addiction problem by any means. No different than taking allergy medicines that [sarcastic] my favorite agency [/sarcastic] has badly regulated.
Unfortunately, because prescriptions are limited on how much can be taken and doctors can only comfortably prescribe so much without the DEA destroying them (the physicians), and the lives of their patients. So many times I've had to resort to taking Aleve, Tylenol and other over the counter poisons in such high quantities, but in some ways I am amazed I am not dead yet. It's no secret the U.S. Health"care" system is in a state of imminent collapse. There was a period of time where I was unemployed, essentially homeless (surviving by staying with my ex-inlaws) and in tears daily while doing a physical job just to make some money. Though I had health insurance at the time of my accident, this kept me from working for some time, so I lost it, and subsequently had no health insurance, no doctor, no medicine, so I was taking 20+ tablets of Tylenol through the day and Ibuprofen and/or Aleve just to function, keep moving, etc. That was also less than a year after the spinal injury. At one point when I did go to a poor persons clinic with what little cash I had, I was given Celebrex and Ultram (tramadol). All I can say, is that's like saying "gee doc, thanks for not believing me." A major insult!! High priced designer drugs that are only minimally and/or not as effective and quadruple the price are another obvious example of drug manufacturing companies wasting money and resources, making healthcare less affordable.
Countless times I have had to take an excess of Tylenol and anti-inflammatory medications (Ibuprofen, Aleve, etc). Now I'm fortunate to have insurance, a good job, etc., but am limited on the number of prescription pain pills in a given day. I never exceed a prescription; as I don't ever want to put a physician's butt on the line, so never take more than what I'm allowed. They work hard to get the letters " M.D." after their name, plus, there are too many repercussions if a person is abusing the Rx meds. It's not worth the risk of losing a good physician who also fears the DEA.
All too often I question the sanity of bothering with saving for retirement, etc., because I honestly don't think I'll live that long. Having nearly died once from liver failure secondary to Tylenol poisoning (had no doc or prescription meds, but had to work to live and eat), and now again from similar causes of being undertreated. I certainly do NOT blame my doctor for my recent near-death experience. The DEA is to blame, and if I should ever die because of a lack of medication, my will would be for a pit-bull attorney to sue the DEA and give the money awarded to my loved ones.
A explanitory paragraph:
As to the details of my recent near-death experience; I will not post exactly what I took, as the herbs (legal kind, obtained at healthfood store) are easily obtainable, I would never want to assist in a suicide. All things internet, certain things are not meant to be public. I have disclosed exactly what I took/mixed with my doctor; and since waking up in ICU on ventilator with family by my side worrying I'd be brain dead *if* I ever woke up because they didn't know how long I had been down without oxygen, I'm now afraid of taking just about any and everything unless it is under my doctors direction.
Details/My personal near death experience story:
It was Tuesday, October 24th, 2006; pretty much a normal week. Life had been going good and I'd been a happy person, so no depressing issues were going on. That day, however, was exceptionally bad. From the time I woke up that morning, I had taken a total of three "vicodin"(hydrocodone) from morning until evening when arriving home from work. Never exceeding 3 tablets, but that accounts for the opiates showing up in low quantity on my toxicology test. I took Aleve throughout the day in the usual excess quantity (have had none since leaving the hospital). Had done stretches, took multiple breaks, laying on the floor trying to stretch out my back, etc., using "Ben Gay" muscle rub cream, ice, any and everything to get relief. Even though the ER (emergency room) is right across the street, there would never be a point going there; they're notorious for both undertreating and not treating pain. They simply label any person with a pain problem as a drug seeker, and act accordingly. But then they expect the person to pay an overpriced bill, often for services not even rendered - of course, that much is an issue on it's own. I'd better be bleeding to death or unconscious to consider going to the ER, and even then I might fight a person about going if I can.
So back to that fateful day: I had gone home and still in excruciating pain. I probably resembled the hunchback of Notre-Dame trying to move around. I took an Ambien tablet as per my normal bedtime routine (and yes, only *1* tablet). About one hour later, it was not working and I was in too much pain to sleep. It was at this point I created an accidental death-cocktail consisting of herbs and OTC meds. At that time though, I didn't care if I lived or died due to the amount of physical pain I was in, my actual intention was that by playing pharmacist with just legal stuff, I'd knock myself out and sleep good until noonish or so the next morning. The longer I stay horizontal (laying down) the better the back feels. Needless to say, when I woke up the next day with a breathing tube down my throat in the ICU(intensive care unit), the first question I scribbled down on a piece of paper was "What happened?". I was a bit confused not waking up in my own bed. After an auto accident (before the spinal injury sustained while snowboarding), I woke up in an ICU on a machine breathing for me, so this was a situation I remembered. This time though, because the day/night before were not anticipated to turn out this way, I was wondering if I had been in another auto accident or something and was not entirely sure what was going on.
The Frightening Saga of 10/25/06:
Luckily I don't remember that morning/day, but as it has been relayed to me: At about. 7 a.m. I was found completely unconscious on the bathroom floor. Toilet lid was up with my business unflushed - very uncharacteristic for me. Pants apparently were pulled up. It appears I had finished my business, pulled the sweatpants up, and it appears I passed out before turning around to flush, close the lid, etc. I'm told my bed was barely touched and obviously not slept in. They say me and the floor were covered in puke. No vomit in the toilet, so I'm guessing my body may have vomited/rejected things after my lights were out. I'm told I was called by my name and that I looked up then closed my eyes again, but that obviously "no one was home". 911 was called. Onlookers tell me they intubated me right on the hall floor by the bathroom and started bagging(term used on manual breathing for a patient). They were told I had a weak pulse but not breathing. I suspect one or two things; I had been breathing throughout the night, shallowly and respiration just wasn't barely detectable and/or God is obviously not done with me and sent me one heck of a wake up call with this one!
My mother and aunt knowing all this drove to the hospital. What understandably frightened my mother was that shortly after her arrival, the chaplain went to talk to her in a private room, telling her that they didn't know if I would be brain damaged or ever come back to consciousness, be normal, etc. In reviewing my chart upon my waking up, I see they had used narcan amongst other meds, but since this was NOT an opioid reaction and no one knew what I took at the time, it did not bring me to consciousness. The reversal drugs/meds are known as "antagonists" but I know exactly why what they gave didn't work, and since all this took place and confiding in my doctor what was in my system, pieces of the puzzle were coming together for those who care so much about me.
To make this all too true story even more over the top; it was the boss who became the primary doctor looking after me, also not knowing anything. For those reading this and aren't aware, I work as the second hand for a group of doctors on a regular basis and we have a fairly close personal friendship and know one another very well. My primary physician is out of the area, as it would not been kosher and more or less in poor taste for my bosses to be prescribing narcotic medicines for me. We're all close, but also keep things appropriate, professional, etc., even when snowboarding, wakeboarding and playing outside of the office. Puzzling to them was the fact they also knew I had not been depressed or exhibiting signs of despondence, etc. I care very much for them, and I know the reverse can be said. On with my personal story....
Wednesday afternoon (10/25) about 3 p.m. I had regained consciousness. Apparently during the night I had aspirated emesis. (layman phrase: inhaled puke into my lungs) Aspirate your own emesis and you'll earn a breathing tube and an E ticket to the most creepy sensation in the world; getting junk suctioned out of your lungs through a breathing tube has got to be among the worst freaky sensations I can think of. Extubation wasn't all too pleasant a feeling, but a relief at the same time. I couldn't really vocalize well immediately after. Two weeks or so after the incident, I STILL had a sore throat and was somewhat hoorifice. At first was coughing up blood clots and such, so apparently it was a rather traumatic intubation (endotracheal intubation: term means breathing tube shoved down throat). Also, when I came to in ICU, I was somewhat sad when I found out my favorite sweatshirt had been cut to shreds by paramedics, but all considered, I have nothing to complain about.
Reflection:
Most bothersome to me; I NEVER intended to hurt or scare anyone, myself included. It's a shame that my physical pain yo-yo'ed so out of control that any of this took place. Thanks to the DEA my medical insurance company is shelling out some big bucks after this one. I'm done "playing pharmacist". At this point, I confided in my doctors (bosses and regular physician) on exact details (again, no need for details and suicide seekers on the net getting hold of this info) and on the road to more definitive treatment. I have a referral and pending appointment with a pain specialist in the area to see if perhaps localized pain injections or other reasonable medicinal methods might be more appropriate. Also for myself, I am seeking counseling, as I don't ever want to get to a point pain-wise that I'm in such a crisis that I think death is the only answer. So many flaws in the healthcare system though. How could anyone afford the aftermath of my recent issues and go on to heal? Shutting down and/or decreasing the power of the DEA would sure be a good start.

Of note, I've shared this with my PCP and we're working on getting in with a pain specialist, etc. The most unfortunate thing; there is no way I would have gone to the local ER that frightening night when at the end of my rope from pain, as they probably would have simply labeled me as a "drug seeker" and done nothing more than send me a bill but have done nothing to treat the problem.

leslie :-D · Dec 26, 2006

such an incredibly disturbing story, jessica.

my ears were going nuts, hearing all the rings of truth you so articulately expressed.

md's prescribing habits are mind-boggling, arent' they?

they refuse to help those who truly need it yet can't write enough for those who are addicted.

both situations suggest the ubiquitous threat of the malingering dea.

so pain remains undertreated and so desperate that sufferers resort to their own creative devices; or in the absence of any plausible solution, suffering continues.

i wish all who are victims of chronic pain, would empower themselves by learning the legalese for abandonment, neglect and undertreatment.

then become so enraged at the audacity of the naysayers and all others who judge.

i'm pleased that after all you've been through, you're finally being referred to a pain specialist.

peace be with you jessica.

i'm glad you shared your story.

leslie

SaharaOnyxRN · Dec 26, 2006

Sahara,
Yes, you describe perfectly the dark side to our current approach, and it's cost to the healthcare system. These types of people are also a drain on our Emergency Depts. I think part of the problem is fear of litigation.

I think that's what it is, too. I think doctors are fearing litigation so much, that they prescribe, prescribe, prescribe. It's sad that it's come to this, and it's not going to get any better, I fear.

SaharaOnyxRN · Dec 26, 2006

Thats a lot of jobs and it makes me sad to think that all of those facilities are like you describe. I would have perhaps naiively thought that this is the exception rather than the rule. No easy answers I guess.

I wish that it was the exception. I love my new job because I work with renal patients and they are wonderful. We don't get many drug-seekers because we don't get what you would call a "medical" patient. And these patients are truly sick, yet, they don't complain and call for pain medicine every 30 minutes. Like someone said earlier, I also, have seen so many young, otherwise, healthy people that are going to smoke every 2 minutes and walking all over the hospital and watching the clock so they can see when they can get their next fix. And I know that they are there for that reason, because they'll say something like: "Make that shot good and strong" in other words telling me not to dilute it. Or they'll say, "Push it fast, I don't feel anything when you push it". I guess because I push it slow and carefully. This is all too common. And these types of patients will work you to death and keep you away from the patients that are much more acutely ill. I tell you, I am beginning to get a bad taste in my mouth from it all.

grandee3 · Dec 26, 2006

Jessica, my heart goes out to you. Please keep us posted on your progress. Like I said earlier, the docs give the seekers all they need and then some and the poor post CABG gets Tylenol.

I think you are right on the money as to this horrible problem. Please remain an avecate for those who suffer in slience. Well wishes ane hugs to you.

LouRN92 · Dec 26, 2006

I haven't read every single post on this site but here is my take on pain control from my ER experience in a small rural town. Many of our patients can't afford to see their PCP because they have no insurance, they often end up in the ER for their pain needs. Some of them are abusers of meds and have specific pain control contracts with their PCP's that allow them to have specified amounts of the needed meds in a certain time period.

That said they will Dr shop, counting on the fact that we have many different doctors each weekend in the ER who might not look up their chart and find the contract or who might be willing to give them meds.

One patient this weekend ran out of his Norco and ended up showing up 3 times in a 30 hour period. I was there 2 of the 3 times. I was very sympathetic, non judgemental and charted his pain level and complaint. The doctor gave him Flexiril, then Toradol and finally the last visit I gave him IM Dilaudid and Phenergan.

The Dr told him he really needed to get the issue sorted out with his PCP. Will he? probably not, he can't really afford to. And he admitted that he is more or less addicted.

That said, I do think that nurses are so much better about providing pain relief in general to all patients. Our state requires that we take a pain control course to renew our license. I feel that in our hospital most post op patients, trauma patients, dying patients, and ER patients get compassionate care and good pain control/relief.

Obviously this is a complex issue.

Sheri257 · Dec 27, 2006

And these patients are truly sick, yet, they don't complain and call for pain medicine every 30 minutes. Like someone said earlier, I also, have seen so many young, otherwise, healthy people that are going to smoke every 2 minutes and walking all over the hospital and watching the clock so they can see when they can get their next fix. And I know that they are there for that reason, because they'll say something like: "Make that shot good and strong" in other words telling me not to dilute it. Or they'll say, "Push it fast, I don't feel anything when you push it". I guess because I push it slow and carefully. This is all too common. And these types of patients will work you to death and keep you away from the patients that are much more acutely ill. I tell you, I am beginning to get a bad taste in my mouth from it all.

I've had the exact same experience. This one woman would always lie and try to trick me into giving her more drugs. She'd say night shift didn't give her anything when, in fact, they did 30 minutes ago. She literally took all of my time ... constantly riding the call lights for meds I couldn't give any sooner than what was prescribed. No matter how many times I explained it to her ... she would keep riding the call light.

Very frustrating to say the least ... because they do work you to death and take you away from other patients.

It's funny because I just had knee surgery this morning and one of the MD's was really surprized when I told her that I haven't been taking any pain meds for my knee injury, which I've had for months now. I got scripts for pain meds but never filled them.

When she asked why, I said I'm a recent nursing school grad and, I just didn't want to take pain meds unless I felt really needed them ... being in the healthcare field and all. I guess I'm just paranoid because of what happened to my friend and, ice really helped with the pain anyway.

She said that was good because if I do need them I won't have the tolerance that other patients have and the meds should work well. I've got a bottle of Vicodin and, maybe I'm crazy but, my leg just doesn't feel that bad. The ice machine seems to be doing the trick.

So I'm not going to take the pain meds, at least for now.

:typing

tddowney · Dec 27, 2006

I've got a bottle of Vicodin and, maybe I'm crazy but, my leg just doesn't feel that bad. The ice machine seems to be doing the trick.
So I'm not going to take the pain meds, at least for now.
:typing

I've got a bottle of Percocet for a root canal I had a couple weeks ago.

I got it filled, but never used one. Ibuprofin did the trick nicely.

Between us, with all our leftovers, maybe we can be drug lords....... :lol2:

ginger58, ASN, RN · Dec 27, 2006

Do you think that the increase in the mg's in the Vicodin could be due to the fact that 2.5mg tabs probably weren't effective, and by going to the 10 mg tabs they can use less Tylenol?

"The current treatments out there highly designed at creating and turning people into drug addicts."

I'm sorry but your blanket statement scares me for all the patients out there that are in pain! Unfortunately, you're one of many with this mentality.

Zizka · Dec 27, 2006

The current approach to pain control has been to believe the pt's self report of pain no matter what. Is this creating drug dependency, and or addiction, in emotionallly susceptible people? Should we be concerned? Is there going to be a backlash to what has been a more liberal policy towards pain relief in the past 20 years.
I bring this up for a few reasons. For one thing, our hospital let go one well liked doctor, the reason we heard being that she was catering to the drug-seeking community with too many prescriptions. We were all aware of her liberal attitude on this and that she was a soft touch in that dept, but when she was apparently suddenly fired, it was a shock.
The hospital clinic does happen to attract more of the misfit population btw. It's a small town, and there aren't too many docs that take new pts. The clinic tends to get more of the riff raff, if you'll pardon me using that term.
Then, our weekend hospitalist got paranoid. He actually told a nurse who called him for pain meds that he didn't want to be fired like Dr So and So was. I also noticed that he was being reluctent to give narcotic orders when I called him.
I was reading the new ANA magazine an article titled Improving Pain Management. It takes the approach of believe the pt no matter what, don't allow people to be in pain. One thing the article condemns is the use of placebos.
I haven't seen placebos used myself, but I personally think they might have a place with a certain type of pt. The reality of the situation is that there ARE drug seekers who are good at manipulating the system. Any nurse who doesn't see that in some people must have his/her blinders on, in my opinion.
So, how do we address that reality without punishing the many people who truly are in pain? Sometimes I think the whole pain control industry is a self-perpetuating machine, and a classic case of the fox minding the henhouse. On the other hand, I wouldn't want to go back to the old days when pts were expected to grin and bear it for fear they'd all end up druggies.
Any thoughts?

In the nursing care setting I think the opposite is true. It's human nature to not want to work and therefore providing people with pain management is usually just another chore. You have to give it out, chart it, etc.

For PRN medications the nurse will look to excuses to not give. Couple that with a judgemental, "christian/purtianical" society and we'll be turning away more needs than people wanting to get "high".

HTH (hope that helps)