Overuse of opiates?? Opinions?

[NiteShiftNut]

would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. :uhoh3: :uhoh3:

[Traveler]

>

It does sound like this patient had some issues I agree. But, we must remember that there are many different types of pain and they don't all respond the same. For example, nerve pain doesn't respond to opiates as well as other types of pain do.

[medpsychRN]

It does sound like this patient had some issues I agree. But, we must remember that there are many different types of pain and they don't all respond the same. For example, nerve pain doesn't respond to opiates as well as other types of pain do.

Not sure if this is directed to me! In our unit we get the majority of chronic pain (usually back) patients. Anesthesiology is there 24/7 and they manage pain patients. They are always consulted and can be called any time day/night.

This particular person was on more than pain medication. So beyond having sedation from pain meds, her other meds would naturally contribute to the sedation. I'm not advocating the use of sedating meds to replace pain meds. This is just the way it was.

I am an old nurse!! I have seen patients go bad from too much medication. Dilaudid, methadone, valium and last week a little old lady from 0.25 of resperidol and 5mg of Ambien! (And I talked to the resident before this little old lady got her meds!) You just never know.

I am the one who is going to be responsible if something goes wrong. I am making the assessment and giving the meds. When someone's respiration is 6, they're nodding off, or responding to internal stimuli (no known psych issues), pain or not, it's dangerous to give them more.

[teeituptom, BSN, RN]

I have 2 friends I golf with on a regular basis. One is an ER Medicine specialist, the other is a pain management specialist. Makes for a fun round of golf listening to these 2 as they discuss their widely differing views of pain management. Im surprised that at times they dont inflict pain on each other with their 4 irons.... I work with the ER doctor and he really is quite gentle and compassionate and gives plenty of pain medications. The pain management doctor gives out so much pain medicine I cringe. I subbed in his office one day when his regular nurse was ill. One of the worst days of my life and I have been around quite some time. I never gave out so many scripts and so much methadone at one time since back when I used to work in drug rehab. And the clientelle coming into his officem the way they were dressed, the way the acted, and behaved was appalling. I would have felt safer in a crack house, do the still call them that. All I saw and heard were these chronic pain patients refusing any and all other pain relieveing options, All they wanted were there medications.

Now on narcotics there some simple rules you have to live by

1. dont mix them with alcohol

2 dont drive a car or truck or operate heavy machinery

3 stay out of hot tubs and swimming pools

These are basic rules of life and narcotic medicines. But these chronic pain patients feel these rules dont pertain to them. They drive while under the influence of narcotics, they injure, maim, and kill people, and even do more harm to themselves.And they never feel like they are responsible for thei actions either. Yes I am an ER nurse.

These chronic pain types mix their meds with alcohol, then wonder why their liver fails, why they develope pancreatitis, why they vomit and aspirate their vomitus and eventually drown in their own puke.

keep it in the short grass

[apaisRN, RN, CRNA]

Teeituptom, PLEASE emphasize that you are not judging all chronic pain patients. I know the population includes plenty of addicts, but there are many, many truly sick people. My MIL has terrible knees - she has had one replaced, but it still hurts, and she's afraid to have the other done now. She's limited in her expeditions, her husband does the food shopping and anything involving stairs. She complains that she hates taking her meds because they put her to sleep, but she can't cope with the pain sometimes. I prefer that she takes Percocet and ambulates independently, at least to church and around the house, to her giving in and using a wheelchair. I would hate her to be treated like an addict - she's a 50-odd year old married woman, runs a cancer charity, adores her granddaughter. She's a real, mentally healthy (as much as anyone is) person. But her knees are murder. I don't think she's the only one, or one of a small minority.

Wher WAS this pain clinic? A depressed area or inner city, perhaps?

[teeituptom, BSN, RN]

Teeituptom, PLEASE emphasize that you are not judging all chronic pain patients. I know the population includes plenty of addicts, but there are many, many truly sick people. My MIL has terrible knees - she has had one replaced, but it still hurts, and she's afraid to have the other done now. She's limited in her expeditions, her husband does the food shopping and anything involving stairs. She complains that she hates taking her meds because they put her to sleep, but she can't cope with the pain sometimes. I prefer that she takes Percocet and ambulates independently, at least to church and around the house, to her giving in and using a wheelchair. I would hate her to be treated like an addict - she's a 50-odd year old married woman, runs a cancer charity, adores her granddaughter. She's a real, mentally healthy (as much as anyone is) person. But her knees are murder. I don't think she's the only one, or one of a small minority.

Wher WAS this pain clinic? A depressed area or inner city, perhaps?

Its in North Dallas

[apaisRN, RN, CRNA]

I don't know nuthin' 'bout Texas, is that a bad area?

[teeituptom, BSN, RN]

I don't know nuthin' 'bout Texas, is that a bad area?

Well it has its good points and bad points

good point there are a lot of nicely priced golf courses all around me

bad point, whole place is chock full of them thar republican idjits

good point there are a lot of driving ranges all around me

bad point we are surrounded by lawyers here and they are all republican

good point you can golf year round

bad point sometimes you have to golf with them republican lawyers