prescription drug addiction

[shedevilprincss]

Noticed a Facebook "trending topic" this evening (early morning?) about neonatal abstinence syndrome and it talked about prescription drug abuse. Thought it was an interesting article.

Researchers say the increase coincides with the increase in opioid use in rural communities and rising prescription pill overdose rates.

Honestly, I would be happy if I never had to give IV dilaudid.

I have told all my docs and nurse friends, if I end up in the hospital, NO IV NARCS. I had auditory hallucinations when I had PO oxycodone after a knee surgery. I can only imagine that dilaudid would probably kill me.

[Davey Do]

I have told all my docs and nurse friends, if I end up in the hospital, NO IV NARCS. I had auditory hallucinations when I had PO oxycodone after a knee surgery. I can only imagine that dilaudid would probably kill me.

Amen, shedevilprincss!

My present state of an altered sense of consciousness is quite enough for me to contend with as it is.

[Not_A_Hat_Person, RN]

Narcotics are becoming as stigmatized as psych meds.

[KatieMI, BSN, MSN, RN]

Well, that sounds great in theory. But what exactly do you want your anesthesia team to do if you, once in a while, need a surgery? Not a wisdom tooth pull. Not even an I&D. A real thing, your flesh being cut with cold steel.

The hard fact is, modern surgical anesthesia is not possible without opioids. It will look like you want a driver to take you from point A to point B through a large city but you expressively prohibits him to ever hit the brakes because you just happen not liking them.

From my experience, as a patient and health care provider, there are very few things worse than dictating health care providers how to do their jobs because you read, heard or otherwise think you know something (while you do not). I see the heroic souls (and their victims) who decline pain relief for themselves or for their loved ones out of fear of addiction, out of wish to see them "alert and oriented", etc. The typical result is bad pneumonia because the patient in pain cannot breath and cough. By the point I see the patient, he is PICCed, PEGed, trached and hooked to the vent with long and windy road of "prolonged wean" lying in front of him. This is the price of "just wanting things to be my way".

I had bad side effects when I was given opioids, and so in my med alert card there is a line to please give me everything according to local PONV protocol if I need any opioids. I will choose a hospital where regional anesthesia is practiced in in its full capacities (which are nothing short of amazing). But I will never deny anything basing on my personal ideas unless I know what I know... and what I don't.

[Farawyn]

Agree Katie.

What do you do if you are in intractable pain?

Bring it.

[shedevilprincss]

duplicate

[shedevilprincss]

Except I don't see patients coming in demanding depakote and lithium refills. /snark

Unfortunately I think acute mental health care is also a very broken field.

[Libby1987]

More money is thrown at and more lives are affected by our lifestyle.. We will destroy ourselves before anything else can.

However I don't see the relevancy of newborn narcotic withdrawal with my own acute pain mgmt. How many of these moms were hospitalized for unavoidable illness and injury needing acute pain mgmt? Is that what they're saying is the start of most of their addiction? Or did their issues start with seeking out drug use?

I'm not dismissing the overuse of narcotics and lack of alternative regimens but I'd like to know the profiles of these moms before denying myself reasonable pain mgmt.

[shedevilprincss]

Well, that sounds great in theory. But what exactly do you want your anesthesia team to do if you, once in a while, need a surgery? Not a wisdom tooth pull. Not even an I&D. A real thing, your flesh being cut with cold steel.

The hard fact is, modern surgical anesthesia is not possible without opioids. It will look like you want a driver to take you from point A to point B through a large city but you expressively prohibits him to ever hit the brakes because you just happen not liking them.

From my experience, as a patient and health care provider, there are very few things worse than dictating health care providers how to do their jobs because you read, heard or otherwise think you know something (while you do not). I see the heroic souls (and their victims) who decline pain relief for themselves or for their loved ones out of fear of addiction, out of wish to see them "alert and oriented", etc. The typical result is bad pneumonia because the patient in pain cannot breath and cough. By the point I see the patient, he is PICCed, PEGed, trached and hooked to the vent with long and windy road of "prolonged wean" lying in front of him. This is the price of "just wanting things to be my way".

I had bad side effects when I was given opioids, and so in my med alert card there is a line to please give me everything according to local PONV protocol if I need any opioids. I will choose a hospital where regional anesthesia is practiced in in its full capacities (which are nothing short of amazing). But I will never deny anything basing on my personal ideas unless I know what I know... and what I don't.

I can absolutely see your point. I can see opioids for acute issues, for a short period of time. I don't work in a field where we are giving anesthesia so I have a different experience. I have the patients who have chronic issues or a lesser acute issue who aren't willing to try the lesser combination and want to shoot straight to IV dilaudid. And I have to explain to them, if you start at the top of the food chain, and it doesn't work, you are out of luck and there isn't anything we can add on. But if we start with the lesser meds and get the pain under control, or don't get it under control and you need other medications, then we can add on.

I also have the patients who are months out of surgery, and instead of being weaned off narcotics or given other pain control methods, the doses are increased and obviously increasing their tolerances. I understand as an ER nurse I am not going to fix anyone's addiction overnight, but I do face the front lines of overdoses and I do think it is a sad and widespread problem due to over-prescribing.

[Farawyn]

Except I don't see patients coming in demanding depakote and lithium refills. /snark

Unfortunately I think acute mental health care is also a very broken field.

No, you don't. Because those drugs are not addicting.

Leave off the snark.

[elkpark]

Except I don't see patients coming in demanding depakote and lithium refills. /snark

That's because no one gets dependent (or gets any kind of rush) from Depakote or lithium. The challenge with most psych meds is getting the people who really need them to keep taking them. EDs, psychiatrists' offices, and PCPs' office, though, are full of people demanding benzos and stimulants.

[shedevilprincss]

That's because no one gets dependent (or gets any kind of rush) from Depakote or lithium. The challenge with most psych meds is getting the people who really need them to keep taking them. EDs, psychiatrists' offices, and PCPs' office, though, are full of people demanding benzos and stimulants.

That was a point I was trying to make. Thanks for putting it into words. Not sure how we ended up on psych when talking about opioids.

An ED is a horrible place for a patient in an acute mental health crisis, especially off their psych meds or needing an adjustment. We get them in, immediately restrict their freedoms and then have to wait for an acceptable placement (which can take a few days in some cases). And tell them they can't come out of their rooms, have a TV for comfort and stimulation. And sunshine or fresh air--forget it.

Definitely another broken system.