The backside of the opiod epidemic.

[42pines]

Last November I lifted something and hurt my back. Took some naprosyn and cyclobenzaprine and thought it'd be fine by the next day. But it wasn't. If I laid on my back pain was fine 2/10 but I found that I could only stand for one minute, the pain would ramp right up to 10/10 and oddly I could walk (stiff-legged) for about two minutes before the pain would ramp up. My R leg had about 15 degrees of movement, no more.

Four days went by and I became worried. I could not stand long enough to empty my bladder and was limiting fluids because it was so painful and difficult to get up. I could not roll to the L or R at all without causing extreme pain. Four days went by and eventually I called an ambulance who transported me to a hospital in Brockton, MA. The doc gave me an injection of an NSAID and two percocets (which I did not ask for). She came back after about 1.5 hours and asked how I was. I said I imagine the same, explaining "as long as I lay on my back, I'm ok." "Try walking" she said. "I said well, I can walk for about 2 minutes before falling down," and she said "well' let's see if it's better.

So she helped me off the gurney and she directed me this way and that way, and *poof* I found myself in the ED waiting room, near the end of the 2 minutes. She said: "take a seat." I said "I cannot sit." She, in an arrogant tone demaned: "take a seat." My two minutes was up and I collapsed to the floor to lay on my back, my only position of comfort.

"Get off the floor," she demanded, "I can't I responded." This went round and round till I said: "Call 911, call the police." She then put me on a gurney and tucked me away in a small room. About half an hour later they moved me, on the gurney out the waiting room door and there was a taxi. "Get in the taxi" she said. "I told you I can't sit, I can't take a taxi." In a very threatening tone she said: "You must leave NOW." I suspected (was quite sure) that there were two burly security guards who would PUT me in the taxi and so I tried laying on my back in the taxi, but I could not pull that leg in. Someone, I don't know who, forced my leg in and all I remember was a flash of pain and then found myself laying on the sidewalk, on my back. The taxi driver left and I was left laying on the concrete in 23 degree weather, for about 20 minutes. Eventually they came back, put me on a gurney and called an ambulance to return me home. The doctor wrote: "not medically necessary for ambulance" so I was forced to pay for the return ride.

The next day, realizing that eventually I would suffer kidney damage because I was drinking very little) I called 911 and they took me to another hospital Good Samaritan. They admitted me, kept me there for 4 nights, did an MRI + CAT, diagnosed me with severe bilateral neuroforaminal stenosis and set me up for a spinal steroid injection which allowed my mobility to return.

As I look at it that doc was absolutely certain that I was a narcotics seeker (which I'm not). As I look at it I was violated by many avenues. Assault: Fear that the security guards would hurt me further if I did not comply. Battery: Whoever pushed my legs in to the cab causing severe pain is battery. Violation of ADA: ADA acknowledges "sitting disability."

I'm 67 but most think I'm mid-fifties. On that day unshaven (it was all I could go to try to urinate within that one minute) unwashed (no shower for me) helpless, I was simply a crippled old man. I'd say it was one of the worst days of my life--all because (my hypothesis) she was sure I was there simply for narcotics. The alternative if that hypothesis is not correct is that she's sadistic.

I've pulled the med reports. In the doctor's notes there is NO mention of a fall and we all know about fall protocol. Mind you, all this is on multiple security cameras. But management refused to review the video, and I'm sure it is long gone by now.

Undoubtedly this story is not uncommon. I sent a fellow out to a NP for what I suspected was a diaphragmatic hernia. He was accused of being a drug seeker. I sent him to another doc. Diagnosis: "He tore the cartridge from where his rips were connected to the sternum.

The doc never even asked: what do you do for work (I probably looked so awful she assumed I was on SSD or homeless or something) maybe if I said I'm an RN that runs a clinic for 600 employees in the 49th largest company by annual revenue in America it would have made a difference but then she may have simply thought I was delusional.

Have any of you other similar stories where a person is suspected as a drug seeker and maltreated, yet the person is not a narcotics seeker?

[MunoRN, RN]

I've "thrown out my back" a few times, I've been stuck on the floor for more than 24 hours straight, I don't try and not pee though, I wouldn't recommend that, instead I use a 2-jar system; a smaller one to pee into while lying on the floor, then I empty it into a larger jar that hopefully someone will come and empty at some point.

One of these got to the point where I couldn't stand just as I got to work, I managed to get out of the car then my back locked up and put down on the ground in the parking lot, I tried and failed to at least crawl into the backseat to get off the cold cement, I finally had to call the unit where I work and ask if they could have a CNA come scoop me up, they dropped me off at the ED where I also work, I made it clear I just needed some heat applied to my back to buy me enough time to get back home.

There was a new Doc that I hadn't worked with before, he came in and immediately went into how he couldn't give me as many opiates as I was probably looking for, I told him that as a rule I don't take opiates particularly when my back is in this state because I could potentially cause more damage, I only treat these episodes with NSAIDS and Physical Therapy. He gave me a disbelieving look and left, one of the nurses I work with got me a heat pad, and eventually I was able to become upright and hobble my way home.

[JBMmom, MSN, NP]

It's unfortunate that sometimes the day to day experiences of care givers in the acute care environment lead to a change in attitude that makes them more suspicious of patients. I am sure that you're not alone in this experience, similar to those that are admitted with pancreatitis and it's assumed that they're denying alcohol intoxication, but a CIWA protocol is added to their care plans. I think that people get tired of feeling like they're being played, and there are certainly scenarios where the ED is used by those seeking drugs and back pain is a common complaint for which narcotics are requested/prescribed. I'm sorry that you both had such negative experiences, it's unfortunate that, as usual, a few bad apples can really spoil things for everyone.

[mmc51264, BSN, MSN, RN]

I am so sorry that happened to you! The only experience I had similar was a bout of back spasms as a teenager. It literally threw me to the ground. I could not get up no matter what. My parents took me to the doctor and said it was related to growing and I got muscle relaxers. I have not had it happen like that since then.

I am just stunned at the way you were treated. I would have to go to the media or get a lawyer or something. That is horrible. Hope you are feeling better now.

[LovingLife123]

I can tell you my story. I take low dose opiates as part of my pain management routine. I have suffered from chronic pain for years. Opiates, in addition to exercise, and other meds, make my pain manageable. Just manageable.

I had to have a root canal done about a couple of years ago. My dentist was in another town at the time because I was preparing to move to that town and was getting myself established medically. My dentist in my current town had retired so I went with this guy, who I love.

The root canal didn't take. By that evening, I was in awful pain. I tried ibuprofen and acetaminophen for 3 days. I was also given an antibiotic which was causing me to vomit. I was vomiting constantly. My husband called the dentist on that third day because the pain was maddening and I was dehydrated. My dentist said the tooth would have to be pulled but he didn't know if they could get me into the oral surgeon that day and to go to my local ER to get the pain under control and to check me out for dehydration.

We went. The PA flat out called me a drug seeker. He said he had seen me for a "toothache" before. He had not. He saw me two months earlier for my miscarriage in which I never asked for any type of pain medication. I simply needed to confirm my miscarriage. I corrected him on that in between tears due to the pain and he opened the door to my room and told me to leave.

We called the dentist who called the oral surgeon. Their office stayed open late and pulled mybtooth that night. The immediate relief was immense. The oral surgeon was dumbfounded at the ER. He says had they even done a simple X-ray they could have seen the infection was so bad it was the whole way into my sinuses. He sent me to their local ER for fluids and electrolytes. I was given 3 days worth of pain meds and didn't need anymore.

It was in my chart that I suffer from chronic pain. So the PA accused me of being a drug seeker. I will also add my vitals were indicating I was in pain and I was vomiting in front of the PA in the sink because they wouldn't give me an emesis basin or show me where a bathroom was. He refused to treat my nausea or check the electrolytes I asked for.

I'm so mad about it to this day. The way I was treated was horrible.

I wish society would stop blaming everyone else for drug addicts and take responsibility themselves. Oxycontins were not meant to be crushed and snorted. Buying Oxys on the street without a script illegal. I don't care if you self medicate. It's illegal. We have a mental health crisis in America which has lead to a drug crisis. It's not as simple as an opiate crisis.

[42pines]

Yikes, I'm a bit astonished. It seems that my story is not so uncommon. Indeed, there were plenty of reasons to suspect me. I went in the wee hours of the morning. I knew something had to be done and knew it was not emergent and thought 2AM would be a more laid back time. (Early morning visits: Drug Seeker). I stated I had little to no pain when laying still on my back but that it would go to 10/10 after one minute (Bingo--drug seeker). Unshaven: (Drug Seeker) Lumbar back pain: (Drug seeker) Unable to sit but can walk for 2 minutes before falling down: (Strange symptoms must be a drug seeker).

I can appreciate the frustration. The hospital (Brockton) is on the edge of Boston, it's not inner city, it's worse and late in the night as many as 40% of "patients" are likely to be drug seekers. But gosh, the guy falls to the ground and asks that the doc call the police? That is not drug seeker behavior. And then to be forced into a taxi while unable to sit? I'll call that battery. But the fact that I could not sit to save my life but could after 20 minutes hobble up and walk for 2 minutes really confused people. After being treated and having some improvement at the 2nd hospital (Cortisone helped) still nobody asked me how I would get home. I was in a new job, did not know anyone, and had no relatives. How did I get home, unable to sit? Simple: Offer $100 on Craiglist for someone who has a truck or van where I can lay in the back, and that's how I got home.

But two falls and no fall protocol. Worse the doc report says nothing about the patient collapsing twice and being left outside and ALL this is on video. It does stretch the imagination. Yet there was no "real damage" (other than extreme pain, humiliation and perhaps some worsening of symptoms) and so no lawyer wants the case. As an RN I can only say that in such a case, the system has so very much become broken.

I have learned: Research where you want to go in an emergency before it happens. Had I gone to the 2nd hospital I would have been treated and put on the path to recovery. The 2nd thing is never go to the ED alone especially if you happen to look old.

Thanks for those who responded.

[Rocknurse, MSN, APRN, NP]

I'm very sorry for the way you were treated....it was appalling but unfortunately the same happened to me on several occasions. The first time I had sudden onset back pain that rendered me on the floor...similar to as you described. I went to the ED by ambulance but they were very dismissive and sent me home, again by ambulance. When the ambulance got me home I was in such pain that the paramedics refused to leave me there and brought me back to the hospital. The charge nurse acted like I was a big inconvenience and I neither asked for nor received any pain medications. My mother simply collected me in the morning. At the time I had no idea what was wrong with me.

The second time I was at work in the ICU when I was overcome with intense and sudden pain in my back, hip and coccyx. I ended up leaving work and somehow driving home to lie on my back until morning where I thought I would be better. In the morning it was worse so my partner took me to the ED...in my own hospital! I never asked for pain meds....it never occurred to me. I just complained of pain wanting to find out what was going on. I had an MRI which showed nothing and immediately the charge nurses stance changed towards me and she acted as if she was disgusted with me. I received 2 mg Dilaudid that I did not ask for. I kept asking her what was wrong with me if the MRI showed nothing. She just shrugged her shoulders and told me there was nothing they could do for me and that I should leave.

I saw a total of 10 different doctors who dismissed me constantly, and eventually I was diagnosed with stage 4 endometriois and adenomyosis, neither of which are visible on an MRI. My ovaries were stuck to my pelvic wall because of endometriomas and my uterus was also covered in lesions. I had 3 surgeries and my entire pelvic wall was excised. I live on low dose opioids now but will never forget the way I was treated in that ED. For years I seethed over it and wish I'd gone back to confront them or complained to the ombudsman. If it happened today I'd make such a big stink they wouldn't know what hit them. I never expected to be treated like that in the very hospital I worked in. I never asked for pain meds...I asked for medical treatment. It took me a year to be diagnosed by which time I was unable to bend down because all of my organs were stuck together. It's time for patients to complain and take things to the higher ups when treatment like this happens. I'll never stand for it again.