Suicide by chronic pain sufferers after opioids reduced

Davey Do · Jun 12, 2018

Wow. So much could be said.

Thanks for the link, Emergent. Sad case. Sad story.

It makes me rethink a concept I read years ago in the book about suicide, Night Falls Fast where I believe the author relayed that people with chronic pain rarely take their own lives. Maybe I should reread that book.

A veteran with Parkinson's had his pain med decreased. He resorts to buying it off the streets. Illegal, but perhaps a better option than suicide.

The same sort of dosage decreasing goes on with psychotropics. For example, many psychiatrists cut down or discontinue antipsychotics due to guidelines and we deal with lots of admissions as a result of patients' exacerbation of their psychotic symptoms.

It seems to be that things were better when the power was more in the hands of the professionals & patients and not the bureaucracy.

I don't know. Maybe my memory is merely a result of "the sweetest days were the days that use to be".

brownbook · Jun 12, 2018

I have nothing against "pain is pain", and giving chronic pain patients as much pain meds as they are ordered. I gave a patient 1000 micrograms of fentanyl over (I don't remember exactly) but around half an hour, per anesthesia orders. It didn't phase him, (didn't phase me), I think, hope, it keep his pain at a dull roar. He was in for an epidural spinal steroid injection for chronic back pain.

My boss asked me about it the next day, I simply told her it was ordered by anesthesia, the patient was on massive doses of pain meds at home, and it didn't do much, if anything to his mentation or breathing. She was fine with that.

It is shocking to think a MD is so stupid as to bluntly, abruptly, tell a chronic pain patient their dosage will be cut. I hate lawsuits, but that doctor should be sued! I'm only an ADN nurse but I can figure out on my own that limiting opioid use does not apply to someone on opioids for many months or years.

However evidenced based studies show that long term opioids are not helpful, and may worsen, chronic pain. I compare this to antibiotic resistance, super bugs. Hopefully everybody is on board with cutting down antibiotic use, (seems it has only taken about 20 years for that to filter down to everyday practice). The same mind set needs to start with opioids use. But not abruptly for a chronic pain, long time opioid user.

Rocknurse, MSN, APRN, NP · Jun 12, 2018

This is happening all over and is, in my opinion, self-defeating. What's going to happen is that by denying patients their pain meds it will push people to buy unsafely off the street and potentially buy contaminated product laced with Fentanyl. This will do nothing but contribute to the opioid death statistics. I can't see how denying legitimate patients their meds can help. I am on a prescription myself for a chronic incurable health condition, and luckily my doctor treats me like an equal professional and said to me she has no wish to pull the rug from under my feet, which I appreciated. I'm sure others who are not afforded that same respect won't have that luxury. I believe that those who demonstrate they are able to responsibly use medication as they are supposed to should be left alone, and agree that there should be some restrictions on prescribing for acute conditions. However, I'm lately hearing about patients undergoing surgery with inadequate medication and don't agree with that at all. These are frightening times.

blondy2061h, MSN, RN · Jun 12, 2018

I have excruciating neck pain and after years of Botox, nerve blocks, tramadol, and being offered nsaids I'm allergic too, I've had moments where I have thought suicide might be my only option. Thankfully, I've got a decent pain management doctor now. It's insane pushing Dilaudid at work on someone eating nachos and laughing on the phone then another day having tears running down my own face and being offered a toradol shot by a doctor I've told at every appointment I really am allergic to nsaids, call my allergist if you don't believe me.

floramary, RN · Sep 26, 2019

I have to admit I'm scared for my old pts and myself. I'm a 65 yr old retired nurse with injuries = chronic pain/ Tramadol & neuropathy. I had pts that were on a cocktail of opioids at home with only partial relief and now here I am. lf they reduce my meds for pain relief that I have fought to keep at a minimum , I can see myself understanding suicide ideation in practical everyday life better. Bureaucracy has no place in medical decisions. Physcians know their patients, their history......not the pencil pushers. Geez

mmc51264, BSN, MSN, RN · Sep 26, 2019

My beef is that yes, they want to cut down on opioid use, but add more medications.

I have chronic pain. I cannot take NSAIDS or steroids. My PCP did not feel comfortable prescribing the tramadol I had been on for years so I was referred to pain clinic. They are awesome. They are working with me to see what I can do to reduce my needs. I have weaned down off of some meds. They keep offering me new stuff, but I would rather stay with one or two meds.

PT, massage, dry needling topicals all help. I can see how people would get frantic or suicidal about the loss of the one thing that helps them function.

I get frustrated when we get pts from outside facilities and the pts pain has been managed with 1mg of IV dialaudid Q2H. We manage with multimodal methods. PO, topicals, nerve blocks, TENS units. It is amazing the things that can be done alternatively. Very few are on a long-acting (any of the contins). We rarely use PCAs or epidurals.

I work on an ortho floor where pain is a huge issue. I feel like I do well as an ortho nurse because I myself understand pain.

Nurse By Day · Sep 26, 2019

All to true the people who are abusing the opioids are the issue, now I get that they were over prescribed at one time, but people got smart to it and wanted to try it, therefore creating addicts who didn’t need the meds to begin with, so do we blame the doctors or the idiots abusing it? Now people like myself are forced to go to a pain mgmt doctor who is decent but doesn’t listen to a word I say. I live with 3 chronic illnesses and some days I just cry from the pain. I also see patients having massive major surgeries and sent home with only a 5 day prescription for Percocet? We are taking cancer patients who just had a Hipec or Whipple! It honestly disgusts me!

Tiffanny Lacoski · Sep 27, 2019

That’s fine if they want to cut down painmanagement narcotics. But to pull the rug out from under someone and give them no warning is cruel and harmful. I was cut down and the depression that followed made me really look at the situation and forced me to make a choice. Can I continue on day after day after in this much pain with no hope of improvement. Or do I just end it know while the goings good. I begged my doctor to refer me to a pain clinic in hopes they had different options for me. She refused three times until saying she’s worried they will increase my pain meds. SHE IS WORRIED A PAIN EXPERT IS GOING TO OVERRIDE HER GD STATUS AND THE EXPERTS ARE GOING TO PRESCIPE MORE PAIN MEDS. does anyone else see the lunacy in that?? As it turns out,I did eventually get the referral and decided to live long enough to see what the experts had to say. They gave me a nerve block and I was pain free almost immediately. First time in five years. I bawled like a baby for a good hour. And kept crying during the day in utter disbelief I had no pain. I didn’t take any narcotics or even Tylenol after the procedure and it was a wonderous feeling I won’t soon forget? and the experts gave me a phychologist to work with for 3 months to treat the mental aspects of living with pain and medical ptsd(which I acquired during the original incident that landed me in the er and created my chronic pain). Chronic pain equals just as chronic pain management.

PeachyERNurse, BSN, RN · Sep 29, 2019

I know this thread is kind of old, but I felt the need to comment. My sister has sickle cell. Yeah yeah I know the stigma. I worked in the ED for 10 years, and I came across a lot of fakers who didn't even really have sickle cell and just wanted drugs. And also the sicklers who we treated like/or actually were seekers.

My sister's never had a whole lot of hospitalizations until this last year when she was hospitalized multiple times, received multiple transfusions, had to have a couple surgeries, etc. She's had a script for Dilaudid for YEARS. She fills it maybe 2x a year. Nothing excessive. She called me the other day hysterically crying because she'd been in pain, was out of her Dilaudid (because she let the previous script run out...always tries IBU 800 first which is generally helpful) and her Dr wrote her a new one. But apparently the pharmacies are now refusing to fill certain scripts??? Written by legit well known hem/oncs. I called one of the pharmacies and was told they can refuse to fill scripts written by certain docs, and they can choose to give pts only x amount of their prescriptions? Oh, and they have to call and confirm with the doc that you really have what illness you say you have. I had no idea that was a even a thing! No snark intended, but do they call the oncologist to confirm your cancer before they fill your script? Or the ortho to confirm your bone really is broken in 3 different places and you need that oxy or whatever?

She was turned away from multiple pharmacies that she'd regularly used in the past for her other meds. They treated her like a seeker even though they could see she wasn't on the PDMP (yep I confirmed this). I had to call a fifth pharmacy to get her her meds. So yeah, I can definitely see chronic pain med users with legitimate pain issues killing themselves when their pain relief is taken away or severely limited.

Trauma Columnist · Sep 29, 2019

12 minutes ago, PeachyERNurse said:
I know this thread is kind of old, but I felt the need to comment. My sister has sickle cell. Yeah yeah I know the stigma. I worked in the ED for 10 years, and I came across a lot of fakers who didn't even really have sickle cell and just wanted drugs. And also the sicklers who we treated like/or actually were seekers.
My sister's never had a whole lot of hospitalizations until this last year when she was hospitalized multiple times, received multiple transfusions, had to have a couple surgeries, etc. She's had a script for Dilaudid for YEARS. She fills it maybe 2x a year. Nothing excessive. She called me the other day hysterically crying because she'd been in pain, was out of her Dilaudid (because she let the previous script run out...always tries IBU 800 first which is generally helpful) and her Dr wrote her a new one. But apparently the pharmacies are now refusing to fill certain scripts??? Written by legit well known hem/oncs. I called one of the pharmacies and was told they can refuse to fill scripts written by certain docs, and they can choose to give pts only x amount of their prescriptions? Oh, and they have to call and confirm with the doc that you really have what illness you say you have. I had no idea that was a even a thing! No snark intended, but do they call the oncologist to confirm your cancer before they fill your script? Or the ortho to confirm your bone really is broken in 3 different places and you need that oxy or whatever?
She was turned away from multiple pharmacies that she'd regularly used in the past for her other meds. They treated her like a seeker even though they could see she wasn't on the PDMP (yep I confirmed this). I had to call a fifth pharmacy to get her her meds. So yeah, I can definitely see chronic pain med users with legitimate pain issues killing themselves when their pain relief is taken away or severely limited.

This is incredibly sad. I care for sickle cell dialysis pts and I can tell you - they hurt. One of my pts had the same issue so this is becoming a huge issue. I finally took the script myself (I'm the provider) and took it in person to a pharmacy to ensure it got filled. This opioid crisis pendulum has completely swung in the opposite direction. I'm so very sorry for your sister.

PeachyERNurse, BSN, RN · Sep 29, 2019

8 hours ago, traumaRUs said:
This is incredibly sad. I care for sickle cell dialysis pts and I can tell you - they hurt. One of my pts had the same issue so this is becoming a huge issue. I finally took the script myself (I'm the provider) and took it in person to a pharmacy to ensure it got filled. This opioid crisis pendulum has completely swung in the opposite direction. I'm so very sorry for your sister.

Thanks so much for the response. I was at work when she called me, and she can be a drama queen about a lot of things. But when she says she hurts, she's really hurting. She actually said the words "I want to die" because she was in so much pain and no one cared. I was crying along with her because I couldn't believe this is the new reality! This is truly insanity, and we're gonna be having a heck of a lot more than an opioid abuse crisis here soon, when pts like these can't get their meds. Thank you so much for the care you provide your patients!