BushyFromOz Posted November 13, 2013 Posted November 13, 2013 Kiwi, I dunno about pavlovaland but if our state government would actually invest in some IT infrastructure so record sharing was able to happen between those prescribing and those filling the prescriptions a lot of this prescription drug abuse could be avoided. Endone is easier to get than heroine, and its legal too!
Just Plain Ruff Posted November 13, 2013 Posted November 13, 2013 I had a physician who supplied my family pretty good with narcs. I went into her office and she wrote me a script for vicodin for 150 pills, a script for percocet for 150 pills and a script for 50 dilaudid's. ( I only got the vicodin script filled) She kept my mother and father in pain supplies for nearly 5 years. My last appointment with her is when I found out she had terminal colon cancer and she asked me point blank what medications I needed and she would write the scripts. I told her I needed more pain pills and she wrote me multiple scripts for multiple pain meds, including fentanyl patches. I was given all my normal meds RX's as well as 8 pain scripts of differing strengths. I asked her if she was worried that the DEA would come after her and she said "I'm dying, they can try but what are they going to do, put me in jail?" My parents fared much better with the pain scripts. Bottom line, this doctor didn't fear the DEA. She did tell me to get the scripts filled at different pharmacies though. Get one filled at Walgreens, one at CVS another at a local mom and pop shop. She asked if I understood what she was saying. I told her I did. But the pharmacies didn't care, I filled 3 of the scripts at one CVS and they didn't bat an eye. This doctor also just left script pads that were signed lying all around her office. She had a stamper that she just stamped all her pads when she got them I guess. It would have been easy to just grab a pad or two. I can see how Missouri is 7th in the US for overdose deaths, I ran quite a few deaths in my small town, I'm just surprised the numbers aren't higher. boy I miss Dr. Prohaska. RIP Doc, apart from being a drug dealer, she was a great clinician in her day.
Richard B the EMT Posted November 13, 2013 Posted November 13, 2013 Wow. Despite my heavy duty (10 out of 10) pain from my angiogram/angioplasty that resulted in an internal bleed I nearly died from, some years ago, I was hesitant in getting one bolus of Morphine, fearing addiction even with the one and only dose.
Just Plain Ruff Posted November 13, 2013 Posted November 13, 2013 Wow. Despite my heavy duty (10 out of 10) pain from my angiogram/angioplasty that resulted in an internal bleed I nearly died from, some years ago, I was hesitant in getting one bolus of Morphine, fearing addiction even with the one and only dose. I had a migraine a couple of months ago and went to the ER. 25 mgs of phenergan, 10 mg toradol and 2mg of dilaudid and I was done. I can definately see how people can get hooked on that crap. It took an additional 1mg of dilaudid to get rid of the migraine. the only reason I got the dilaudid was that I knew the doctor from a long time ago during paramedic school and he felt that I was not a drug seeker. He said that I got the special treatment that other migraine sufferers didn't routinely get. They got everything but the dilaudid.
Eydawn Posted November 13, 2013 Posted November 13, 2013 (edited) I share the concern with this. We have one doctor I refer to as the "candyman" because his patients are all on large amounts of narcotics. Combo #1: Soma (carisoprodol) PO 350mg Q6H, 8mg Dilaudid PO Q4h, Nucynta (Tapentadol) ER 40mg BID, 5mg oxycodone Q6H PRN for "breakthrough" and IVP dilaudid 2mg Q2h for "breakthrough" Combo #2: Morphine ER 40mg PO BID, 15mg roxicodone IR Q4H PRN, Valium 10mg Q8H and of course, dilaudid PCA... high dose settings. Combo #3: Opana 30mg ER PO BID, Morphine 20mg ER PO BID, 10 mg morphine IR PO Q6H PRN, Lyrica 300 mg TID All of these had me shaking my head... just try to be more than 10 minutes off from the "due" time too... what's even scarier is the folks that I know STILL had pain, despite all these combos, who were not sedated in the slightest. Holy shit, batman. I did have to get into it with a PA who was mad about the patient "not being on their home medications" and my very pointed comment was that their sedation level contraindicated resuming some of those medications right now... OMG, they're nodding off/desatting as we're sitting here talking about this, ain't no way I'm adding in more sedation... I have noticed that there's a distinct behavioral difference in some folks. Some folks are driven by the pain medication schedule and become abusive when it is deviated from; others are adamant about it, but understanding of interruptions and much more reliable in pain self reporting. Even if they do never get below a 7/10. Good resouce, Mike! Thanks for posting it. Wendy CO EMT-B RN-ADN Edited November 13, 2013 by Eydawn
ERDoc Posted November 13, 2013 Posted November 13, 2013 I never use narcotics with migraines, both real and fake. For people who really have migraines, they can get some pretty wicked rebound headaches that are hard to control. FOr the fakers, because it pisses them off. My standard goes something like this: Round 1: 1L NS bolus, 0.625 IV Droperidol (when it is available, otherwise 10mg reglan), Toradol 30mg IV, Benadyl 50mg IV and Ativan 0.5mg IV Round 2: Droperidol 0.625mg IV, Benadyl 50 mg IV, Ativan 0.5mg IV and Solu-Medrol 125mg IV Round 3: DHEA 1mg IV The few that make it this far will get narcs for true migraines and a script for OTD for seekers.
Eydawn Posted November 14, 2013 Posted November 14, 2013 All I got for a migraine at urgent care once was a shot of toradol and a shot of phenergan in the ass. Felt like I was sitting on golf balls. Learned I don't tolerate Macrobid... would have really appreciated not finding out that way! ~_~ The combo did work, no narcs required... On this note, how often do you ER types prescribe narcs for pain of unknown etiology? My chest pain ER visit comes to mind, and they tossed me out with a scrip for 30 vicodin, which I said I didn't want, and when they made me take it with me anyway I promptly deposited it in the shred box up on my home floor when I went to retrieve my stuff from my locker. Was that wierd, or par for the course? Wendy CO EMT-B RN-ADN
Just Plain Ruff Posted November 14, 2013 Posted November 14, 2013 I can tell you that I did not want the dilaudid but it did feel good though and I can understand how people get hooked. Maybe the first batch without the dilaudid would have worked. Can't say for sure as I was shitfaced snowed under and flying over the grand canyon all from room 3 at the ER.
ERDoc Posted November 14, 2013 Posted November 14, 2013 I've never had dilaudid but I did have morphine once. I can't say I felt much since it was for a kidney stone and I was asleep in a matter of minutes from the phenergan. I did take a vicodin once and I agree, I can see how someone would get hooked.
mobey Posted November 14, 2013 Posted November 14, 2013 How about Maxeran? That's what we are doing 2nd line prehospitally.
Recommended Posts