Question regarding narcotic addiction

[bethin]

The nurses and aides have been arguing for some time about addiction. A nursing student told a nurse that a patient cannot get addicted to narcotics IF they only take the medication when they are in pain and they take it as prescribed concerning time and dosage. Makes sense. She said a pain specialist came to her university to discuss this with them.

Many nurses disagree. Our hospital is notorious as one that believes if you take a narcotic pain medication more than once a day then you are addicted. If an order is written for 1-2 pain pills the nurse will only bring one, even if pt requested 2. Then, if one hour later same pt is still in severe pain they will not administer the second pain pill. Is there anything wrong with taking the second pain pill an hour later than receiving the first?

Can anyone give me some good reliable links regarding these questions while posting your thoughts? It angers me that people think if you take a narcotic then you are an addict. Right me if I'm wrong, but I always thought an addict takes medication without having pain, purely to get high and takes more than the required dose.

A pet peeve: the nurses that roll their eyes when I tell them that a pt needs pain meds even if they're post op. Like I said, we are notorious.

[Kirsti1181]

Nurses refusing to give pain meds is a big pet peeve of mine too. I suffer from chronic back pain and have to take narcotics daily to function. Yes, I have built up a tolerance to my meds but I am not addicted. But yet anytime I have to list my meds, I usually get a sarcastic "...and you're on this because?" or a not so subtle eye roll. If the patient needs something for pain, it should be given. It is not our job to determine whether or not the patient is really in pain, it is our job to assume that pain is what the patient says it is and to treat it accordingly.

[Jamesdotter]

In my state, as far as I know, the only (!) continuing education requirement for relicensure is in pain management.

(However, the nurse also has to have worked X# of hours in the preceding four years)

[Tweety, BSN, RN]

Do doctors and nurses say that Hypertensive patients are "addicted to their blood pressure meds" despite need for increased dosage to control elevated BP?

Do doctors and nurses say that Diabetic patients are "addicted to their diabetic meds" despite need for increased dosage to maintain control over elevated blood sugars???

Then why should patients with pain be treated any differently?

To have adequate relief to be able to function in daily life is all most people with acute/chronic pain are asking for...

Excellent!

I'm going to use that analogy myself. :)

[Kitnurse]

I work in a pain management clinic with a multiple fellowship trained(pain mgmt and emergency) surgeon who uses that same analogy with our patients.

We see daily patients in hysterics because some damn fool(pardon) with no concept of chronic pain told them they were a junkie because they took an opioid.

Unfortunately, the State Medical board here seems to share that common prejudice and has been conducting a systematic witch hunt against pain docs. They have been scrutinizing the practices patient records, checking every prescription for the slightest inaccuracy or variation from established protocols, and revoking physicians licenses at the drop of a hat. They have family practice doctors too terrorized to prescribe necessary opioids to legitimate pain patients for fear the eye of the Board will fall on them as well.

The re-education needs to come from the top, starting with the very physicians who, if they dont understand pain management, damn well better find out the FACTS, before punishing ethical fellowship trained physicians who Do understand PM, with thier midaevil ignorance and egos.

In the medical and legal worlds' drive to punish the few criminals who do abuse, they are putting the many innocent who desperately need relief in even more unecessary pain.

What ever happened to "Harm None"?

/rant.

[paulale45]

To whom says that you cannot get addictated to narcotics is very untrue. i was on Methadone for chronic back pain i its hell going through the withdrawls since my doctor took me off all together.

There is no excuse for giving inadequate analgesia from ignorance about addiction.

Great link for the issues:

http://www.ahrq.gov/clinic/medtep/acute.htm

There is just so much research about this topic that it's unforgiveable to be so inflexible from lack of education. It's so much harder to relieve pain than to prevent it.

Do you have a pain management department/specialist you can organize to talk to the unit as an in-service?

Grrr.. this is a pet hate of mine.

[paulale45]

you may think your not addicated to your pain meds but you are, just as my pain specialist said that i wasnt and now that my family doctor took me off of my narcotics its hell. i have been going through withdrawls for about 10 days of pure HELL!!!!! so dont ever think your not addicated. Try to go off of them and see. i also have chronic back pain along with a herinated disc.

Nurses refusing to give pain meds is a big pet peeve of mine too. I suffer from chronic back pain and have to take narcotics daily to function. Yes, I have built up a tolerance to my meds but I am not addicted. But yet anytime I have to list my meds, I usually get a sarcastic "...and you're on this because?" or a not so subtle eye roll. If the patient needs something for pain, it should be given. It is not our job to determine whether or not the patient is really in pain, it is our job to assume that pain is what the patient says it is and to treat it accordingly.

[rehab nurse]

you may think your not addicated to your pain meds but you are, just as my pain specialist said that i wasnt and now that my family doctor took me off of my narcotics its hell. i have been going through withdrawls for about 10 days of pure HELL!!!!! so dont ever think your not addicated. Try to go off of them and see. i also have chronic back pain along with a herinated disc.

narcotic DEPENDENCE and ADDICTION are two very different things.

if you were on narcotics for a long period of time, your body certainly is dependent on the medications. read the posts above, it is described very well. if you are taking opiates long-term and try to go more than 12 hours or a day without that medication, you WILL go through withdrawal. not because the person is an ADDICT, but because the person was DEPENDENT on the pain meds to maintain his pain at a decent level.

why were you taken off your methadone without a taper or a switch to a different medication? methadone shouldn't be prescribed by anyone other than a Pain Management specialist if it's being used for chronic back pain. No family practice doctor around here will prescribe it. I know quite a few of the PM docs won't either.

of course, becoming addicted from pain meds CAN happen. from what i have learned and been told, the rate is very low, around 1%. i don't have links right now, so don't get me for that statistic. i was told that by my own PM specialist that the rate is extremely low. most pain patients have no difficulty being on pain meds for months or years. the issue is, can you stay within your monthly and daily prescribed pills/dosages without issue? do you obtain additional pain meds through illegal sources, or go to mulitiple doctors to get multiple scripts for pain meds? do you crush meds that are controlled release? those are all signals that the person is getting into trouble.

i hope the nurses in the OPs post get some new knowledge regarding pain medication. it was always an issue at my last place of employment as well. god forbid a poor patient who had chronic pain asked for her pain pills every four hours (as ordered!)...those nurses would eat you alive in there. it was all very sad. even after pain management handouts/inservices, the attitudes never changed.

[bethin]

narcotic DEPENDENCE and ADDICTION are two very different things.

if you were on narcotics for a long period of time, your body certainly is dependent on the medications. read the posts above, it is described very well. if you are taking opiates long-term and try to go more than 12 hours or a day without that medication, you WILL go through withdrawal. not because the person is an ADDICT, but because the person was DEPENDENT on the pain meds to maintain his pain at a decent level.

why were you taken off your methadone without a taper or a switch to a different medication? methadone shouldn't be prescribed by anyone other than a Pain Management specialist if it's being used for chronic back pain. No family practice doctor around here will prescribe it. I know quite a few of the PM docs won't either.

of course, becoming addicted from pain meds CAN happen. from what i have learned and been told, the rate is very low, around 1%. i don't have links right now, so don't get me for that statistic. i was told that by my own PM specialist that the rate is extremely low. most pain patients have no difficulty being on pain meds for months or years. the issue is, can you stay within your monthly and daily prescribed pills/dosages without issue? do you obtain additional pain meds through illegal sources, or go to mulitiple doctors to get multiple scripts for pain meds? do you crush meds that are controlled release? those are all signals that the person is getting into trouble.

i hope the nurses in the OPs post get some new knowledge regarding pain medication. it was always an issue at my last place of employment as well. god forbid a poor patient who had chronic pain asked for her pain pills every four hours (as ordered!)...those nurses would eat you alive in there. it was all very sad. even after pain management handouts/inservices, the attitudes never changed.

If the rate is so low for addiction (1%) I wonder why we as a society and as healthcare professionals talk about it so much as if it happens to 95% of pts who take narcotics.

I take Vicodin PRN for Crohn's. I can't eat a meal without experiencing pain. Sometimes excrutiating pain where I curl up in a ball and pray to God to kill me then I won't feel anything. I worry that I will become addicted but after reading all this info that everyone has provided my fear has lessened - a little. I receive my meds from one dr, I don't steal narcotics from pts and I don't seek outside sources for my meds. My dr has asked me numerous times if my pain med is strong enough (sometimes it isn't) and he says he can prescribe something stronger but that fear creaps up and I refuse. It's as if society has brainwashed me into thinking if I take a narcotic for longer than a week I'll become addicted.

I have went off the Vicodin to see how I do. I wanted to test myself to see if I'm addicted. It's misery so back on it I go. I don't take it every 4 hours as it says on the bottle, I don't take it to escape. I take it for pain. And anyone who says that Crohn's AND Ulcerative Colitis isn't painful is full of it. The other pts that I've talked to have equated it with giving childbirth.

You think asking for an epidural will work? Since it numbs from the waist down then I wouldn't feel my LUQ and RUQ pain.

Sorry for the rant.

[rehab nurse]

If the rate is so low for addiction (1%) I wonder why we as a society and as healthcare professionals talk about it so much as if it happens to 95% of pts who take narcotics.

I take Vicodin PRN for Crohn's. I can't eat a meal without experiencing pain. Sometimes excrutiating pain where I curl up in a ball and pray to God to kill me then I won't feel anything. I worry that I will become addicted but after reading all this info that everyone has provided my fear has lessened - a little. I receive my meds from one dr, I don't steal narcotics from pts and I don't seek outside sources for my meds. My dr has asked me numerous times if my pain med is strong enough (sometimes it isn't) and he says he can prescribe something stronger but that fear creaps up and I refuse. It's as if society has brainwashed me into thinking if I take a narcotic for longer than a week I'll become addicted.

I have went off the Vicodin to see how I do. I wanted to test myself to see if I'm addicted. It's misery so back on it I go. I don't take it every 4 hours as it says on the bottle, I don't take it to escape. I take it for pain. And anyone who says that Crohn's AND Ulcerative Colitis isn't painful is full of it. The other pts that I've talked to have equated it with giving childbirth.

You think asking for an epidural will work? Since it numbs from the waist down then I wouldn't feel my LUQ and RUQ pain.

Sorry for the rant.

Rant away.

I, for one, understand what you are feeling. I took PRN meds for pain for about 2 years. felt terrible, like i was this person who was evil thinking about my back pain all the time. felt horrible when i had to ask my doc for pain meds (darvocet at that time). i finally got a discogram and several MRI's and a decent surgeon finally told me what was wrong with me. that i deserve to have my pain managed properly. so i went to see a PM specialist (which is where i heard about this low rate...that's why i said not to quote me as i don't have the link for a study/studies) and i have had to since leave nursing due to the meds i take and the demands on my body being too much. i have recently faced a cancer battle as well, and i've been off work for a few months. i couldn't do it anymore.

i don't know why, now as just a patient, if i present to a different doc or to ER for a totally different reason, and i give mymed list to them why i have to get the eye rolling, sighing healthcare people who treat me like a low life. i have been a nurse 11 years. i don't work anymore. i am trying to get disability for now. i hate life right now. i truly feel for anyone who has to deal with pain, especially those with chronic pain. it is miserable. even when treated, my pain is usually hovering about a 4. if i get OOB, it shoots up. my quality of life is very poor right now. but i get up, cause i have two little kids who need me.

i hope you find relief. i truly do. i don't know why pain patients have to fight to get treatment and fight to "prove" ourselves time and time again. i don't know. not all nurses are like that. i have met very many kind and caring (and competent) nurses and other HCP who help.

[bethin]

Rant away.

i don't know why, now as just a patient, if i present to a different doc or to ER for a totally different reason, and i give mymed list to them why i have to get the eye rolling, sighing healthcare people who treat me like a low life. i have been a nurse 11 years. i don't work anymore. i am trying to get disability for now. i hate life right now. i truly feel for anyone who has to deal with pain, especially those with chronic pain. it is miserable. even when treated, my pain is usually hovering about a 4. if i get OOB, it shoots up. my quality of life is very poor right now. but i get up, cause i have two little kids who need me.

i hope you find relief. i truly do. i don't know why pain patients have to fight to get treatment and fight to "prove" ourselves time and time again. i don't know. not all nurses are like that. i have met very many kind and caring (and competent) nurses and other HCP who help.

Do you think that others are jealous? Do you think that they think we enjoy taking our pain meds so we can get high and they want to join in the fun? It's crossed my mind. It's the only reason I can account for the eye rolling. What's it to them it to administer the medication? You don't see eye rolling when nurses have to give insulin shots.

If it is jealousy, they need help more than we do. Personally, I hate taking pain medication. I hate the loopy feeling and sometimes I get headaches. Who would choose to get a headache? When I take my pain meds, I go to bed because I'm so tired I can't do anything else. I don't want to live my life in bed.

[solumedrol]

This is an e-learning program based on the Assessment and Management of Pain guideline.

http://www.rnao.org/Pain_e-learning/index.html

[Gompers, BSN, RN]

Oh this just burns me up!!!

Nurses not giving pain meds because they assume the patient will become addicted - even if the patient is in obvious pain - are just plain cruel!!! That is one of my pet peeves - nurses who don't give pain meds when they are necessary. Why not give them? I know if I was a patient I'd want my nurse to give me whatever she could to make me more comfortable!!!

My other pet peeve (totally unrelated) is when a nurse or anesthesiologist won't give pain meds to a patient in pain or during surgery simply because the patient is hypotensive. They fear that giving the narcotics will further drop the BP. Hello!!! Two totally separate issues! Give the pain meds if they're needed and do something else to increase the BP if it drops. A patient can be in excruciating pain and hypotensive at the same time.

There is a big difference between physical and psychological addiction. Yes, after a few days on narcotics the body does start to get addicted to the meds. But you can always wean them off by cutting back on the dose and frequency AFTER the pain starts to resolve. Psychological addiction is a totally separate issue - yes it involves physical addiction as well, but there is more to it than that. The main issue, to me, though, is that if a patient is hospitalized an in pain, then thoughts of addiction should be put on the back burner and the patient's comfort should be the top priority.