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.

[Lev, MSN, RN, NP]

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.

Why don't you get yourself a new PCP or go to a pain management doctor?

[Julius Seizure]

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.

omg....I am so sorry. How horrible...I am so sorry that you were treated like that. And I hope that you find someone to help manage your ongoing pain.

[Libby1987]

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.

This fits more with what I've been acquainted with in my area.

[Horseshoe, BSN, RN]

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.

What.An.Idiot.

This is exactly the kind of thing I knew would happen when the push back against opioids started.

[BostonFNP, APRN]

What.An.Idiot.

This is exactly the kind of thing I knew would happen when the push back against opioids started.

In this case, I don't think the PCP appropriately handled the situation. I also don't think the PCP is an "idiot" either; save for the fact that any non-idiot provider understands that opioids need to be safely tapered and not just "d/c'd".

Prescribing these meds in the primary setting is becoming more and more difficult; from state and federal regulations to insurance company approval. For example, after the 90-day threshold or if quantity exceeds 100mg morphine-equivalency per day, several insurance plans require demonstration that a provider has attempted to taper the medication in order for the PA to be approved.

[MrNurse(x2), ADN]

Had an interesting conversation with a pain specialist at WVU. When I first started, very few patients needed more than Morphine 4 mg, that was considered a huge dose back then. Now, sickle cell patients are requiring upwards of 150 mg Dilaudid a day. He stated that research shows that one dose of Dilaudid not only resets what you can tolerate, it also intensifies how you perceive pain. Therefore what you perceived as a 1/10 pre-Dilaudid now feels like a 4/10. I always ask patients if they have ever had Dilaudid when dealing with their pain issues. I educate the mid levels that will listen and I try to find alternatives for those patients who luckily have not experienced hydromorphone.

[Farawyn]

(((((((((Esme))))))))

Ruby, too.

Great posts, all.

[Horseshoe, BSN, RN]

In this case, I don't think the PCP appropriately handled the situation. I also don't think the PCP is an "idiot" either; save for the fact that any non-idiot provider understands that opioids need to be safely tapered and not just "d/c'd".

Prescribing these meds in the primary setting is becoming more and more difficult; from state and federal regulations to insurance company approval. For example, after the 90-day threshold or if quantity exceeds 100mg morphine-equivalency per day, several insurance plans require demonstration that a provider has attempted to taper the medication in order for the PA to be approved.

I think she's an idiot because she is talking about DC'ing Esme's meds NOT because they are inappropriate for HER, but because of a societal problem. And not only that, doesn't give her any indication that her pain will be addressed in any other way. Just, sorry, other people are addicted, so you will have to suffer as well even though you are in pain and are not actually showing any signs of addiction or inappropriate use.

It's absurd.

[Spidey's mom, ADN, BSN, RN]

In this case, I don't think the PCP appropriately handled the situation. I also don't think the PCP is an "idiot" either; save for the fact that any non-idiot provider understands that opioids need to be safely tapered and not just "d/c'd".

Prescribing these meds in the primary setting is becoming more and more difficult; from state and federal regulations to insurance company approval. For example, after the 90-day threshold or if quantity exceeds 100mg morphine-equivalency per day, several insurance plans require demonstration that a provider has attempted to taper the medication in order for the PA to be approved.

You are making me wonder about my hospice patients who receive high doses of Morphine Sulfate or Dilaudid via a CADD Pump. Of course, we don't worry about addiction with hospice patients.

Since I'm very anti-government-regulations . . . and I'm not a provider, just a nurse . . . I'm going to ask our hospice physician and pharmacist about how we as hospice are affected by the opioid brouhaha.

(We had a good discussion at IDT about how much government regulations has changed the original intent of hospice but that's another story).

[Here.I.Stand, BSN, RN]

Esme...I am in tears after reading your post. Tears of sadness for what you have endured (even before all this...I remember you posting about the obesity and how you were treated before the critical illness), and tears of anger for how you were treated. Nobody deserves that kind of treatment, but you are such a lovely person who deserved the same level of care as you have given to others over your lifetime. Truly, I am so sorry for what you have been through. And I pray for your continued recovery and for nothing but the most compassionate, appropriate treatment going forward -- which clearly includes pain control.

[Esme12, ASN, BSN, RN]

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.

I still face a complicated surgery to put my insides back together....where they belong. Being so sick and septic my teeth are ruined and I am in the process of removable teeth...something which I dread but cannot avoid. The abdominal surgery will be extensive and include a mesh (which I am terrified of) so I need to minimize danger of infection....the saga continues.

[Esme12, ASN, BSN, RN]

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

Thanks...I feel for my poor family...for weeks they were told I was slipping away.