prescription drug addiction

katfish67lpn · Dec 18, 2016

What happened to the term and state of being 'dependent' along with 'tolerance' and skipping straight to 'addiction'? Huge difference, and addiction carries with it a special set of lifestyle issues, changes, loss of normality compared to their life before opioids, with a complete loss of control, choosing these medications over everything else. Is every patient of yours that has been prescribed opioids 'months out of surgery', an addict? You are also judging thier pain. I agree with starting low and going slow. This just seemed like a very important step was stepped over.
This is is an issue I am so tired of reading about and seeing the judgement by nurses, no matter what our specialty. If you ever find yourself on the other side, you may (quickly) look at this in a very different light.

I could not agree with you more! Pain and a persons tolerance to and for pain is absolutely individual. Until you have had pain, severe, intractable, debilitating, acute or chronic pain you just wont understand. For those of you who have been lucky enough to never have been through that type of pain, count your lucky stars!.

allnurses Guide · Dec 18, 2016

Listen of course I dont expect to live my life without any discomfort. I am realistic enough to know that to think I or anyone else is going to go through life never having a ANY pain or discomfort isnt going to happen. I am speaking of so many patients, friends, family that have legitimate pain issues that affect their lives significantly that for whatever reason can not get their pain controlled adequately...lets not get so literal.

I understand this is a personal as well as a professional issue to you. I really can't speak to the personal side, only the professional side. I am sorry you or your family/friends have had difficulty with pain impacting your lives.

I think you misunderstood my point.

What you think is adequate to function may not be so for someone else. Also when we ask a patient to rate THEIR pain on a scale of 1-10 ~ 0 being no pain and 10 being the worst pain THEY have ever experienced that is just what we are asking...in their experience. I, in my 30 years experience, have never seen or even heard of someone having an opioid script for 0 pain!

In practice, I do need to make a judgement call, and I do that to the best of my ability/training/experience. My point above wasn't that a patient came in with a pain scale of 0 asking for Percocet, it's that their expectation is to be 0 on the pain scale,and the seek medication to get it to a 0. As an outpatient (and probably inpatient too, though I handle it differently there), the pain scale is nearly useless to me: it is too variable and too subjective. Pain is pain. If patient A can be functional at a reported 8/10 then my goal is to treat them to an 8/10. If patient B can't be functional at a pain scale of 4/10 then I need to treat them to less than that.

If you have that is more than mind boggling and if it is something you have only heard or read about I would say more investigation should be done because I just don't think it happens.

I have the extant data like everyone else does; I have some experience as a provider responsible for writing these meds (or not). You tell me: are there any studies out there that show narcotics are effective in treating chronic pain?

But I digress, Pain control is so individual for TPTB to now say that everyone must be under a certain, and btw arbitrary, MED per day is utterly ridiculous.

Research has demonstrated that doses over 200mg of morphine-equivalent p[er day do not improve outcomes. Have you read the research?

As to your last question well personally I dont really care but I would like to see where exactly you have acquired that data however, I would hazard a guess that it may have something to do with the US being a compassionate country. I find you and I have very differing opinions so I will say we need to agree to disagree because I have no desire to go back and forth with you any longer.

It's pretty easy to find this data: https://www.asipp.org/documents/ASIPPFactSheet101111.pdf. Please, everyone, look at this summary sheet.

We are all entitled to our own opinions, but I always encourage everyone, to read the facts before they let opinion influence practice.

katfish67lpn · Dec 18, 2016

*Quote form BostonFNP*:

In practice, I do need to make a judgement call, and I do that to the best of my ability/training/experience. My point above wasn't that a patient came in with a pain scale of 0 asking for Percocet, it's that their expectation is to be 0 on the pain scale,and the seek medication to get it to a 0. As an outpatient (and probably inpatient too, though I handle it differently there), the pain scale is nearly useless to me: it is too variable and too subjective. Pain is pain. If patient A can be functional at a reported 8/10 then my goal is to treat them to an 8/10. If patient B can't be functional at a pain scale of 4/10 then I need to treat them to less than that. *Quote*

You maybe need more experience behind you (?)and (GOD forbid) some pain of your own! Maybe your provider will say to you...you're functioning at an 8/10 so that will be our goal. Are you kidding me?!! Just because one can function, and by that I mean barely survive, but hey I guess you're surviving, so you're good, is so devoid of actual understanding I can not begin to comprehend that thinking. Also if someone comes in expecting to have a goal of 0 out of 10 pain then possible some patient teaching may be in order, depending on the diagnosis. I have and do go to pain seminars and keep abreast on the subject however, as I said, it is individual and thats where I am leaving this conversation. It is exhausting tbh!

sallyrnrrt, ADN, RN · Dec 18, 2016

I just had knee surgery. My doc basically gave me a prescription for a max of seven doses, because that's the typical course of moderate to severe pain requiring narcotics with this kind of surgery. No refills. No chance of dependence, much less addiction. In general, I'd say that's a pretty prudent course to take. Obviously, if my recovery deviated from the norm in some way, he'd hopefully be open to re-assessing the pain control plan.

for reverse total shoulder replacement, thirty Norco, then I went to thirty tramadol, then nsaid thereafter, is was per my request, as I am very opioid tolerant, and needed to avoid prolonged narcotic..... By the way I was able to return to my LTC DON job in 12 days...

allnurses Guide · Dec 18, 2016

You maybe need more experience behind you (?)and (GOD forbid) some pain of your own! Maybe your provider will say to you...you're functioning at an 8/10 so that will be our goal.

I have some extensive practice experience in prescribing these meds and managing both acute and chronic pain patient from the in-pt and out-pt sides. I also did a fellowship in in-patient palliative care. Sure more experience always helps but I also wouldn't let my personal experience with pain influence my practice.

And if I am in 8/10 pain and functioning while asking my provider for pain meds, I hope they do what is in my best interest, and say no. Thanks for assuming I have never been in "some pain", as someone who was speaking about nurses and their judgement.

sallyrnrrt, ADN, RN · Dec 18, 2016

Well said.
Narcotics have gotten an increasingly bad reputation because folks are increasingly abusing them. However, had I not had narcotic pain medicine for post-op pain after my orthopedic surgery, I would not have been able to participate in PT to the level possible for a full recovery. Narcotics have their use. Use is not abuse.

Im very opioid tolerant on my third shoulder replacement, this time reverse prosthesis.....anes. Was supposed to do scale if nerve block at end of case, so 45 mins awake, agony in recovery, another anesthesiologist. Comes in to do the nerve block....very painful, awake, but I had nearly 24 hours of zero pain, regional anesthesia can be a godsend blessing....

LadysSolo · Dec 19, 2016

How does abuse happen? 15-year-old went to ER for a sore throat (not strep, brought me the ER papers.) Came to me as a provider for a refill of his Vicodin the ER gave him a Rx for to manage a SORE THROAT!! What happened to warm salt water gargles and acetaminophen? Needless to say he did NOT get more Vicodin from me!

allnurses Guide · Dec 19, 2016

I've been watching ZDoggMD videos . . . and he had this article linked. It's pretty good . . . or as ZDogg said "This is barking up the right alley".

Dr. Anna Lembke: Well-Meaning Doctors Have Driven The Opioid Epidemic : Shots - Health News : NPR

Horseshoe, BSN, RN · Dec 19, 2016

How does abuse happen? 15-year-old went to ER for a sore throat (not strep, brought me the ER papers.) Came to me as a provider for a refill of his Vicodin the ER gave him a Rx for to manage a SORE THROAT!! What happened to warm salt water gargles and acetaminophen? Needless to say he did NOT get more Vicodin from me!

Two years ago, I had a throat infection that caused the worst sore throat I've ever experienced. It was agonizing pain. I've had back and neck problems for decades and never asked for narcotic pain relief, but I sure as heck would have accepted a script for them for this sore throat. It lasted 4 or 5 days and by the end of it, I was exhausted, I think in part from my body's reaction to extreme pain. Where was that kid's doc when I needed him?

Skippingtowork · Dec 19, 2016

Back to the original subject, most of the moms of NAS babies are true drug abusers. They have little to no prenatal care and urine screen comes back with a combination of multiple drugs, not just opiates. Most will have either Cocaine, Heroin, Meth, THC, benzos in addition to opiates. The mothers that are truly concerned about the effect of their drug abuse on their unborn child are few. It is not until after the baby is born and in the NICU that they become Mom of the Year and become demanding of the quality of care of their child in a futile attempt to persuade CPS of their fitness as a mother. These are not soccer moms that had a back injury and got hooked on pain medicine.

The narcotic addiction crisis in the U.S. and many other countries, is now presenting in Newborn nurseries as NAS. These mothers (at least in the U.S. often had legitimate reasons for being prescribed narcotics, but then became addicted. It is a true tragedy. All mothers, when in their right mind, care about their children. They are not trying to be mother of the year, but they do feel the stigma and judgement related to their child's NAS. They may even feel suspicious of staff due to staff's judgmental atitude towards them. The emerging face of NAS is the child of a middle class caucasion woman who's addiction was subtle at the onset. There are studies that have been completed on this population and approaches that not only help these mothers and babies, but the mothers and babies afflicted with other addictions.

On the subject of pain management, most prescribers do not have a grasp of how each pain medication works and how different meds work together. A well-trained pharmacist should be part of any pain management team. This could cut down on inappropriate medication orders after discharge.

allnurses Guide · Dec 19, 2016

It is a really scary fact that incidence of NAS in the US has risen from 1.5/1000 to 6/1000 over just 10 years.

Jules A, MSN · Dec 19, 2016

These mothers (at least in the U.S. often had legitimate reasons for being prescribed narcotics, but then became addicted. .

Do you have statistics to support that often these moms were initially prescribed narcotics? Again just anecdotally but this has not been the case with the consults I have seen.