A Funeral | Arthritis Information
I am attending the funeral of a 26 year old woman who died of an accidental prescription narcotic overdose. Her mother is my friend. I'm devastated for her mom and the rest of their family.
As I head to work today (yeah, I got sucked into an 8 hour shift today) I have to wonder how I contribute to some of this addiction. This is heavy on my mind a lot when I work. I think I can last in this profession for another 5 years but not much longer than that. I don't want to be the reason someone goes to sleep on a narcotic and never wakes up. I know I'm not solely responsible...but I know I'm part of the problem.
I have had to personally question every dose of every narcotic that I give someone. Is this dose going to be the one that puts them over the top? How much is too much? What is the maximum dose a person can tolerate?
Anyway, this is just on my mind today. I hope none of you need pain meds today but if you do....know what your limit is. Have a great evening(because I sure won't, LOL)
Yea, it sucks at both extremes. My stepmother won't even take a tylenol with codeine to deal with the pain of bone tumors on her spine and sternum (recurrent ovarian cancer) because she doesn't want to get addicted and she doesn't want to "get high."
I'm very sorry for the loss of your friend's daughter and her family. I'm sure it's a sad day for many.
Keep in mind that it isn't your fault Lorster. When people are in pain they come to you - you do your best to help to relieve their pain. There are warnings on the label. It is very unfortunate that sometimes these things happen. You are only trying to help people. If you could give somebody a piece of gum to help ease their pain - you would...unfortunately it's narcotics that tend to make us numb to the pain. Some people can't get through a day without the drugs- and you make their day bearable.
Hugs to you~
~Brenna
Sorry for death of you friend's daughter. PRESCRIPTION NARCOTICS KILL. They are not things to play around with. I have seen and heard of many prescription narcotics deaths. As I have said before. I don't like the heavy marketing of drugs. I think it is very destructive.
Jan
This is one reason I left my first RD. She seemed way to eager to prescribe narcotics and even gave me methadone after trying plaq. for only a month. I did fill the prescription..but ended up flushing them!Carolinagirl-
Glad you made that decision. Responsible docs don't encourage narcotics.
Jan
[QUOTE=Jan Lucinda]Sorry for death of you friend's daughter. PRESCRIPTION NARCOTICS KILL. They are not things to play around with. I have seen and heard of many prescription narcotics deaths. As I have said before. I don't like the heavy marketing of drugs. I think it is very destructive.
Drugs are advertised all the time. If you have a problem, take a pill. It will fix it . Make everything alright. We have a pill mentality. It doesn't have to just be a narcotic ad.
People need to be VERY careful of what they take. VERY careful. Drug companies are into profit, not public health.
Jan
[QUOTE=Jan Lucinda]Carolinagirl-
Glad you made that decision. Responsible docs don't encourage narcotics.
Jan
[/QUOTE] I have a very responsible RD and he prescribed Vicodin for me after my hip was fractured. I also have a very responsible Ortho and he prescribed narcotics for almost a year after my leg was shattered in an accident.
Yes, misuse of prescription drugs, especially narcotics is a horrible, tragic thing. But not everyone who used these meds has problems and if your doctor is a 'responsible" one, he will monitor your usage. It is very hard to gauge other people's pain and what meds they may need, when you don't know their medical situations...........
If carefully monitored narcotics have helped you, good. But if you sense the doctor is too eager and you are uncomfortable, as Carolinagirl said, find another doc. My opinion. Just my opinion. That is what I would do.
Jan
Wow. This is a tragic story. I'm so sorry for your friend and her family. I honestly don't see how you contribute to addiction. You don't prescribe meds and you don't make people take them. Don't be so hard on yourself my friend. You help people get better, remember?
They obviously have because I went from being in a wheelchair for 7 months and having a 50/50 change of walking, to waterskiing earlier this week. The meds, a excellent surgeon, fabulous PT's and a lot of willpower made all the difference!
I've never had any of my physicians push me to use narcotics and from what I've read on various boards, very few RD's even prescribe narcotics. Just my opinion..............
Sorry about your friend's daughter and sorry things are weighing so heavily on your mind. I can tell that you care abour the effect of your decisions & evaluate each situation the best you can before administering drugs so please have a free conscience.Lorster, I am sorry for your loss. What an awful thing to happen to anyone let alone someone so young.
So sad...always more tragic when someone is so young.its a sad situation for sure. but Lorster keep in mind when a patient is in a hospital they are in the best possible situation for administering narcotics. Yeah there are accidents but the patient doesn't have direct access to the drugs or alcohol and if everyone is doing their jobs then the patient will be monitered as well. We can all only do our best
schedule 3 drugs which include narcotics can only be advertised in professional journals. there is no direct to consumer ads for these drugs
This is so sad, but Lorster, people like you who worry about their contribution to addition are not the ones who contribute to it. You have a very responsible attitude and what you do helps people escape from their pain. That's no small thing. [QUOTE=JasmineRain] Yea, it sucks at both extremes. My stepmother won't even take a tylenol with codeine to deal with the pain of bone tumors on her spine and sternum (recurrent ovarian cancer) because she doesn't want to get addicted and she doesn't want to "get high."
[/QUOTE]
Jas, try to convince your stepmom that if you are truly in pain, you cannot become addicted to these meds and it is actually less stress on her body and will heal better if she takes the meds. Pain causes stress and she does not need this. This is so sad. We see such extremes all the time.
[QUOTE=lorster] [QUOTE=JasmineRain] Yea, it sucks at both extremes. My stepmother won't even take a tylenol with codeine to deal with the pain of bone tumors on her spine and sternum (recurrent ovarian cancer) because she doesn't want to get addicted and she doesn't want to "get high."
[/QUOTE]
Jas, try to convince your stepmom that if you are truly in pain, you cannot become addicted to these meds and it is actually less stress on her body and will heal better if she takes the meds. Pain causes stress and she does not need this. This is so sad. We see such extremes all the time. [/QUOTE]
I've tried for years. Once in a while we'll get her to pop a Vicodin so she can actually get off the couch and leave the house, but it's gotta be a special event (typically a birthday dinner out).
My mother, on the other hand, is at the other extreme... popping vicodin and valium for almost every symptom she claims she has. I was at her house once, had a headache, and asked for some ibuprofen. She offered me Valium.
lorster.. I am sorry for your loss.. but you have no accountability in that. I know you prescribe w/ good conscience and that is what is expected..
[QUOTE=carolinagirl]This is one reason I left my first RD. She seemed way to eager to prescribe narcotics and even gave me methadone after trying plaq. for only a month. I did fill the prescription..but ended up flushing them![/QUOTE]
you don't mean methotrexate do you?
methadone for RA? I think that's a little extreme.. and not for long term use, from my understanding.. and certainly not the first line of defense.. WOW
I may be wrong, but I don't think Methadone can be prescribed for RA unless you're in a pain clinic setting and are seeing a pain specialist. You can barely get an RD to prescribe Ultram/Tramadol much less Methadone!!!! Must have meant MXT. LindyNo, it was Methadone. Like I said, she was a little eager to go the narcotic route. When on my first visit I mentioned that the best sleep I had gotten in a while was when I was on vicodin for some dental surgery, she said she didn't have a problem getting me another prescription for the vicodin to sleep. She never did diagnose me, just called it "unexplained pain" and said all she could do was treat the pain and handed me a prescription for the methadone. ( she did try plaq. for a month but after that it was like she completely gave up on trying to find out what the real problem was )Lorster, you know I am a nurse too, I work in the ER where vast quantities of narcotics are dispensed and prescribed daily. You can't follow the person home and make them behave in a responsible manner. I am sorry for your loss, it's quite coomon in the area I live in. At least once a week we have an OD die, usually under the age of 30. The situation has gotten totally out of hand. But you have to know in your heart that you aren't responsible for these people.
Oh, LinB, in AL a dcotor can prescribe methadone for his/her patients. There is a drug called suboxone that doctors have to have a special license to dispense, but as far as I know, not methadone. A lot of doctors like to prescribe it because it doesn't have acetaminophen in it.Wendyr. I had a guy respiratory arrest on me about a year ago after giving him 8 mgs of po Dilaudid. I gave him 4 and then 4 more in an hour when he told me his pain was still an 11/10. (I hate the pain scale by the way) and since that time I am a bit gun shy when it comes to dispensing them. We have quite a problem with narc addiction in this small community and I see so much of it. I no longer use the pain scale when assessing. I really have to go with my gut when medicating because I never want that kind of stress on the job again. The guy also didn't have an IV access so I had to IM Narcan him so it took what seemed like forever to bring him out of it. It is becoming so complicated, I'm going to be glad to be out of this profession. I have more to post on this but don't have time today. Maybe later.
Jan
Regarding narcotics and RA. THe John Hopkings website says "Chronice narcotic therapy is not used routinely due to side effects such as diminished mental status, hypersdomnolence, constipation, and dependency. Furthermore, they have no anti-inflammatory activity." I noted DIMINISHED MENTAL STATUS.
They are a necessity for those undergoing surgery. A friend who had surgery and was concerned about the diminished mental status she would have after leaving the hospital for home, had a friend give her the narcotics so she would not accidentally take too much or whatever until she could wean to Tylenol. Worked for her.
Another friend, A.A. gal, was having minor gynecological surgery, didn't want to take narcotics, had her internist who was an addiction specialist, work with her surgeon to use ketoprofen for surgery and after. Worked well for her. This was done at a major hospital in L.A.
More options are becoming available.
Jan
Just a little more info......
What do I need to know about opioid medication choices?
Opioids can give good pain relief. But they must be used the right way and under the close watch of a health care provider. Like all drugs, they have both potential risks and benefits. Side effects can include being constipated and drowsy.
Some people worry about addiction. For most people, the risk of addiction is low. The chance of developing an addiction depends on family and personal history and other factors.
Should I not take any medication at all to treat my pain?
You should be aware that being in pain can be a health risk. It may limit your activity. This can have an impact on your overall health. Being inactive can increase the risk for heart disease and other health problems.
Many people find that they need pain medicine along with healthy food and exercise to help manage pain. Many may find relief with other types of treatments and do not use pain drugs. In either case, it's important that you talk to your health care provider. Only then can you make the right choice about what treatment is appropriate for you.
Where can I find more information about pain relief?
You should talk to your health care provider about what you need for pain relief. Ask what type of treatment plan may be appropriate for you.
There are also organizations that you can contact to help make sense of pain relief:
[QUOTE=Jan Lucinda]Regarding narcotics and RA. THe John Hopkings website says "Chronice narcotic therapy is not used routinely due to side effects such as diminished mental status, hypersdomnolence, constipation, and dependency. Furthermore, they have no anti-inflammatory activity." I noted DIMINISHED MENTAL STATUS.
Lynn-
I've heard that 10% of the population has the addictive biochemistry. I'll check the figures.
Betty Ford, my favorite first lady, became addicted to pain pills when treated for osteoarthritis of the neck.
Here are some sites I will check:
in Rancho Mirage, CA
Here's some info from the National Pain Foundation concerning addition and chronic pain.
The Myths Surrounding Opioids
Why are some physicians reluctant to treat chronic pain with opioids — the most effective available class of medications for treating pain? It's for the same reasons that many patients fear strong pain medications — the many myths surrounding the use of opioids. These myths include:
- using opioids means you are a bad or weak person,
- opioids damage the body,
- people who use opioids are likely to become addicted, and
- the body gets used to the opioid dose, which then needs to be increased again and again in order to continue getting pain relief.
Every one of these beliefs is incorrect. Below we'll go over the facts one by one and see what the reality is.
Myth — Using opioids means you are a bad or weak person
Fact — Opioids are just another drug treatment for pain
Over and over again, when I've suggested an opioid to suffering patients, they say, "Morphine! That's a dangerous drug. My family would think I'm an addict," or "Methadone? That's what heroin addicts use. Not me!" Because opioids can be abused, their legitimate use for pain has become stigmatized. As a result, too many people suffer with pain.
Myth — Opioids damage the body
Fact — Opioids are very safe drugs when used as directed
You may be surprised to learn that the American Geriatric Society has determined that opioids are safer for older people than anti-inflammatories (NSAIDS) such as ibuprofen or naproxen. NSAIDs can increase the blood pressure, cause gastrointestinal bleeding, and damage the kidney. Opioids do not — opioids do not damage any organs. They do have some side effects, such as nausea and sedation, but these effects rapidly diminish as you continue using the drugs. Other side effects, such as constipation, don't lessen with time, but can be prevented or minimized by taking stool softeners and bowel stimulants on a regular basis. Some men on high doses of opioids experience decreased testosterone levels, but this hormone can be replaced by using a testosterone gel or patch.
Myth — People who use opioids are likely to become addicted
Fact — Most people who are treated with opioids do not become addicted
Addiction is a psychological and behavioral disorder. Addiction is characterized by the presence of all three of the following traits:
- loss of control (ie, compulsive use),
- continuation despite adverse consequences, and
- obsession or preoccupation with obtaining and using the substance.
As an addiction advances, the person's life becomes progressively more constricted. The addiction becomes the addict's number one priority, and relationships with family and friends suffer. The addict's inner life becomes filled with preoccupation about the drug. Other activities are given up. Life revolves around obtaining and using the drug. This constriction is an important characteristic that distinguishes use of a drug by an addict from its appropriate use by a patient with chronic pain. Patients who take opioids for chronic pain hopefully expand their life, the opposite of what happens with addicts. Pain patients feel better and are able to increase their activities. They may begin gardening, going to movies, playing with children and grandchildren, and many are able to return to work.
A patient who is addicted to drugs may keep increasing the dose without discussing it with the doctor, might repeatedly use up the medications early, go to several physicians for opioids and lie about seeing other doctors, might inject their oral or topical drugs, or sell drugs to get money with which to buy other drugs. These behaviors are not typical of most pain patients.
Most pain patients taking opioids are not addicted to drugs. What is true of them is that they usually become physically dependent on the drug. Physical dependence has nothing to do with addiction. It simply means that a habituated user will experience certain symptoms if the drug is stopped abruptly. For opioids these withdrawal symptoms can include: anxiety, irritability, goose bumps, drooling, watery eyes, runny nose, sweating, nausea and vomiting, abdominal cramps, and insomnia. Withdrawal from morphine starts six to 12 hours after stopping the medication and peaks at one to three days. Longer-acting opioids, such as methadone, have a slower onset of these symptoms, and they are less severe than with shorter-acting drugs such as morphine and hydromorphone. Withdrawal symptoms can be avoided simply by tapering the drug dose over several days.
Myth — Opioid dosages will have to be increased because the body gets used to the drug
Fact — Significant tolerance to the pain-relieving effects of opioids is unlikely to occur
Tolerance means that a person needs more medication to continue getting the same effect. This is also true of addiction. With time, the addict needs more of the drug to obtain the same mood-altering effect. This is why cigarette smokers tend to increase the number of cigarettes they smoke. When opioids are taken for chronic pain, tolerance develops to some of the opioids' effects (eg, nausea and sedation will lessen) but not to others (eg, constipation and pain relief will continue as long as a patient takes the opioid). Unless the source of your pain progresses, as is true of many cancer patients, you are likely to remain on the same dose that gave you adequate pain relief when you first took the drug.
Lynn492008-07-25 14:54:17Excellent information. Thanks Lynn!
You're welcome! Just wanted to share some facts that I considered important to this discussion...I have more to post but no time now. Later.
Jan
I've been hearing alot of ads for treatment for opioid dependency, www.turntohelp.com It is sponsored by a company that makes methodone. Don't know how many, but there are people who become addicted to opioids. Made me think of this post.
THe company is Reckitt Benckiser.
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