Is stadol contraindicated in drug abuse patient?

babyktchr, BSN, RN · Apr 9, 2010

Stadol is contraindicated in patients with narcotic addiction becasue of its antagonist effects (as well as Nubain). It can cause severe withdrawal symptoms, including seizures (not pretty). Epidurals are generally successful with this type of patient. Speak to your anesthesia department about it or better yet, speak to your local drug treatment center physician. We had a doc come and speak to us about Methadone and Suboxone therapy and it was very enlightening. He gave wonderful recommendations about pain control and the addicted patient (or those in a program such as methadone).

Jiayou · Apr 9, 2010

Thank you very much babyktchr ! I really appreciate your information.

sleepy_time · Apr 9, 2010

stadol is not contrindicated and is not solely antagonist. Stadol is both an agonist and antagonist just like nubain. They are not contraindicated but they are probably not the best choices. However they are useful for decreasing respiratory depression in patients receiving mu2 receptor agonists.

BabyLady, BSN, RN · Apr 9, 2010

I have seen two births from mother's who were drug addicted and they were not pretty...anesthesia was unable to get either mother even close to comfortable.

chris_at_lucas_RN, RN · Apr 9, 2010

Hello,
I had a drug abuse pt whose drug screen result shows that she is positive in Amphetamines, Metamphetamine, Methadone, and THC last night. She screamed for UC pain all the time. The doctor refused to give her Stadol because he said it was contraindicated in drug abuse pt. I am wondering if it is true. If it is true, how can you deal with pain for those kinds of pt when epidural anethesia are not available? Thanks.

Thank you for bringing up this important issue.

People with intractable pain who are also drug dependent are especially challenging if you subscribe to the concept that pain is not acceptable and should be assessed and treated, period. Which is, of course, what nurses and other health care professionals are supposed to do.

You sound like you are more on the ball than the doc. Good for you, except I know having to care for a patient screaming in agony while you had nothing to offer her had to be heartbreaking.

If he didn't like stadol, he could have used something else. He might have called in a consultant, say, a psychiatrist specializing in substance abuse patients.

Leaving a patient in severe pain screaming for relief and doing nothing is a sad and frequent event in health care.

I googled just now and cannot find (with any reasonable ease at least) anything I considered usable. I'm sure it is out there, maybe I just didn't use the right buzz words.

This site (http://www.flexyx.com/S/Stadol.html) says that stadol can potentiate alcohol, barbs any other CNS depressant and thus if used should be the lowest dose possible. The contraindications are only for sensitivity to the drug itself.

I'm guessing your poor patient might have had some relief. It sounds like the doc doesn't like addicts. (They are kind of hard to love, but.....)

Thanks for the thread!

Christine Johnson RN LMFT CHPN

sleepy_time · Apr 9, 2010

At what point is the patient responsible for their actions. It's unfortunate that she has pain, but you are dealing with 2 patients. You can't just load these patients up with narcs until they are in a zero pain state. We don't know the full history of the patient was she in labor? Was she just in for some sort of monitoring? Is the pain related to something else? We really don't know. The fact is this is the exact kind of patient that would be the first to sue if something were to happen and they could blame it on someone else.

Jiayou · Apr 9, 2010

Thank you all for your wonderful posts. I appreciate that, especially thank you Christine for your web site. I learned a lot. Thanks.

klone, MSN, RN · Apr 9, 2010

I wonder if IV fentanyl would be an appropriate substitute?

chris_at_lucas_RN, RN · Apr 10, 2010

At what point is the patient responsible for their actions. It's unfortunate that she has pain, but you are dealing with 2 patients. You can't just load these patients up with narcs until they are in a zero pain state. We don't know the full history of the patient was she in labor? Was she just in for some sort of monitoring? Is the pain related to something else? We really don't know. The fact is this is the exact kind of patient that would be the first to sue if something were to happen and they could blame it on someone else.

Pain is not acceptable. No one said to load anyone up until they were dopey. But pain relief is a serious issue and the failure to provide it is neglect.

The other nurse was right: the patient should have had something.

If you are concerned about liability, consider the law suit against the hospital, doctor and nurse when the patient figures out that they were left in severe pain unnecessarily.

You are right about not having all the info, but (and I could be wrong) seems like the OP put in pertinent info--if labor or chronic liver or kidney disease or cancer or something else was at issue, I believe it would have been posted.

If you have two patients, you have two patients. If one of them is in pain, you need to treat the pain. There are of course non med pain interventions, but severe pain is severe pain.

I would hate to think that someone would withhold pain med because they thought a patient should be "held responsible for their actions." Should laboring mothers not receive pain med because they should have known what they were doing when they got pregnant? Of course not.

Look up about "blaming the victim" and consider the relationship with pain management (or any other treatment). I think you will see what I mean.

Hope this helps to clarify why we treat pain, even if we think the patient doesn't deserve it....

Christine