I had a pt the other day that was addicted to dilaudid. I'll also assume he was addicted to xanax since he does take that 4x/day. He also takes several other psych meds. He requested a pain management specialist see him in the hospital so I had that arranged. They saw the pt and they checked the prescription reporting service (I don't recall the exact name) and they determined the pt is addicted to dilaudid and has multiple subscribers for his medications. I know I'm not supposed to judge his pain. Subjectively he states he has a lot of pain all the time. Objectively he looks comfortable. Those are facts and not my opinion.
I was wondering if a pharmacy is legally required to always fill prescriptions when it is known that they get prescriptions from various providers and there is a pattern of "doctor shopping" for lack of a better term. I asked another nurse I work with who said "well they have the prescription so the pharmacist has to fill it". I just think there should be some accountability and don't really know who it should fall on.
Needless to say the pain doctor would only authorize the pt to have dilaudid 1 mg ivp q3h prn. The pt takes dilaudid 8 mg po q4h atc at home. Of course the pt left AMA because he was not getting the pain meds he wanted.
Please make sure you're using the correct terminology. Addiction is a psychological and behavioral disorder characterized by the presence of all three of the following traits:
loss of control (i.e. compulsive use),
continuation despite adverse consequences, and
obsession or preoccupation with obtaining and using the substance.
What many of those responding to this thread have described is dependence, a physical condition. People who live in chronic pain and take narcotic pain medications may develop a physical dependence on those medications and will suffer the effects of withdrawal if the medication is stopped, but they are not addicts.
As someone who takes high doses of opioids to make the severe central pain and nociceptive pain I've lived with every day for decades more manageable, it's immensely frustrating that the majority of medical professionals don't know the difference between addiction and dependence, and fail to understand that the techniques and tools they use to assess acute pain (heart and respiration rate, outward affect, etc.) are meaningless when assessing someone living with chronic pain.
Dear hipcrip,
THis was extremely well said.
I also suffer from chronic pain. And I have had the unique experience of having been physically dependent on opiods for 8 years...I have multiple degenerative conditions and have had bilateral hip and knee replacements. Also autoimmune dx...that's not the issue.
I have to say, the ignorance of some who have posted here about chonic pain, and how to manage it, has made me shake my head.
Others have a handle and at least some sort of understanding.
First I have to say...this was MY experience, and it is unique, as chronic pain is UNIQUE to each person suffering it. To say that ALL persons requesting xyz drugs are drugs seekers or addicts...and yes, there is a difference between dependence and addicition...is absurd.
The last year I was dependent on opiods, I was taking, on average 300mg of long acting MSO4 with 10mg IR q6 for break through pain. I was not zonked...I was fully functional...this is called TOLERANCE....
I was not "Doctor shopping"..or buying them on the street....I was going to a well respected Anesthesiologist who specialized in pain management where I was monitored biweekly.
However, as the doses continued to rise, I belive what was happening was, I was so sensitive, that I would start to withdraw as the levels would drop, leaving me with the pain I already had in addition to the pain I would feel in withdrawal.
It was becoming a vicious cycle.
After discussing it with my Doctor, both my pain Dr and my primary, I decided to detox off of all pain meds....
It wasn't pretty...and I didn't go cold turkey...I did it with my doctor's help.
BUT...it has been 2 and 1/2 years now, and I do not take anything stronger than NSAIDS..I do see my Rheumatologist ( I have RA, too)
and I can HONESTLY say that my pain level is so much less than when I was on the BIG guns....and I was on them all...(oxycontin,morphine,roxy) but I am still in chronic pain and it does wear on you.
I am only saying....each person is unique....and we are not all ragingADDICTS...you would have been shocked to know I was on those meds back then and have NEVER guessed it.
I only went off of them b/c it was a spiral...not b/c it was any sort of moral decision.
Please becareful of whom you judge.
Unless you have walked, or in my case LIMPED, in my shoes...you really don't know what it's like.
I had chronic pancreatitis, one of the most debilitating diseases and extremely painful. Mine was caused by gallstones blocking my duct, and backing up into my pancreas...however, it is common for us to be accused as alcoholics, and thus we become what everyone terms a drug seeker.
I had acute pancreatitis, and I was ASTOUNDED at how everyone assumed I was an alcoholic!! My Mom was, and I don't drink. The assumptions were OK, but it was the disbelief when I said "No, I'm not" that made me mad. Kudos to you--I had enough pain with my one episode, I can't imagine living with chronic pancreatitis.
there's another thread cooking somewhere here on this-- it is so disheartening to hear that nurses -and obviously physicians- do not know the difference between addiction and tolerance. go look those up.
your patient who was taking high doses of dilaudid said he had pain; you didn't believe him because you thought he just came to the hospital for drugs and so you interpreted his appearance as being "not in pain," feeling that you were being "objective." didn't they teach you in school that pain is what/where/when the patient says it is?
he didn't just whine about it-- he specifically asked for a pain management consult. sounds like he didn't get a very good one. you may not have learned much about the complex specialty of pain management in school-- it is a complex specialty like any other. most nurses think that opioids are appropriate for all pain (they aren't by a long shot), that high doses mean addiction (nope), and that people who are addicts (by which they think "anyone who takes high doses" don't really have pain (nope again).
even real addicts, who take opioids for the psychoactive effects and need escalating doses to achieve the high they crave (dang, i just gave away the answer to that question) can still develop painful conditions; it is unethical not to treat their pain, using doses that are effective.
you want to go read some margo mccaffery, the nurse expert on pain management.
Hear, hear, GrnTea ... definitely check out McCafferey's work. I first read her stuff over 30 years ago when taking care of people with sickle cell disease.
She once made the observation that if we are treat pain adequately, then we have to accept the fact that some frank addicts are going to "get over".
This is not to say that we should ignore an addiction ... just that focusing narrowly on keeping a junky from getting high at our hands means that there will be a whole lot of real pain going untreated. At some point, we have to decide which objective is more important.
diva rn, BSN, RN
963 Posts
Dear hipcrip,
THis was extremely well said.
I also suffer from chronic pain. And I have had the unique experience of having been physically dependent on opiods for 8 years...I have multiple degenerative conditions and have had bilateral hip and knee replacements. Also autoimmune dx...that's not the issue.
I have to say, the ignorance of some who have posted here about chonic pain, and how to manage it, has made me shake my head.
Others have a handle and at least some sort of understanding.
First I have to say...this was MY experience, and it is unique, as chronic pain is UNIQUE to each person suffering it. To say that ALL persons requesting xyz drugs are drugs seekers or addicts...and yes, there is a difference between dependence and addicition...is absurd.
The last year I was dependent on opiods, I was taking, on average 300mg of long acting MSO4 with 10mg IR q6 for break through pain. I was not zonked...I was fully functional...this is called TOLERANCE....
I was not "Doctor shopping"..or buying them on the street....I was going to a well respected Anesthesiologist who specialized in pain management where I was monitored biweekly.
However, as the doses continued to rise, I belive what was happening was, I was so sensitive, that I would start to withdraw as the levels would drop, leaving me with the pain I already had in addition to the pain I would feel in withdrawal.
It was becoming a vicious cycle.
After discussing it with my Doctor, both my pain Dr and my primary, I decided to detox off of all pain meds....
It wasn't pretty...and I didn't go cold turkey...I did it with my doctor's help.
BUT...it has been 2 and 1/2 years now, and I do not take anything stronger than NSAIDS..I do see my Rheumatologist ( I have RA, too)
and I can HONESTLY say that my pain level is so much less than when I was on the BIG guns....and I was on them all...(oxycontin,morphine,roxy) but I am still in chronic pain and it does wear on you.
I am only saying....each person is unique....and we are not all raging ADDICTS...you would have been shocked to know I was on those meds back then and have NEVER guessed it.
I only went off of them b/c it was a spiral...not b/c it was any sort of moral decision.
Please becareful of whom you judge.
Unless you have walked, or in my case LIMPED, in my shoes...you really don't know what it's like.
Thanks for reading
diva :)