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.

[Esme12, ASN, BSN, RN]

I always feel conflicted when I have a new patient in LTAC who gets Dilaudid maybe once on my shift, then the next day maybe twice, then by day 3 they are setting their phones for the Q4 and they are around the clock from then on.

I am not sure if you read my post. I too was in an LTAC for complicated wounds. Unlike some in the LTAC...I was perfectly alert and oriented. Unlike some patients my wounds were exquisitely painful....I did not have any diabetes nephropathy like to dull the pain. I was not paralyzed. Those wound vacs were absolute torture as they constantly sucked on my wounds. It felt like someone was constantly digging in my wounds....which were significant.

Pain meds on the money every three hours....you betcha. Hold onto your hats ladies....I was on Dilaudid 20mgs every three hours. I took MSContin 160mg Q 12 hours. I received Dilaudid 4-6mg IVP for drsging changes TID with Ativan 2mg IV. I took Gabapentin, Cymbalta, and Seroquel to help with pain and anxiety. It took 2 hours, 2 nurses, and one CNA to change my dressings. I wept the entire time. I took these meds for MONTHS. I was alert. Oriented. I interacted appropriately with everyone. I had trouble sleeping because of the pain.

Tell me why you are conflicted about giving pain meds that are ordered.

[Esme12, ASN, BSN, RN]

Ecme12,

Hugs and tears...

THanks...it sucked

[Esme12, ASN, BSN, RN]

Oh, Esme, how horrible. It's too bad that healthcare is being dictated by those who have zero knowledge of providing healthcare and no training. A few bad apples among prescribers have led to punishment not only for all those associated with those bad apples (even if only by profession) but for those who truly need treatment for life-altering pain.

Thanks. This is just the highlights....LOL But it really chaps my ass how other people feel that they can tell me whether or not my pain is real.

As a patient I would hear them talking....they too were conflicted about the amount of pain meds I was on and they were POSITIVE that they would not require high dose narcotics for any reason. I heard some talk that they felt it was clear I was seeking pan meds for the dose alone was proof for they felt it would sedate an elephant. It fascinates me how some nurses are able to look into their crystal balls and personal bias to try to reduce the pain meds I was on even though my pain docs at the academic facility prescribed them.

Now I am on only a minute fraction of my previous dosages but it is exhausting just to get the prescription. I drive into my MD's office, in Boston. I Take it to the pharmacy where they look at you with skepticism as they look my ID. My son's ID. My insurance card. They bring up the state druggie site to check and make sure I am not hopping around filling prescriptions. The next thing they are probably going to do is look at my arms to see if I have track marks (insert eye roll). It's exhausting and frustrating...especially when you don't feel well.

[Esme12, ASN, BSN, RN]

I have no words, Esme. You've been through hell and back. I pray that you heal and find some relief. It's criminal what you went through.

Thanks...it's been crazy beyond belief

[Esme12, ASN, BSN, RN]

Ugh Esme. So sorry. And sorry your PCP felt the need to "handle" things that way.

Thanks....There are so many days I just sit and shake my head...it's been a long continuing bad dream.

[Esme12, ASN, 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.

Thank you so much. I feel so bad for my family. My children. My daughter as she is in nursing school and understands what sepsis is.....I am so glad my sister (a nurse) was there to help her. Help all of them. Once I got to the "Famous" hospital in Boston...they saved my life. I don't remember much and I am grateful for propofol.

This has been a crazy ride.

[chiromed0]

Wow...nothing spurs health care workers up like narcotics. Let's see...I see dependents, addicts, and plain ol' acute care everyday. I've given out plenty of IV meds in critical care and ortho. The bottom line is I have waned back and forth from jaded to skeptical to empathetic to apathetic. Like most of you. All that to say...it depends on the patient-the individual patient. It is true that at the base of the problem was somebody with a license somewhere prescribing a drug to someone who either didn't need it or quit needing it so much. It is hard to blame the provider though b/c "pain" is subjective, as nurses we are taught the most liberal of pain definitions, and you have to be prudently trusting of your patients. That's a problem b/c drug seeking patients know the system so we are always one step behind.

I would not feel "bad" or "guilty" giving a patient in a hospital IV pain meds (within reason). Some of them are opioid tolerant when they get there and are NOT LYING when they say that 4mg morphine did NOTHING to them. At least for pain symptoms...you still need to watch their vitals. So while they may need dilaudid for pain it's still on you to make sure they don't die with that last dose. It's a problem for sure. I have no answers. You do what you can over time to try to get them less dependent, identify the addicts and get them help, and intervene with therapies to ameliorate or eliminate their symptoms. At the root we have a societal problem in the US that drug use is just a sign of...people are just a "mess". Other countries I don't know.

[ItsThatJenGirl, CNA]

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

Because I have really terrible insurance - but our new plan kicks in in January, leaving me more options to find a provider that is willing to be a partner.

[Farawyn]

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

I just can't.

I'm so so sorry.

[Horseshoe, BSN, RN]

Esme's story is one of my worst nightmares. Being in pain, not being believed, not being treated, not being helped...usually by people who have no idea what excruciating, debilitating pain even feels like. It's the smug attitude that burns me the most. That's when I find myself being very uncharitable and hoping for that thing called Karma.

[Graduatenurse14]

What is not being discussed here is that addicts regardless of their substance of choice are not created they are born. This is a controversial topic but since the mapping of the human genome was completed in 2003 there have been several genes identified as shared in common among people addiction issues. The University of Utah has been doing research on the genetics of addiction for some time: the following is a list of genes that appear to influence addiction:

The A1 allele of the dopamine receptor gene DRD2 is more common in people addicted to alcohol or cocaine.

Mice with increased expression of the Mpdz gene experience less severe withdrawal symptoms from sedative-hypnotic drugs such as barbiturates.

Mice without the cannabinoid receptor gene Cnr1 are less responsive to morphine.

Mice lacking the serotonin receptor gene Htr1b are more attracted to cocaine and alcohol.

Mice bred to lack the β2 subunit of nicotinic cholinergic receptors have a reduced reward response to cocaine.

Mice with low levels of neuropeptide Y drink more alcohol, whereas those with higher levels tend to abstain.

Fruit flies mutated to be unable to synthesize tyramine remain sedate even after repeated doses of cocaine.

Mice mutated with a defective Per2 gene drink three times more alcohol than normal.

Non-smokers are more likely than smokers to carry a protective allele of the CYP2A6 gene, which causes them to feel nausea and dizziness from smoking.

Alcoholism is rare in people with two copies of the ALDH*2 gene variation.

Mice lacking the Creb gene are less likely to develop morphine dependence.

Genes and Addiction

I attended a conference in 2007 where a lecture was given by an addictionologist and is was described very easily with the following story:

A guy who has never taken opioids goes on a ski trip and falls and breaks his leg - he is seen and stabilized and sent home to follow-up with an ortho within 5 days. He is given a ten day supply of opioids. When he sees his ortho the man who is not a potential addict still has lots of opioids in the bottle and tells the MD "I don't like the way this stuff makes me feel" The potential addict has an empty bottle and tells the md "I need a lot more of this!"

Peace out

Hppy

Very interesting!!! THANKS Hppy!!! I KNOW that they are born as my paternal grandfather was an alcoholic and 5 out 6 of my dad's siblings are/were alcoholics including my dad and several of their kids including my sister.

Out of the third generation, my second cousins, most are ok. There is a set a male twins who live out of state who had issues from when they were young boys and I would be surprised if addiction was not part of their lives at one point. It's sad and hard to see generations of people you love so sick as my aunts and uncles and cousins are the nicest people and would give you the shirt off their backs. My dad and sister too. It really is a family disease that tries to destroy everyone it can.

If the science Hppy presented is correct, which I believe is, from a nursing perspective how do we say to our patients who are post-op and in terrible pain but white-knuckling it for fear of addiction, that they won't become addicted if they take narcotics that are ordered for them?

I tell them that the chances are very, very, very slim and give the cough & deep breathing and PT examples of the necessity to have lower levels of pain BUT if their genes are already pre-programmed, what can practically be done to prevent it??

I'm going to look at the link she provided as I need to educate myself!!

[CelticGoddess, BSN, RN]

I am not sure if you read my post. I too was in an LTAC for complicated wounds. Unlike some in the LTAC...I was perfectly alert and oriented. Unlike some patients my wounds were exquisitely painful....I did not have any diabetes nephropathy like to dull the pain. I was not paralyzed. Those wound vacs were absolute torture as they constantly sucked on my wounds. It felt like someone was constantly digging in my wounds....which were significant.

Pain meds on the money every three hours....you betcha. Hold onto your hats ladies....I was on Dilaudid 20mgs every three hours. I took MSContin 160mg Q 12 hours. I received Dilaudid 4-6mg IVP for drsging changes TID with Ativan 2mg IV. I took Gabapentin, Cymbalta, and Seroquel to help with pain and anxiety. It took 2 hours, 2 nurses, and one CNA to change my dressings. I wept the entire time. I took these meds for MONTHS. I was alert. Oriented. I interacted appropriately with everyone. I had trouble sleeping because of the pain.

Tell me why you are conflicted about giving pain meds that are ordered.

Esme: I am so sorry you went through all that. I can't even begin to imagine.