prescription drug addiction

allnurses Guide · Dec 15, 2016

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.

No surprise it's been associated with higher levels of M&M.

I told a patient yesterday that "I'm sorry for your pain, but my goal as your provider is to make your pain tolerable so you can function not to make it non-existent" and she launched into a tirade about how "I don't know what it's like". You are right, I don't know what it's like to be in my 20s and on a narcotic, a stimulant, and a benzo for non-existent pathology. She looked even more shocked when I said that I would be happy to help her to the best of my ability but my plan involved none of those meds and perhaps she should keep searching for a provider.

Jules A, MSN · 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.

I agree with most all of your post but wonder if there is data to support that the problem started with poorly managed chronic pain patients. Speaking only anecdotally a majority of the patients I see in the ED, acute psych unit, corrections who are opiate dependent did not start with legitimate pain prescriptions. I wonder if it isn't another attempt of the more affluent to normalize this issue now that their beloved, do-no-wrong, little blonde hair, blue eye'd college kids are main lining heroin.

The other thing that I will say again and again is there is absolutely no data I am aware of that indicates opiates are appropriate for long term pain treatment and can in fact make the chronic pain loop worse, opioid induced paradoxical hyperalgesia. This has nothing to do with appropriate, short term post op treatments with narcotics.

**NICU Guy, BSN, RN** · Dec 15, 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.

Esme12, ASN, BSN, RN · Dec 16, 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.

The Joint Commission? Really? The JC has NO prescriptive powers. It is not the JC, or drug companies for that matter, who prescribe100 Norco for a sprained toe...it's the MD. Lets go after the right folks here...the prescribing physician. But they aren't punished. They aren't tracked...it's the legitimate patient that is going to suffer.

I know because it's my story.

KatieMI, BSN, MSN, RN · Dec 16, 2016

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.

When I was in rehab in 2003, there was no talk about drugs because I was nursing mom. In two weeks, my husband acquired a good set of English obscenities from my RRT and PT as they tried to get me going. One of them happened to be a former Marine sergeant, and I had to address him as "sir" all along, by hubby's suggestion. They, in turn, learned how to pronounce a couple of dozens of purely Russian words almost without accent - too bad they would have very limited use for them. Only in good company, after lots of vodka and preferably no ladies around :roflmao:

Jules A, MSN · Dec 16, 2016

While I can't speak for the poster but my guess is it has something to do with the JC coming out with the push for pain as the 5th vital sign.

Joint Commission Statement on Pain Management | Joint Commission

Esme12, ASN, BSN, RN · Dec 16, 2016

For those of you who are long time members know that I have been critically ill. I have promised to tell my story and it is time.

I have been chronically ill for the last few years from an auto-immune connective tissue/inflammatory muscle disorder....dermatomyositis There have a few auto-immune disorders tossed about, including MS and Lupus (lucky me), so I know bear the new disease assignment of MCTD: Multiple Connective Tissue Disorder.

Back in October of 2014 (hang with me it is relevant) I had a month of abdominal pain that finally got diagnosed as a bowel obstruction which required emergency surgery and a stay in ICU. For just over a month I had this terrible pain, diarrhea, and vomiting I was lectured about "using the emergency room for pain control". I would leave frustrated, ill, and in terrible pain. But that didn't matter....I was obese (80mg daily steroids for my dermatomyositis), female, and a nurse....and "we ALL KNOW how nurses are"....don't we???? and my fat behind made "imaging difficult. Code for....you're too fat for us to care. I finally had emergency surgery that left me with an incision from just below the zyphoid process to the semphus pubis......18cm long.....impressive, I know.

Upon discharge there was a lengthy discussion about the use pain meds. The surgeon felt that my "chronic use of pain medicine" for chronic pain.....(I took 1 (one) Vicoden p.o. Qhs prn) caused me to have a disturbed perception of actual pain. I'm thinking...WHAT THE #@^@&%$#^??? Disturbed perception of pain and my abdomen is fillet open from my breasts to my privates???? Ultimately he did order 1 (one) Tylenol #3 every 6 hours for pain...10 meds dispensed!! What ever...I occupied my time by having day dreams of being his nurse post CABG and EXTERNAL Fixation device to bilateral lower extremities and offering feedback techniques.

I never felt well...so for 3 months I saw MD's. my surgeon, went to the ED because I am still vomiting with abd pain....I am getting sicker and sicker. My abdomen was huge and distended...but remember I am just too fat for proper care. I decided to take matters into my own hands. I did a google search and found a surgical group at a famous hospital but I had to wait 3 weeks to see them. I took the appointment.

I continues to deteriorate rapidly. Another ER visit and lecture about using the ED for pain meds which made me want to slap the MD across the room...I went home broken and very ill. My husband is furious. Two weeks go by....I am incontinent of urine and stool. My urine smells strongly of ammonia...I knew I was gravely ill and couldn't help myself. I had to get to that appointment in Boston. My husband would drag me to the bathroom, hose me off. I would scream and cry in pain...but I REFUSE to be humiliated again by going to the ED again for abdominal pain.

It was 3am....my husband was washing me off again....too weak to help.....he said "you are dying. I can't lose you...." and called 911

Well....back at the worthless ED I go! with the same worthless surgeon.....in septic shock, heart, and renal failure. I remember looking at the ED doc and asking him...;"Am I sick enough now?" Ct scans now suddenly show gigantic liver abscesses. They essentially told my husband to make funeral arrangements and I wasn't stable enough to transfer. My hubby called my baby sister (also a nurse at an important employer) and got me transferred to the very place that had "no beds". I bled under my skin which then developed necrosis and sloughed off...there was brief talk of narcotizing fasciitis, My bilateral hips, thighs and groins sloughed to muscle.

In the mean time.....They removed 4 LITERS (yes 4,000mls) off of my liver of just plain ole pus. I respiratory arrested and intubated. I suffered a couple cardiac arrests and ran my own rapid response at the LTAC for complete heart block and now sport a pacemaker. I was hospitalized for 10 months. I still have home services for dressings and a hospital bed in my family room. I had 10 drains in my abdomen and a total of 5, yes 5, wound vacs and multiple debridement surgeries

All of this because I was fat and asking for pain medicine a deaf ear was turned and assumptions made. You betcha I wanted pain meds. Lots of them. My screams would melt the paint of the walls when drsgs were changed The nurses who cared for me I thank you and can never repay you.

Over the past year for the most part I have been home and slowly decreasing the pain meds...but I still have pain. My incision "internal dehissance" remains 18cm long (internal) and contains small bowel, large bowel and my stomach...I look 9 months pregnant. I still have some wounds. It stinks

Why did I go through this whole story? My "new " PCP (I was her first repeat patient) that I had to go to because of my pain meds when I was discharged recently sent me this e-mail...."I know you still have terrible pain but "we" need to dc your pain meds with the opiate crisis they way it is." REALLY? What does a drug addict have to do with my pain.

I will be speaking to my New PCP tomorrow. People who need pain meds should not be treated as a criminal. Anyone who picks up my meds has their drivers license entered into a computer bank. I don't have my daughter pick them up she is in nursing school and I don't what someone to become confused and deny her to sit for NCLEX.

I want relief from pain. I don't not want to be unconscious or high....I just want some measure of relief. Is that too much to ask? Just because the JC stated pain is the 5th vital sign it doesn't require the MD's to order 100 percocets with 3 refills.

Boomer MS, RN · Dec 16, 2016

For those of you who are long time members know that I have been critically ill. I have promised to tell my story and it is time.
I have been chronically ill for the last few years from an auto-immune connective tissue/inflammatory muscle disorder....dermatomyositis There have a few auto-immune disorders tossed about, including MS and Lupus (lucky me), so I know bear the new disease assignment of MCTD: Multiple Connective Tissue Disorder.
Back in October of 2014 (hang with me it is relevant) I had a month of abdominal pain that finally got diagnosed as a bowel obstruction which required emergency surgery and a stay in ICU. For just over a month I had this terrible pain, diarrhea, and vomiting I was lectured about "using the emergency room for pain control". I would leave frustrated, ill, and in terrible pain. But that didn't matter....I was obese (80mg daily steroids for my dermatomyositis), female, and a nurse....and "we ALL KNOW how nurses are"....don't we???? and my fat behind made "imaging difficult. Code for....you're too fat for us to care. I finally had emergency surgery that left me with an incision from just below the zyphoid process to the semphus pubis......18cm long.....impressive, I know.
Upon discharge there was a lengthy discussion about the use pain meds. The surgeon felt that my "chronic use of pain medicine" for chronic pain.....(I took 1 (one) Vicoden p.o. Qhs prn) caused me to have a disturbed perception of actual pain. I'm thinking...WHAT THE #@^@&%$#^??? Disturbed perception of pain and my abdomen is fillet open from my breasts to my privates???? Ultimately he did order 1 (one) Tylenol #3 every 6 hours for pain...10 meds dispensed!! What ever...I occupied my time by having day dreams of being his nurse post CABG and EXTERNAL Fixation device to bilateral lower extremities and offering feedback techniques.
I never felt well...so for 3 months I saw MD's. my surgeon, went to the ED because I am still vomiting with abd pain....I am getting sicker and sicker. My abdomen was huge and distended...but remember I am just too fat for proper care. I decided to take matters into my own hands. I did a google search and found a surgical group at a famous hospital but I had to wait 3 weeks to see them. I took the appointment.
I continues to deteriorate rapidly. Another ER visit and lecture about using the ED for pain meds which made me want to slap the MD across the room...I went home broken and very ill. My husband is furious. Two weeks go by....I am incontinent of urine and stool. My urine smells strongly of ammonia...I knew I was gravely ill and couldn't help myself. I had to get to that appointment in Boston. My husband would drag me to the bathroom, hose me off. I would scream and cry in pain...but I REFUSE to be humiliated again by going to the ED again for abdominal pain.
It was 3am....my husband was washing me off again....too weak to help.....he said "you are dying. I can't lose you...." and called 911
Well....back at the worthless ED I go! with the same worthless surgeon.....in septic shock, heart, and renal failure. I remember looking at the ED doc and asking him...;"Am I sick enough now?" Ct scans now suddenly show gigantic liver abscesses. They essentially told my husband to make funeral arrangements and I wasn't stable enough to transfer. My hubby called my baby sister (also a nurse at an important employer) and got me transferred to the very place that had "no beds". I bled under my skin which then developed necrosis and sloughed off...there was brief talk of narcotizing fasciitis, My bilateral hips, thighs and groins sloughed to muscle.
In the mean time.....They removed 4 LITERS (yes 4,000mls) off of my liver of just plain ole pus. I respiratory arrested and intubated. I suffered a couple cardiac arrests and ran my own rapid response at the LTAC for complete heart block and now sport a pacemaker. I was hospitalized for 10 months. I still have home services for dressings and a hospital bed in my family room. I had 10 drains in my abdomen and a total of 5, yes 5, wound vacs and multiple debridement surgeries
All of this because I was fat and asking for pain medicine a deaf ear was turned and assumptions made. You betcha I wanted pain meds. Lots of them. My screams would melt the paint of the walls when drsgs were changed The nurses who cared for me I thank you and can never repay you.
Over the past year for the most part I have been home and slowly decreasing the pain meds...but I still have pain. My incision "internal dehissance" remains 18cm long (internal) and contains small bowel, large bowel and my stomach...I look 9 months pregnant. I still have some wounds. It stinks
Why did I go through this whole story? My "new " PCP (I was her first repeat patient) that I had to go to because of my pain meds when I was discharged recently sent me this e-mail...."I know you still have terrible pain but "we" need to dc your pain meds with the opiate crisis they way it is." REALLY? What does a drug addict have to do with my pain.
I will be speaking to my New PCP tomorrow. People who need pain meds should not be treated as a criminal. Anyone who picks up my meds has their drivers license entered into a computer bank. I don't have my daughter pick them up she is in nursing school and I don't what someone to become confused and deny her to sit for NCLEX.
I want relief from pain. I don't not want to be unconscious or high....I just want some measure of relief. Is that too much to ask? Just because the JC stated pain is the 5th vital sign it doesn't require the MD's to order 100 percocets with 3 refills.

This is the kind of post that drives me crazy. To put everyone in one category of "drug seeking" or any other category is egregious. This poster, Esme, has suffered significantly (including information from previous posts), and I believe her. Reading what she had been through has upset me, although I find it somewhat comforting to see her post here, if, for no other reason, she helps to educate us. One size does not fit all in nursing or medicine on any level, including pain control.

allnurses Guide · Dec 16, 2016

Esme - wow, I'm so sorry. I know you've been ill but the details are tough to read.

I work wound care and I know wound vacs and have a couple of patients with large abdominal wounds so I sort of understand. One of the patients has a great amount of pain and is having trouble with getting pain meds as well.

Yes, you should not have to suffer and your example is exactly why this "opioid crisis" needs further consideration and not knee-jerk reactions.

Sharing your story gives people another important perspective.

Thank you.

Emergent, RN · Dec 16, 2016

Wow Esme, just wow. Thank you for sharing. What a horrible ordeal. I'm so thankful you made it.

I'm hopeful that you and other survivors can eventually gather in strength and numbers, and shake some common sense into the system. We can't let this governmental overreaction to go on.

Jules A, MSN · Dec 16, 2016

Esme, that sounds so horrible, I'm praying you have some relief soon.

sallyrnrrt, ADN, RN · Dec 16, 2016

I have significant opioid tolerance due to multiple ortho.surgies, from Mva, on my third shoulder replacement..... I have to be very careful, and when pain can be managed, turn to NSAIDs, and other non pharmaceutical endeavors as meditation....etc.....cause after a while tolerance, makes a slippery slope....so grateful my ortho and I have this understanding, and so glad no surgery since 2011...