No pain meds in ER??

[ShaneTeam]

So, how does everyone feel about the New Jersey hospital that decided to pull pain meds out of their ED?

[betbrennan]

I have heard this from many patients, and a few years ago I went to a conference where the pain expert reported that studies revealed that mu receptors can have an affinity or like opioid over another. Then you have the codeine thing. If you don't have the enzyme in your GI tract that converts codeine to morphine, then codeine is useless to you. For many, it is trial and error.

[ERnursebyday]

The article I read confused the heck out of me. In parts it said no opiates, in others it said they had a plan to manage opiate use. It ended with a quote saying that opiates will always have a place, but will no longer be first line in their ER. Opiates were never meant as first line pain treatment. I can't have any NSAID products without having severe asthma flares, so if I come in with a broken leg, I better get me some opiates- as should anyone. It doesn't sound like they're planning on totally eliminating opiate use in the ER.

I wish they weren't the first line of therapy, however, from my experience it seems to be more and more "expected" by the patient.

[ERnursebyday]

I worked in the ER for just over 9 years and saw many overdoses but those that died did so not from the opiates but from the acetaminophen. Most died from liver failure some time after the fact. Not one of our OD's were from the opiate itself. We saw our fair share of patients wanting narcotics. Most of the "drug seekers" wanted their doses in IV form and would try to sneak out with the INT intact. But we did not routinely write opiate prescriptions in the ED. Most patients got scripts for toradol or naproxen sodium. We reserved the dilaudid for sickle cell patients, MSO4 was saved for cardiacs, open fractures, kidney stones and other severe traumas. I have also seen raglan stop a migraine mid-attack. We were doing that 10 years ago. If our Doc's did write a narcotic it was for only 2 days with a referral to another doctor. We treated the pain without going overboard. What is wrong with that formula? Patients are being treated as customers. Somewhere along the line administrator's decided that the "customer" is always right however patients may know what they want but not what they need. It is up to all hospital's and ER doctors to give them what they NEED. Patients need to go back to being patients not customers.

But what frightens me is the effect these new actions will have on my pain management. I have been in pain management for 8 years now. I have had 2 surgeries for herniated disks in my neck, there is one in my lower spine now but I am no longer a surgical candidate. I have a right shoulder that needs replacement and a bum knee. Most nights I do not sleep well even thought I am on Norco 10's 4 times a day. I nave never yet experienced a "high" due to the medication. I could not get out of bed without my meds but I do not know if my pain management doctor will be allowed to continue my current treatment (meds plus injections).

Removing opiates from ER's is just the first step those of us that live with chronic pain have been totally overlooked.

How long has it been since you worked in the ER?

[Munch]

Maybe it's just my cynical mind at work. Targeting prescription opioids rather than cracking down on heroin entering the country seems like the wrong way to go about it. In New York, you can walk into a pharmacy and purchase syringes without a prescription, no questions asked. The pharmacist I know said it was done to try to control sharing contaminated needles to combat AIDS and hepatitis. So, the government is encouraging IV heroin use, isn't it? You can also buy beer at the same pharmacy, along with your needles. Somehow, this doesn't seem like the right way to address the heroin epidemic.

I know this thread is old and I haven't read through all the replies but I had to reply this. The gov't is encouraging IV heroin use because you can get syringes from the pharmacy counter? Chances are the person that goes to get them is already using IV heroin and not some clean person that says..gee I can get some syringes now let me go find some heroin to use?

I live in New York and NYC in the 80s and 90s was ravaged with HIV and AIDS. Maybe some users aren't ready to quit yet but access to clean syringes helps keep them disease free so they don't spread it to your family member during a sexual encounter. They have needle exchange programs across the country and many states across the country allow you to buy syringes from the pharmacy counter. Addicts are going to find a way to get their fix. God forbid we go back to the 90s in NYC where 6 addicts would hover over the same needle they got from a diabetic or even worse..the trash can! You stop access to syringes you won't discourage IV drug use..you just encourage unhygenic practices and HIV and Hep C will reach crisis levels again.