No pain meds in ER??

[MunoRN, RN]

Despite many of the headlines, it doesn't appear that this hospital has stopped or plans on stopping opiate prescribing, they just try to avoid it, which isn't all that unusual. From one article:

If you show up at the emergency room of St. Joseph's Regional Medical Center in Paterson, you'll have only a one-in-four chance of leaving there with a prescription for opioid pain pills.

I assume they're referring just to patients who present primarily for pain, since that's actually a higher rate of opiate prescribing at discharge than the national average, which is just 17%.

[ShaneTeam]

Hi trouble! Haven;'t seen ya in a while. I agree. The pendulum seems to go to the extremes. After reading more on the story, which I should have done before starting this thread, it sounds like maybe they can actually find a middle ground. At least I hope. I just pray they are sincere about still giving for the ones in true pain.

[Libby1987]

Oh geeze, I'm one of those who gets no relief from morphine. When I had a traumatic fracture from a horse accident, morphine IM and IV didn't touch it* pre or post op, dilaudid worked in the ER and oxycodone worked post op. I was coming undone before the dilaudid.

There must be alternatives to both morphine and dilaudid?

*just love the nurses who can't believe morphine doesn't work on some people..

[iluvivt, BSN, RN]

Morphine actually causes me pain as it irritates my biliary tree by causing spasms of my Sphincter of Oddi. I do not have any biliary disease I am just sensitive to it so there are other reasons other than allergy where one may need other options.

[sailornurse]

Oh geeze, I'm one of those who gets no relief from morphine. When I had a traumatic fracture from a horse accident, morphine IM and IV didn't touch it* pre or post op, dilaudid worked in the ER and oxycodone worked post op. I was coming undone before the dilaudid.

There must be alternatives to both morphine and dilaudid?

*just love the nurses who can't believe morphine doesn't work on some people..

It's genetics. They can do some testing it's genetics they use a saliva swab to see if you do or do not metabolize certain medications pain medications opiates , ADHD antidepressant meds that's been going on for about the last 5 to 7 years.

[Farawyn]

It's genetics. They can do some testing it's genetics they use a saliva swab to see if you do or do not metabolize certain medications pain medications opiates , ADHD antidepressant meds that's been going on for about the last 5 to 7 years.

Thanks. I love learning new things to read up on. :)

[Rocknurse, MSN, APRN, NP]

It is true that people metabolize drugs very differently, mainly due to certain CYP450 enzymes that can affect the way morphine and derivatives are broken down. Some people are faster metabolizers and some are slower metabolizers which will effect the rate and depth of which they feel the relief (or not) from the opioid. Specifically, the CYP 2D6, 2C9, and 2C19 are the ones that can effect that.

Personally, I worry about this move to shut people off from opioids in the ED. I've heard all the arguments against, mainly due to addiction, and I get it. But that leaves the people with genuine pain conditions high and dry and without relief. It scares me to know that when my endometriomas rupture (which they could at any time) I might be offered a darned Tylenol. Don't think I'll be too happy about that!

[ShaneTeam]

It is true that people metabolize drugs very differently, mainly due to certain CYP450 enzymes that can affect the way morphine and derivatives are broken down. Some people are faster metabolizers and some are slower metabolizers which will effect the rate and depth of which they feel the relief (or not) from the opioid. Specifically, the CYP 2D6, 2C9, and 2C19 are the ones that can effect that.

Personally, I worry about this move to shut people off from opioids in the ED. I've heard all the arguments against, mainly due to addiction, and I get it. But that leaves the people with genuine pain conditions high and dry and without relief. It scares me to know that when my endometriomas rupture (which they could at any time) I might be offered a darned Tylenol. Don't think I'll be too happy about that!

I agree completely, and am also worried for the patient who is in pain. The ED already labels some of their patients as seekers, which some are not. Is this going to alienate more patients who actually need relief? And I haven't been able to find anything on alternative measures they have been discussing, except of course the nerve block, which while effective, is short term.

Any ideas how we might be able to cater to the patient that comes in in severe pain?

[blondy2061h, MSN, RN]

Come to think of it, the last time I was in the ER, for an asthma attack, I happened to have a headache as well. They gave me 4mg of morphine IV push for it. They were also hoping to help my dyspnea discomfort, which it did. It probably was excessive, though.

[BuckyBadgerRN, ASN, RN]

Fox News: they report, you decide. Nuff' said

So, Fox News had brought on this Dr. to discuss some trends in medicine, and this was brought out as kind of by the way thing. And the guest Dr. was for them pulling opiates. He said something about how we use 80% of the opiates manufactured in the world, but by no way could we be in that much pain. Then, they had stated it was to reduce dependency and addiction of opiates. I know ED's have been trying to reduce the amount of drug seekers in the ED, but if you pull the drugs, what do you do with the patients, like the PP who actually needs them?

[Lunah, MSN, RN]

The article I read said that opiates are no longer first-line in that ED, but that doesn't mean that the Dilaudid has been removed from the Pyxis.

New Jersey hospital emergency room becomes first in U.S. to end use of opioid painkillers | New York's PIX11 / WPIX-TV

[Lev, MSN, RN, NP]

My ER is also "dilaudid free" and we haven't had that much trouble from patients. We give a lot more morphine than before and we use fentanyl (stronger than dilaudid but doesn't last as long) for really severe pain or for those with low blood pressure. We have to physically walk over to pharmacy to get dilaudid.