morphine,dilaudid,demerol

Butterfly0328 · Dec 23, 2010

oceanfamily1992 said:
Regarding "drug seeking" behavior - as a chronic pain patient myself, I've learned not to specifically request what I know words for me because I'm immediately tagged as a drug seeker. People in pain have learned exactly what does and doesn't work. It's less time-consuming and we get relief sooner if we could simply say what works and what doesn't. Doctors have their favorite medications/habits in treating pain, and if a patient asks for something out of the doctor's ordinary habits, alarm bells seem to go off. The attitudes between nurses and doctors I've witnessed are unacceptable and judgemental. I know we see people who are just there to get drugs, but you can't let that blind you to each individual patient before you. Give each person a chance and make them PROVE they aren't being honest.
Also remember that because pain patients have been treated so disrespectfully so many times, we may act a little off. A little suspsicious of nurses and doctors. A little, or more than a little, fearful, because we know we may not get adequate help simply because we aren't believed. Don't throw out your experience and judgement, but give each patient a clean slate and take great care to not make assumptions. You will end up helping patients who are truly in need, and will help the patient be slightly less fearful the next time they have to go to the ER for pain help.
Pain patients have learned to avoid the ER at all costs. Did you know that most questionairres at pain clinics ask how many times you've been to the ER for pain, as if that's a sign you aren't in pain but just want drugs? If a pain patient shows up at the ER, they're really in trouble and need your compassionate, best help.

I couldn't agree with your more. This friend I have has had a multi-level fusion, Degenerative Disc Disease, and Fibromyalgia just to name a few and last year she began to experience the same symptoms she has prior to her fusion surgery when she had spinal cord compression. Her pain doctor and her neurosurgeon told her to go to the ER if she felt she may be at risk of stenosis again and if she was experiencing a lot of pain. I finally talked her into going after she put it off for about 2 weeks. Long story short, the insurance company intially refused to even cover this visit, stating it was not an emergency!! Thank goodness her pain doctor was one to document everything and in the notes from one of her office visits he had noted the fact that he recommened she go to the ER in the event her pain became worse. Once I faxed all this documentation into the insurance the claim was processed. We have a long way to go in this area. It's so very hard for those who have never experienced chronic pain to understand it.

cmram28 · Feb 11, 2011

I worked as a pharmacy tech in the Trauma unit before I became an RN and I asked the pharmacist the difference in short morphine is a short acting narcotic and dialudid is a long acting narcotic. The ratio of dilaudid to morphine is 7.5mg:1 mg ...keep in mind it all depends on the patient. Personally I had kidneys stones and morphine did little for my pain which felt as if I were giving birth thru a straw!! Dilaudid was a savior. Demerol is antequated and is being phased out; too many side effects.

gentlegiver, ASN, LPN, RN · Feb 12, 2011

oceanfamily1992 said:
Regarding "drug seeking" behavior - as a chronic pain patient myself, I've learned not to specifically request what I know words for me because I'm immediately tagged as a drug seeker. People in pain have learned exactly what does and doesn't work. It's less time-consuming and we get relief sooner if we could simply say what works and what doesn't. Doctors have their favorite medications/habits in treating pain, and if a patient asks for something out of the doctor's ordinary habits, alarm bells seem to go off. The attitudes between nurses and doctors I've witnessed are unacceptable and judgemental. I know we see people who are just there to get drugs, but you can't let that blind you to each individual patient before you. Give each person a chance and make them PROVE they aren't being honest.
Also remember that because pain patients have been treated so disrespectfully so many times, we may act a little off. A little suspsicious of nurses and doctors. A little, or more than a little, fearful, because we know we may not get adequate help simply because we aren't believed. Don't throw out your experience and judgement, but give each patient a clean slate and take great care to not make assumptions. You will end up helping patients who are truly in need, and will help the patient be slightly less fearful the next time they have to go to the ER for pain help.
Pain patients have learned to avoid the ER at all costs. Did you know that most questionairres at pain clinics ask how many times you've been to the ER for pain, as if that's a sign you aren't in pain but just want drugs? If a pain patient shows up at the ER, they're really in trouble and need your compassionate, best help.

In many ways I agree with you, I have suffered migraines since puberty. On occasion they get so bad that I have the same symptoms as a heart attack, but on the right side of my body, orders from my PC are to get to an ER when that happen (I also have a heart condition). As soon as I tell them why I'm there they do the EKG, it is thankfully fine. Then they automatically hit me with Morphine. Two things happen: 1. I get extremely nauseous, 2. I pass out. But before they hit me with it, I can see the looks & attitude of the staff. I have learnt to refuse Morphine, I ask for any thing they have that will take the edge off the migraine so the chest pains go away. But mostly it was because I felt funny having them look at me that way.

But as a nurse I have also learnt that their are those who are truely drug seekers, and those like me, who just want to be able to continue functioning. I know the difference, but still try not to give that look even if they are seekers.

nopainNurse · Feb 12, 2011

answers to the why phasing out demerol

http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2004-08.pdf

http://www2.kumc.edu/druginfo/pharmkey/Meperidine%20pharmacy%20key.htm

RescueNinja · Feb 12, 2011

We very, very rarely use demerol. Morph is used a lot, but I would still consider Dilaudid our primary drug. We go through tons of it...

Munch · Aug 18, 2011

In the hospital I work at in the ED morphine is usually the gold standard. Although I have been a patient there myself and being a chronic pain patient most of the doctors usually ask me what works best and for me it's dilaudid. In the same hospital on the floors(especially post-op patients) if the patient has a PCA it's usually filled with dilaudid or fentanyl(I rarely see a PCA filled with morphine). But on the floors if the patient DOESN'T have a PCA and they need IV pain meds they get morphine. I don't understand the meaning of it all but I just administer what the doctors order. As for Demerol our hospital doesn't use it. I had surgery at this hospital and they gave me a dilaudid PCA...at first it wasn't working, so one of the surgeons residents came down and asked if I wanted fentanyl instead(never asked if I wanted Morphine). I stuck with the dilaudid, they just had to get the pain service down to increase the dosage(turns out since I am a chronic pain patient I have a pretty high tolerance and the dosage was too low).

Now in another hospital in which I was admitted to many times(again because I am a chronic pain patient) they give out dilaudid like it's candy in the ED and on the floors(unless a patient has an allergy then they get fentanyl)...they use morphine but very rarely.

xtxrn, ASN, RN · Aug 18, 2011

Sprinkles85 said:
In the hospital I work at in the ED morphine is usually the gold standard. Although I have been a patient there myself and being a chronic pain patient most of the doctors usually ask me what works best and for me it's dilaudid. In the same hospital on the floors(especially post-op patients) if the patient has a PCA it's usually filled with dilaudid or fentanyl(I rarely see a PCA filled with morphine). But on the floors if the patient DOESN'T have a PCA and they need IV pain meds they get morphine. I don't understand the meaning of it all but I just administer what the doctors order. As for Demerol our hospital doesn't use it. I had surgery at this hospital and they gave me a dilaudid PCA...at first it wasn't working, so one of the surgeons residents came down and asked if I wanted fentanyl instead(never asked if I wanted Morphine). I stuck with the dilaudid, they just had to get the pain service down to increase the dosage(turns out since I am a chronic pain patient I have a pretty high tolerance and the dosage was too low).
Now in another hospital in which I was admitted to many times(again because I am a chronic pain patient) they give out dilaudid like it's candy in the ED and on the floors(unless a patient has an allergy then they get fentanyl)...they use morphine but very rarely.

You give meds you don't understand ?

Munch · Aug 24, 2011

xtxrn said:
You give meds you don't understand ?

Sorry I worded it wrong. Of course I understand the medications I administer. What I don't understand is why in the same hospital in the ED they use one medication as a gold standard for pain and on the floors(in the same hospital) another medication is used as a gold standard for pain. As in the ED they only give out morphine for pain(unless of course the patient has an allergy, or a chronic pain patient ends up in the ED(like I did and the doctor asked me what works best and I said Dilaudid)...and on the floors they only use Dilaudid(sorry I re-red my post and said on the floors they only get morphine, my mistake they only use Dilaudid on the floors..unless of course the patient has an allergy or a chronic pain patient states something else works better for them). That's what I didn't understand...why they just don't use morphine and dilaudid in the ED or the floors. Sorry for the confusion.

ljohnson35 · Sep 20, 2011

I would just like to say thank you to Grannyrn65 as a nursing student and the daughter of a 65 year old man that has suffered from pelvic fractures, neuropathy, compression fractures, PAD, crushed nerve due to stenosis, perineural cyst, pneumothorax, and number of other issues and he has been treated like an addict repeatedly because he is always in pain and pain is always his chief complaint. He also suffers from CHF, chronic kidney failure, heart disease, end stage COPD, seizures etc. Obviously he is a terminal patient and he has been taking taking oxycodone 10/325 6 times a day for a year now and they are barely taking the edge off of his pain anymore. The pain clinic has refused to give him anything stronger, but at first they pushed butrans patches on him with his oxycodone. My father also has first stage dementia and I have to control all of his medications daily and this patch terrified me. I was afraid that someone would attack him to steal his patch or that it would gall off and one of his grandchildren would get a hold of it etc. I do not understand why they cannot just give him a stronger pill that cannot be list or stolen once in his possession. I feel that they should provide him palliative care and make him comfortable for the remainder of his time here.

ZippyGBR, BSN, RN · Sep 21, 2011

ljohnson35 said:
I would just like to say thank you to Grannyrn65 as a nursing student and the daughter of a 65 year old man that has suffered from pelvic fractures, neuropathy, compression fractures, PAD, crushed nerve due to stenosis, perineural cyst, pneumothorax, and number of other issues and he has been treated like an addict repeatedly because he is always in pain and pain is always his chief complaint. He also suffers from CHF, chronic kidney failure, heart disease, end stage COPD, seizures etc. Obviously he is a terminal patient and he has been taking taking oxycodone 10/325 6 times a day for a year now and they are barely taking the edge off of his pain anymore. The pain clinic has refused to give him anything stronger, but at first they pushed butrans patches on him with his oxycodone. My father also has first stage dementia and I have to control all of his medications daily and this patch terrified me. I was afraid that someone would attack him to steal his patch or that it would gall off and one of his grandchildren would get a hold of it etc. I do not understand why they cannot just give him a stronger pill that cannot be list or stolen once in his possession. I feel that they should provide him palliative care and make him comfortable for the remainder of his time here.

did you express these concerns at the time ?

let me provide you with some reassurance

1. why would anyone know he was prescribed Butrans unless you or him told people? - it's a small discreet patch and generally it's on the upper arm , shoulder or upper chest - hidden by your shirt

2. in my experience butrans patches stay on very well far better than NRT or even fentanyl

beyond that you should discuss this with your Dad's doctors

turnforthenurse, MSN, NP · Sep 26, 2011

Where I work, we mostly give morphine. One of our doctors prefers Demerol, so ALL of his patients will have that ordered PRN unless there is a contraindication. He is the only one who does that. As for Dilaudid, I see it sometimes - not rare, but less common than morphine.