prescription drug addiction

Farawyn · Dec 15, 2016

Jen, I'm sorry.

Also, what Horseshoe said.

Muser69 · Dec 15, 2016

Joint commission and the drug companies planned this addiction epidemic. Now they have a problem they cant stop. Some states are looking to use cannabis for pain meds. legal states have had a 25% reduction in opiate usage.

Farawyn · Dec 15, 2016

Joint commission and the drug companies planned this addiction epidemic. Now they have a problem they cant stop. Some states are looking to use cannabis for pain meds. legal states have had a 25% reduction in opiate usage.

Links to back your statement re: JC and "drug companies"?

KatieMI, BSN, MSN, RN · Dec 15, 2016

Obligatory not a nurse yet.
I have Chiari Malformation. I always have a headache - usually I can handle them with zero meds, but sometimes I can't. I can't get my PCP to give me a prescription for pain meds to have on hand for the bad days to save my life. He thinks that Advil or Aleve should be sufficient. It's not, not on the bad days - I can't move, speak or see on the bad days - and that lasts about three days at a time. A 'script for 30 vicodin would last me at least a year and give me some of my life back, but I'm refused that comfort and control over my own pain. And it makes me feel like I'm a drug seeker, which is a really, really bad feeling.
It sucks.
I understand and respect the need to be cautious, but I think sometimes that caution negatively impacts patients.

Jen, sorry...

Try to get a doctor from a large academic hospital, if you can. People there tend to think a little more outside the box.

KatieMI, BSN, MSN, RN · Dec 15, 2016

Joint commission and the drug companies planned this addiction epidemic. Now they have a problem they cant stop. Some states are looking to use cannabis for pain meds. legal states have had a 25% reduction in opiate usage.

Big Pharma - yes, absolutely.

Joint commission - probably not that much. Remember -when the question of the "fifth vital sign" came up, there were still talks about preemies "so underdeveloped that they couldn't feel pain". Pain and its undertreatment was a problem around that time in selected settings, especially in Hem/Onc (the main condition which brought it all up was sickle cell anemia). What was done wrong is generalization of the problem and wrong assumptions which bred wrong conclusions. "Patient can experience 10/10 pain and still eat/sleep/behave as usual" can be correct only if we assume that whatever the patient said about his pain is true. He said 10/10, so it is 10/10. Yet, anybody who ever experienced REAL 10/10 (moving kidney stone; some natural L&Ds; severe burn; extremity being torn out) will probably sadly laugh when seeing a fellow killing scores of monsters on his phone with decade-long 10/10 pain in low back. 10/10 pain can kill in minutes, it is not compatible with "norm", whatever a commission says.

To combat opioid abuse epidemics, we need to change ourselves to begin with, first and foremost eliminating these maddening expectations of "excellence" and "perfection" of everything out of our lives. Pain, sadness, anxiety, uncertainety are just parts of our imperfect lives, like death and taxes. They are here. We cannot, and should not, "treat" each and every of them with a pill or two. We need learn anew to live and cope with them and use drugs when necessary, not when we feel like it.

allnurses Guide · Dec 15, 2016

There is a huge problem right now with opioid abuse. That problem started with the folks with the script pads and we need to take an active role in fixing it. The over-prescribing needs to stop but that is just a small part of a complex solution. We need better access to mental health. We need prescriber education on appropriate addiction treatment and for prescribers to take an active role in helping the patients that, frankly, they created. Prescribers that abused the system need to be removed, and those that continue to recklessly prescribe need to be disciplined. Chronic pain needs to be appropriately diagnosed and managed by a specialist so those that truely need opioids can have safe access to them.

KatieMI, BSN, MSN, RN · Dec 15, 2016

There is a huge problem right now with opioid abuse. That problem started with the folks with the script pads and we need to take an active role in fixing it. The over-prescribing needs to stop but that is just a small part of a complex solution. We need better access to mental health. We need prescriber education on appropriate addiction treatment and for prescribers to take an active role in helping the patients that, frankly, they created. Prescribers that abused the system need to be removed, and those that continue to recklessly prescribe need to be disciplined. Chronic pain needs to be appropriately diagnosed and managed by a specialist so those that truely need opioids can have safe access to them.

THIS.

Also, would be nice to finally kill "customer service" paradigm, which leads in part to overprescribing addictive substances.

Our "host" hospital, which, basically, has nothing too exiting to offer in any specialty and so concentrates on "excellent customer service", declares ortho and spinal units as "110% pain free". That idea didn't play that good on cardio progressive floor; now, we regularly get their "guests" and "patrons" (pardon, patients) with horrific complications due to over-medicating them in the first 48 hours post-op.

allnurses Guide · Dec 15, 2016

Its hard to be a good provider when you are trying to please everyone.

Ruby Vee, BSN · Dec 15, 2016

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.

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.

Ruby Vee, BSN · Dec 15, 2016

I'd like to know what the "no narcs" people would do if they ever had open heart surgery or stem to stern abdominal surgery. The pain after a surgery like that can be absolutely EXCRUCIATING. There is no safe amount of Tylenol or Toradol that can even take the edge off some kinds of surgery.
That said, it's one thing to request no narcs after a surgery, but there should be a special place in hell for a family member who would deny their vulnerable and powerless relative pain relief based on their own inflated beliefs about their personal pain tolerance or ignorance about a particular procedure or pain medicine protocol.

And yet we see so many of those family members in the ICU!

Ruby Vee, BSN · Dec 15, 2016

THIS.
Also, would be nice to finally kill "customer service" paradigm, which leads in part to overprescribing addictive substances.
Our "host" hospital, which, basically, has nothing too exiting to offer in any specialty and so concentrates on "excellent customer service", declares ortho and spinal units as "110% pain free". That idea didn't play that good on cardio progressive floor; now, we regularly get their "guests" and "patrons" (pardon, patients) with horrific complications due to over-medicating them in the first 48 hours post-op.

The "customer service" paradigm led to the husband of a dear friend becoming addicted to narcotics. After his knee replacement, he refused to do PT because "it hurts" and "it's stupid." So he didn't do his PT. He never recovered range of motion after the surgery and now his knee hurts more than ever. So, in an effort to please the guy (and probably out of extreme weariness of listening to him whine) he gets a prescription for narcotics and more narcotics. Currently he's taking enough oxy to fell an ox, and it's been prescribed legally.

If the original surgeon, physical therapists, orthopedic staff, etc. hadn't been so concerned about getting poor customer service scores, they might have sat him down and told him "We cannot make your pain level a "zero" without interrupting your breathing. You WILL have some pain. You will still need to do your physical therapy as directed in order to have a full recovery." (Or as I personally told him, as the proud owner of titanium knees, "Suck it up and do the PT. Yes, it hurts, but it's the only way you'll get better.") Perhaps then he might have done the PT, had a full recovery and not "needed" as much narcotic to function. And then again, perhaps not. But it would have been better than giving him more and more narcotics without ensuring that he followed up with PT.

I was in the PT clinic doing my own physical therapy when a patient a few feet away (who I hadn't been paying any attention to because I was focused on my own stuff) started shrieking loudly, kicking and pounding on her PT table and acting for all the world like a two year old having a tantrum. "I CAIN'T, I CAIN'T" she screamed. "Don't you (bad words) know I need my MEDICATION?" The story, it seems, is that several years (or decades) ago, she had some lower back pain and her physician prescribed narcotics. Over the years, he prescribed more and more narcotics. The woman was "disabled" and spent most of her time in bed, leaving only twice a month to pick up her benefits check and to have her narcotics prescription refilled. Then her physician died and the new physician wouldn't write for her "medication" without a physical therapy evaluation. The physical therapist thought she might benefit from some exercise.

It's people like the above who make it so difficult for the folks who legitimately NEED narcotics because they're freshly post op or have end stage cancer or whatever.

Ruby Vee, BSN · Dec 15, 2016

Its hard to be a good provider when you are trying to please everyone.

You cannot please everyone all the time. You cannot please ANYONE all the time. It's crazy to even try. The customer service paradigm should never have been tied so completely to health care. Doing what is best for the patient is not going to generate those great customer service scores . . . and maybe doing what is best for the patient ought to be more important than the damned scores.