prescription drug addiction

Nurses General Nursing

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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.

Specializes in Adult Internal Medicine.
What I find hard to understand is why in this day and age anyone has to live in pain...period!

I am just so disgusted with the about face and the act as if they have no idea how this all happened!

This all happened because of the notion that no one ever has to live in any pain, just as you said.

Pain needs to be treated, yes, to tolerable and function-able levels. When pain is treated to a 0/10 then pain medication is being over used. We created this problem, probably with good intentions, by treating patients to 0. At a pain level of 0 the only benefit a patient gets from an opioid is euphoria. It doesn't take long before the feeling of euphoria is what it means to be in 0 pain. After that only a pill will make the pain go away.

What do you think the reason is that with less than 6% of the world's population in the US we use more than 80% of the world's narcotics?

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Specializes in Family Nurse Practitioner.
This all happened because of the notion that no one ever has to live in any pain, just as you said.

Pain needs to be treated, yes, to tolerable and function-able levels. When pain is treated to a 0/10 then pain medication is being over used. We created this problem, probably with good intentions, by treating patients to 0. At a pain level of 0 the only benefit a patient gets from an opioid is euphoria. It doesn't take long before the feeling of euphoria is what it means to be in 0 pain. After that only a pill will make the pain go away.

What do you think the reason is that with less than 6% of the world's population in the US we use more than 80% of the world's narcotics?

The fact that people have the expectation of 0 pain is unbelievable to me. I was treating a patient with SUD and after having a major abdominal surgery they complained bitterly about the way their pain was not managed to their satisfaction post op. When I asked what their pain score expectation was the patient told me with a straight face 0. I was incredulous they had been sliced open from one side to the other and expected no pain? We need pain, we need anxiety these are our safety nets for those who don't believe this try googling leprosy.

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Specializes in Hospice.

It's all fine and good to blame patients for opioid abuse - but I think it begs the question of the role of the pharm and medical industries, not to mention advertising, in aggravating the problem. There's no question that consumer demand is a major driver of the current over-use ... but they have considerable help with that.

Did you know that the company that makes OxyContin had to pay a fine for deliberately lying to prescribers about oxycodone's potential for abuse? Or that they are now set to make billions off new requirements that insurance cover "new", more tamper-proof formulations?

I remember when the epidemic du jour was amphetimines, back in the 70's and 80's. A consumer group took a look at the numbers and found that only about 50% of the total amphetamines sold by the manufacturer could be accounted for by actual prescriptions. The manufacturers couldn't pretend that they didn't know that. They took the money anyway - considerable amounts of it, too.

They seem to have solved that particular PR problem, but make no mistake, opioid abuse is a major profit center for drug makers and they will do everything they can to preserve it.

Addiction is the very definition of a captive market. There's a reason that Coke was originally formulated with cocaine or that tobacco companies deliberately suppressed the fact that nicotine is addictive.

What about lazy or venal prescibers who can't be bothered to say no or educate themselves about pain and pain relief, let alone steer patients into less lucrative (for them) modalities. For every pain specialist working hard to address the complex and global issues of pain and pain relief, there are dozens of pill mills in the business of selling prescriptions to everyone who walks through the door.

Then there are the advertising salesmen who compete for the privilege of conditioning the consumer to believe that all the ills of modern life can be eradicaterrd at the drop of the latest pill. (Or gadget, or car, or body modification, or electoral candidate ... you get the idea.)

If you really want to address the problem of opioid abuse, follow the money. Cui bono?

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Specializes in Family Nurse Practitioner.
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.

I also have Chiari I and understand the daily headaches. My PCP does not handle any of those medications. I'm not on narcotics currently but see an amazing neurologist that would write the prescription if I required it. Most of the Chiari patients in my support group see pain management for this reason.

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Esme - I am very sorry for what you went through - this is not only degrading and lacks humanity - it is also traumatizing and just plainly horrible.

Myself, I have a very high pain tolerance - which I had as long as I can remember (and is not based on anything great I did....). When I had major surgery per lap I had dilaudid iv one time in the PACU , which made me horribly sick despite all preventative medications and after that one time 5 mg oxycodone after my ride home. i took ibuprofen after that for some days and was off any pain medication quickly. But I am not judging anybody or expect anybody else to do the same.

I had bad experience with physicians and nurses and my daughter ,who has a lot of medical problems, was not always lucky with the MDs or NPs wo saw her. I now mostly insist on MDs as opposed to NPs (though there are few who I am ok with) and have my daughter mostly seen my specialists.

There is a lot of judgement and nonsense out there ....

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I also have the patients who are months out of surgery, and instead of being weaned off narcotics or given other pain control methods, the doses are increased and obviously increasing their tolerances. I understand as an ER nurse I am not going to fix anyone's addiction overnight, but I do face the front lines of overdoses and I do think it is a sad and widespread problem due to over-prescribing.

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.

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Specializes in Adult Internal Medicine.
What happened to the term and state of being 'dependent' along with 'tolerance' and skipping straight to 'addiction'?

I think what the PP was getting as was that chronic pain becomes it's own disease.

After a period of 12 weeks, the chronic pain is no longer associated with the initial insult. This is the major concern of not tapering narcotics: take a healthy 20 year-old post-op for a knee, give them narcotics post-op, neglect to taper them, and a few months down the road you are no longer treating the residual post-op pain. This patient is physiologically and (likely) psychologically dependent, but also now has a chronic diagnosis which makes it very difficult to remove narcotics.

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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.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Esme, I had no clue of your suffering. My heart goes out to you and I admire your strength. I have no other words to suffice.

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I also have Chiari I and understand the daily headaches. My PCP does not handle any of those medications. I'm not on narcotics currently but see an amazing neurologist that would write the prescription if I required it. Most of the Chiari patients in my support group see pain management for this reason.

That's a good idea, thank you. I'll actually be able to get a neurologist now (my PCP wouldn't write a referral, so I haven't had one in years) and I'm sure that will help, too.

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Specializes in SNF, Home Health & Hospice, L&D, Peds.
This all happened because of the notion that no one ever has to live in any pain, just as you said.

Pain needs to be treated, yes, to tolerable and function-able levels. When pain is treated to a 0/10 then pain medication is being over used. We created this problem, probably with good intentions, by treating patients to 0. At a pain level of 0 the only benefit a patient gets from an opioid is euphoria. It doesn't take long before the feeling of euphoria is what it means to be in 0 pain. After that only a pill will make the pain go away.

What do you think the reason is that with less than 6% of the world's population in the US we use more than 80% of the world's narcotics?

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. 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! 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. 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. 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.

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Specializes in SNF, Home Health & Hospice, L&D, Peds.
The fact that people have the expectation of 0 pain is unbelievable to me. I was treating a patient with SUD and after having a major abdominal surgery they complained bitterly about the way their pain was not managed to their satisfaction post op. When I asked what their pain score expectation was the patient told me with a straight face 0. I was incredulous they had been sliced open from one side to the other and expected no pain? We need pain, we need anxiety these are our safety nets for those who don't believe this try googling leprosy.

As a lay person I cant say I would expect any different. Sounds like some patient education was needed at that moment.

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