Busted!

[bainsidhe]

I took Vicodin right after my gallbladder surgery. It did help manage the pain, and I just used enough to get me through the worst part. It wasn't until many months later that someone explained to me people buy Vicodin to get high. Guess I'll never be a drug abuser. I made sure to properly dispose of the extra pills.

[Mishi]

I'm allergic/intolerent to a lot of random things. Codeine, Celebrex and Prednisone (bad reaction, not actual allergy) are on the list, and I've never had morphine. My dad's allergic to codeine and my mother is allergic to morphine, so I tell my medical providers that there is a risk of morphine allergy. I always get a pretty red bracelet!

Recently told off some bimbo on FB that told my best friend to take Valium for the 'flu -"Because it sends you to outer space!"

[Kaylyn]

except it damages your kidneys....

Oh. Uh...well...good thing I only need like 1 pill every 4 months or so. :P

[HappyFun Ball]

A few weeks ago I went to the ER with a migraine ( I was vomiting and in extreme pain and I just could not wait for the urgent care clinic to open). A nurse practitioner came in and started grilling me about my medicine list, I had a script for Lortab 10 filled 4 months prior and she treated me like I was an addict.. It really pissed me off, I told her that I had tried to take one and I could not keep it down and that if I could just get a shot of Phenergan, I'd be happy.. She then starts in on my prescription for Ambien. I then politely asked to see the actual doctor. I told him that I would like a shot of Phenergan and I wouldn't say no to a pain medicine. I know that they probably get drug seekers all the time but it's not like I had several narcotic pain meds filled in a short time.

The doctor reveiwed my med list and gave me Stadol and Phenergan. I also learned that people can get addicted to Ambien.

[LadyAndreca]

Vicodin gives me terrible vertigo. I got it when I had my wisdom teeth pulled, and through some miscommunication (that probably had to do with me being in a drug-induced haze, because the sleepy gas knocked me out for about 18 hours - I remember flashes when someone forced me into moving but otherwise was an unaware lump) I believed I HAD to take it or I'd be in terrible pain. I don't know how I managed to get myself to the airport (on public transportation, thankfully), get myself back to college, and through nearly a week of class considering I was spending the entire week feeling like if my head and the ground had a magnetic attraction for each other. The idea to READ THE BOTTLE finally wormed its way into my disoriented little head, and I saw the 'as needed'...

[Shalom]

The doctor reveiwed my med list and gave me Stadol and Phenergan. I also learned that people can get addicted to Ambien.

Interesting.

Stadol is a combined opioid receptor agonist/antagonist. This means that it does give pain relief, BUT if you're already tolerant to opioids (at least pure agonists like morphine), it can trigger withdrawal symptoms. A true drug seeker wouldn't take Stadol for this reason.

(Although it's possible to be addicted to Stadol as well, and it's a damn tough addiction to break. It wasn't even a controlled substance when it came out, but they had to put it into schedule IV pretty quickly. Back in 1997, I was working for Aid of Rite as a graduate intern, before getting my license, and they sent me out to Tacoma to help out the locals with the computer systems when they had just brought a bunch of newly acquired Thrifty/Payless stores online with RADS, their Rx software. Previous to then, each store had had its own database; now, they all worked off one central database. The day we went live, we caught someone who was getting Stadol in nine different stores in the chain. God only knows how many other stores she was at besides us.)

edit to add: Toradol is not to be taken for more than 5 days consecutively. It is never dispensed in quantities over 20. Oral Toradol is not supposed to be prescribed at all, except as a follow-up to IV Toradol given in hospital (which is included in the 5 days); this rule is not always followed. There was once an oral NSAID called Duract (bromfenac) which was similarly limited, in this case to a 10 day supply; however, doctors insisted on giving it for months on end despite us pharmacists begging them not to, and people started dying, so a really damn good pain medication was yanked off the market because prescribers couldn't or wouldn't read the big black box warning on the package inserts, or thought they knew better than the manufacturer. Thank God this hasn't happened so far with Toradol.

[LewisLegion]

And it's people like that, that make it all the harder for someone who has actual chronic pain issues to get needed pain medications.

I hate opiods and narcotics. I have severe chronic pain issues and most days all I take are advil. I have a very high pain tolerance. I haven't had a prescription for any strong pain medication since I had surgery on my jaw. So don't look at me like I'm an addict and faking just to score some drugs. Look at my chart. Thirty percocet eight months ago after a documented surgery and nothing since then is hardly addict behavior. Besides, I didn't ASK for pain meds. I asked for enough muscle relaxers to get me through the weekend...which translates to four. Or a single shot. You take your pick. I don't WANT pain meds.

Blurgh.

[Shalom]

more on Toradol: they have just come out with a nasal formulation. It's called "sprix". I haven't seen any prescriptions for it yet, so I couldn't tell you how well it works, but it's also subject to the 5 day limitation.

[Seshat]

And it's people like that, that make it all the harder for someone who has actual chronic pain issues to get needed pain medications.

Agreed.

Sometimes I feel like you say 'fibromyalgia' in an emergency room and they immediately dismiss you as a drug seeker.

Actually I'm here because I broke my ankle/have a sudden and severe infection/have the classic 'heart attack' pain set/whatever. Fibro just happens to be part of my medical history. So settle down, dude/dudette.

[LewisLegion]

They do though. Most of them see fibro and immediately shut you down regardless of anything else. I could come into the ER half-decapitated from a car accident, holding my brains in with my hand, and they'd look at my chart, see fibro, call me a drug seeker, and send me home. Obviously an exageration but that's how it feels sometimes.

And try being YOUNG with fibro. My sister has it as bad/worse than me, and she's only 23 (it's her birthday today, squee!). She's been flat out told to her face by medical professionals that she's 'too young to be in this much pain'.

I didn't know pain had an age limit? Do your nerves not work until you're middle aged, or something?

[Sapphire Silk]

Stadol is a combined opioid receptor agonist/antagonist. This means that it does give pain relief, BUT if you're already tolerant to opioids (at least pure agonists like morphine), it can trigger withdrawal symptoms. A true drug seeker wouldn't take Stadol for this reason.

Boy, does it! I've had to argue with inexperienced docs who want to give Stadol to known drug seekers. It's almost as bad as giving them Narcan. We have the same problem with Nubain, another opiod agonist/antagonist, for the same reason.

We use Nubain to treat severe itching in the OB (Post Partum) setting in women who've been given Duramorph (an opiod) in their epidural (a common side effect is severe itching). My students always get flustered when they look up Nubain prior to administering it and find it is a "pain medication." Whereby they then get my lecture on opiod receptor sites in the brain and how they work (In all fairness, they get this in class before we hit the hospital, but someone invariably doesn't pay attention/take notes).

edit to add: Toradol is not to be taken for more than 5 days consecutively. <snip>; however, doctors insisted on giving it for months on end despite us pharmacists begging them not to, and people started dying, so a really damn good pain medication was yanked off the market because prescribers couldn't or wouldn't read the big black box warning on the package inserts, or thought they knew better than the manufacturer. Thank God this hasn't happened so far with Toradol.

Tell me about it Fortunately, most ER docs I know are good about this, but I've had to remind quite a few PAs that they shouldn't be prescribing this without a really, really, really good reason.

And it's people like that, that make it all the harder for someone who has actual chronic pain issues to get needed pain medications.

My sympathies. I do see a lot of that problem in the ER, and I am sorry about it. We get very, very cynical about pain issues in the ER because it's such a frequent ER complaint. Most of these patients should be seeing a pain management specialist and not coming to the ER at all.

That doesn't make mistreating someone in genuine pain the right thing to do. It's not.

more on Toradol: they have just come out with a nasal formulation. It's called "sprix". I haven't seen any prescriptions for it yet, so I couldn't tell you how well it works, but it's also subject to the 5 day limitation.

Great. That's the drug companies angling for a new way to make money. There's no reason to give Toradol intranasally. If you can't take it PO, then you probably need an IV anyway.

Agreed.

Sometimes I feel like you say 'fibromyalgia' in an emergency room and they immediately dismiss you as a drug seeker..

Again, I am very sorry about that. I know it happens a LOT, and I've been guilty of that attitude myself quite frankly (to my shame )

Fibro is often abused by drug seekers looking for an excuse to hold a doc's feet to the fire. And because it's so hard to disprove, a lot of providers feel trapped into giving narcotics when that actually is not the preferred treatment for fibro pain (ditto for migraines). It creates resentment on the part of the providers, and the patients who really DO have fibro catch it in the neck.

Again, it's not right. It's something I try to guard against.

I didn't know pain had an age limit? Do your nerves not work until you're middle aged, or something?

Yeah, that's never acceptable, either. There are lots of legit reasons for young people to have chronic pain.

Young people make up a large portion of drug seekers, sometimes because they want to resell the drugs, other times because they prefer prescription drug abuse to illegal drug abuse (and got started stealing Mom's pills).

[Seshat]

I know, Panacea, that it's really the fault of the drug seekers, not the medical specialists. And I do appreciate those of you (such as yourself) who make a point of guarding against it.

I guess LewisLegion and I are largely venting/complaining about what the drug seekers (as in the OP!) have caused.

[LewisLegion]

Exactly, Seshat. I know most medical professionals out there genuinely do care and want to help, but become jaded when people come in constantly and lie to them to get drugs.

Honestly, if I'm ever driven to the ER it's because at that moment my normal pain management has failed spectacularly, and my regular pain management professional is unavailable to help. All I am thinking is 'this is horrific pain, I need help, I need it to stop now'. Literally when it feels like your only two options at that point are go to the emergency room and beg for help or kill yourself...then the ER is where I head. I also know ERs are busy and triage must happen, but I only ask for the same considerations of every other patient.

I ask the doctor to actually read my chart and medical records and see just how often I hit ERs or, if possible, see how often I actually get or ask for prescriptions for addictive pain killers. They would see the number close to 0.

When I'm crying in pain and telling them I just want a shot or a couple of muscle relaxers and actually REFUSING a narcotics prescription that should tell them something.

At the very least, I would like them to LISTEN to me. This has happened before (not to me, but to my sister) where she's gone into the emergency room, tells them she fell down and hurt her arm, the doctor sees her three hours later and the first thing out of his mouth is, 'I see you have fibro, I'm not giving you any medication, you may leave now' and she has to stop him walking out of the room to inform him that she actually fell and has a broken wrist before he even LOOKS FURTHER in the chart to see the REASON she came in beyond the word 'pain'...then that particular doctor, in my opinion, needs to seriously re-evaluate his position and world-view.

I've been very fortunate in that most doctors/nurses I've dealt with in the ER have at least been kind and attempted to help, especially after dispelling their initial knee-jerk reaction that I'm just after drugs. But just as the medical staff see someone claiming 'pain' enter their perview and immediately start thinking 'probably a drug-seeker' because of all their unfortunate experience...so to do actual chronic pain sufferers start thinking 'i'm going to be ignored and mocked' when they see a medical professional they are unfamiliar with because they've also been jaded due to unfortunate experience. Most chronic pain sufferers will actually avoid going to doctors and ERs when they seriously need to for this exact reason.

Again, this is not directed at you and is more frustration that the actions of a few bad seeds (on both sides of the bar) have to make things so much harder and more frustrating for the rest of us!

[AccountingDrone]

I always thought it would be a good idea to have a registry of pain control clinic patients at the local to them ERs ... just in case of accidents or other than pain clinic problems. I am lucky that my PCP is also one of the local pain control clinics, and he has been my PCP for long enough he trusts me, and I have a selection of drugs for different issues ranging from migraines to my CPPD.

Though I do admit to carrying around a couple of letters from radiologists with dx for some of my joint issues and one from the neurologist for the migraines and strange tremor issue. Makes it easier explaining what I have.

[Sapphire Silk]

I always thought it would be a good idea to have a registry of pain control clinic patients at the local to them ERs ... just in case of accidents or other than pain clinic problems. I am lucky that my PCP is also one of the local pain control clinics, and he has been my PCP for long enough he trusts me, and I have a selection of drugs for different issues ranging from migraines to my CPPD.

Though I do admit to carrying around a couple of letters from radiologists with dx for some of my joint issues and one from the neurologist for the migraines and strange tremor issue. Makes it easier explaining what I have.

A lot of ERs would keep a list of known drug seekers (as in drug abusers) but this practice has been discouraged due to HIPAA and JCAHO pain treatment guidelines.

Keeping a registry of patients being seen by pain management specialists would be a good idea, since those docs need to know if their patients are trying to circumvent the treatment plan (many forms of chronic, non-life threatening pain are best treated with non-narcotic or non-pharmacologic methods).

However, better training of ER physicians and nurses is also a good idea. All too often ER docs and primary care docs don't know how to treat chronic pain appropriately. They either knee jerk won't treat pain because they fear abuse, or knee jerk won't treat other kinds of pain (cancer pain for example) because they fear overdosing the patient.

It's a fine line to walk. Poor training is often the problem.