Nurses against Narcotic Abuse

Nurses General Nursing

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As an Emergency Room Nurse for 5 years, and a Critical Care Nurse for 3, I still think the most harmful disease by far is prescription drug abuse. And with the advent of patient satisfaction driving revenue for vastly underpaid hospitals, prescription narcotic abuse has become a public threat. I have seen Percocet get prescribed to people with chronic back pain, abdominal pain with no known cause, chronic "fibromyalgia", and ovarian cysts that have ruptured months and sometimes years ago. I've seen patients receive up to 30 pills at a time, some people I see back a few days later, looking for more narcotics. I really think this is a symptom of our everything-right-now society, and I think it's probably the most harmful thing we as healthcare workers are doing to patients. A lot of Emergency room physicians have become drug dealers. They get asked for by name, because they order the right combination of Dilaudid, Phenergan and Benadryl, with a Percocet or Vicodin prescription to go home with. The entire practice has become exactly against what modern medicine was meant to stand for in the first place.

I would like to do something about this. I'm writing this to see if there are any nurses with kindred spirits out there who would like to help. I'm envisioning a letter-writing campaign to Washington, and to your state senators, followed by a public campaign/education project to really teach society how bad/insidious these narcotics really are. I think a large group of nurses is what it will take to get this issue under control; the public still trusts nurses more than any other professional. Anyone with me? Feel free to pm me or reply to this thread with any comments.

Specializes in Family Nurse Practitioner.

Honestly I thought, had heard of for years...that narcotic prescriptions would be, could be, checked on line so any prescriber could see what narcotics a patient was on. I guess that aint so yet!

In my state we can check but it really only shows if they are ED shopping and what their doctors are prescribing so even if it is an egregious amount the ED provider is in a tough spot when a person swears they lost their script, are withdrawing etc. In my experience it isn't so much different providers giving contraindicated medications but often 1 provider loading them up on the crap. :(

I have to wonder, those that seek the meds and get them..are they ever really the ones sending back the surveys and giving the better scores thus giving the higher reimbursement. I'll go with a big fat NOPE!

I disagree.

You are right in the case of the obvious BS- Allergic to 3 non-narcotics, multiple non-verifiable pain issues, etc..

But, the 300 lb lady with knee pain caused by the extra 150 lbs? If she is told to stop overloading her arthritic knees, and start a program of diet and excercise- bad review.

OTOH, 40 Percs? Yippee Skippy,

Specializes in Geriatrics, Home Health.
I disagree.

You are right in the case of the obvious BS- Allergic to 3 non-narcotics, multiple non-verifiable pain issues, etc..

But, the 300 lb lady with knee pain caused by the extra 150 lbs? If she is told to stop overloading her arthritic knees, and start a program of diet and excercise- bad review.

OTOH, 40 Percs? Yippee Skippy,

Why not both? Knee pain can make exercise impossible, and I highly doubt she could lose 150 lbs overnight.

I've received lectures on pain and pain control, and so-called myths, and I've heard the line that most patients will not get addicted to pain medication. May be true, but I think the number of patients who end up addicted or physically dependent on pain medication is higher than we'd like to admit. I've also heard there is a difference between addiction and dependence, and that too is BS. It's one and the same, and the symptoms of withdrawal are the same. I believe narcotic medications are wrong, and unless one is having surgery, should not have it prescribed for vague medical complaints, or even after minor procedures. I believe consumers should be informed about the dangerous downside of narcotic medications, and we should be pushing non-pharmacological methods whenever possible. It's hard to do, and I must admit, I don't always strongly push it. But I work in PACU now and have to use narcotics to control pain after a patient's just been cut open. I also use heat and cold when I can.

One thing I know for sure is I refuse to be a part of a system that makes fools out of patients. I don't recall the last time I ever received narcotic pain medication. I had my wisdom teeth removed without general anesthesia, only local, and got a script for Vicodin. Didn't even fill it. And this was well before I became a nurse. I will still refuse to take narcotics as much as I can. Hell, I'm trying to get away from OTC pain medications like Ibuprofen and Tylenol. I only take Ibuprofen once a month for period cramps, and even with that I'm researching alternatives to Ibuprofen.

I may work in this rotten healthcare system, but I refuse to become a victim of it.

Totally agree !!! It heats me up when i see this....i had to deal with patients like that before, so glad i resigned that place

In my experience, ER's are not a long term solution to chronic issues.

For instance, I went to my local ER. I had aching as opposed to pain. I was practically handed whatever narcotic pain medication I would want. Even though I repeatedly stated that I did not want narcotic pain medication, Tylenol and ibuprofen worked just fine for me. I was asked "was I sure" multiple times, and asked if I wanted an RX, "just in case". Now, if I were in a different state of mind, I would have said "heck ya"--which is what many, many patients do every day.

Then the next thing you know, the pain is back. Along with an itchy, jumpy feeling from the days of percocets one has taken. So the issue is now two-fold. And before long, some become addicted in a cycle that is never ending.

There needs to be a lot of non-narcotic options. Narcotics should be the last resort as opposed to the first line of defense for people who have pain. Acute pain is one thing, but acute pain that is below a 5 is another.

Had a friend who hurt herself at work. Acute back pain. Toradol worked wonders. Was given an RX for Vicodin. Took one, as she was thinking it was as great as the toradol was. Had "the best day of her life" Vicodin was a wonder drug for her feeling on top of the world. Her world came crashing down, she was seeking that incredible feeling every day, and got herself into a nasty addicition.

Education needs to be clearer, follow up needs to be clearer. Education regarding the fact that Percocet is not going to cure your back pain. Even follow up to specific people--see your PCP tomorrow to discuss PT, make an appointment for a surgical consult, other options for this pain.

And just as a complete aside "fibromyalgia" is a real process for any number of people. I am of the thought process that it is trauma based pain. In any event, antidepressants can help with chronic muscle pain. And therapy--as in a counselor, as chronic pain suffers need a heckuva lot more than a pain pill is going to give them.

It needs to be multi-disciplined, and should a person continue to seek out meds in the ER, then would be the time to call in the troops--social work, case management, pain MD for a consult.....

Specializes in Family Nurse Practitioner.
And just as a complete aside "fibromyalgia" is a real process for any number of people. I am of the thought process that it is trauma based pain. ..

OT but since you mentioned it the problem I have with Fibro, although thankfully there actually is clinical criteria, is that it tends to be a junk diagnosis given to those, often those with cluster B traits, who the providers can't find a more plausible diagnosis for. I would agree at least anecdotally there does seem to be a large number of these patients with a trauma history and SSRIs are a great place to start but the diagnosis and the enticing drama that seems to accompany it "fibro fog" anyone? can make accurately treating these patients difficult. I guess I just wish providers would exhaust all the options such as PT, diagnostics, therapy and antidepressants prior to handing out this diagnosis.

I've had back and neck issues for decades. Ended up having a cervical fusion a few years ago. With the exception of immediately post op, I have NEVER ONCE been offered narcotics for back pain! And yet apparently they are being handed out like candy.

Guess I have always chosen docs who were not so quick to go there. Plus, I've never asked for any.

Agree that toradol is a great pain killer for acute back pain.

Specializes in Family Nurse Practitioner.
I've had back and neck issues for decades. Ended up having a cervical fusion a few years ago. With the exception of immediately post op, I have NEVER ONCE been offered narcotics for back pain! And yet apparently they are being handed out like candy.

Guess I have always chosen docs who were not so quick to go there. Plus, I've never asked for any.

Agree that toradol is a great pain killer for acute back pain.

You are both smart and lucky. As far as I know the literature does not support that opiates are effective for long term pain control so that providers keep doling them out like candy is just egregious imo.

Specializes in Psych, Addictions, SOL (Student of Life).

I believe narcotic medications are wrong, and unless one is having surgery, should not have it prescribed for vague medical complaints, or even after minor procedures. I believe consumers should be informed about the dangerous downside of narcotic medications, and we should be pushing non-pharmacological methods whenever possible.

Well spoken for a person who has never experienced chronic unremitting pain. For two years I suffered from the worst pain I could ever imagine. Severe generalized body pain, abdominal pain, migraine headaches you name it. because I have a history with alcoholism I didn't want to use narcs and I was basically living off Tylenol and Ibuprophen. My ears were ringing all the time and The IBU wore a ulcer in my stomach lining . After many visits to my PCP I was referred to a large medical school for a differential diagnosis. By that time the IBU had reduced my kidney function by 25% and my liver enzymes were problematic as well. I was diagnosed with a rare form of ulcerative colitis that is almost always precancerous as well as Fibromyalgia degenerative joint disease from all the steroids my PCP pumped into me rather that go the opiate route. My then doctor put me on Morphine ER twice a day. I had surgery to remove 18 inches on my colon in June 2012 and remained on morphine for another two months. I gradually stepped down to Norco then to tramadol. I can not ever take any NSAIDs due to liver and kidney complications. I keep a bottle of Norco in my med cabinet at home which my doctor fills 2 to 3 times a year. I have found my greatest pain relief comes from very strict alkaline diet that reduces intracellular inflammation. But there are occasions when the fibro just has me beat. On the outside I look quite healthy, but I have been diagnosed with three auto-immune disease all of which cause chronic pain. I don't take pain meds when I work which is a lot.

My point is you cannot know what someone's pain is until you have experienced it. In the case of the addict. detoxification and recovery is gradual process and you can do real physical harm to a patient by just cutting them off.

Just my two cents

Hppy

Why not both? Knee pain can make exercise impossible, and I highly doubt she could lose 150 lbs overnight.

Why not both?

Because one is unpleasant.

Working in the ER, I see a lot of chronic problems, most of which are exacerbated by lifestyle choices.

Smokers with a cough get a good talking to. Walk in complaining of GERD and eating a cheeseburger, we'll probably mention the connection.

But come with an extra 150 lbs of you, complaining of an arthritis flare up, or your bad back, and there is a good chance nobody will mention the real cause of your pain.

But- my real point was that as long as we are locked into this ridiculous customer service model, this problem will be difficult to overcome.

We can't ignore the terrible impact of basing re-reimbursement, career advancement, etc on customer satisfaction. Narcotics arejust one part of the problem.

Specializes in Family Nurse Practitioner.
Why not both?

Because one is unpleasant.

Working in the ER, I see a lot of chronic problems, most of which are exacerbated by lifestyle choices.

Smokers with a cough get a good talking to. Walk in complaining of GERD and eating a cheeseburger, we'll probably mention the connection.

But come with an extra 150 lbs of you, complaining of an arthritis flare up, or your bad back, and there is a good chance nobody will mention the real cause of your pain.

But- my real point was that as long as we are locked into this ridiculous customer service model, this problem will be difficult to overcome.

We can't ignore the terrible impact of basing re-reimbursement, career advancement, etc on customer satisfaction. Narcotics arejust one part of the problem.

Yup obesity often gets a free pass and it is especially heartbreaking with the numbers of obese children who I would have to guess aren't the ones purchasing the food or pulling into McDonald's drive thru. :(

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