Narcan

1. You can't force people to do anything. They won't take better care of themselves.

2. Opioids are designed for severe acute pain, or severe chronic pain.

3. Making narcan readily available gives users a false security blanket. More OD. More die. Narcan often won't reverse huge overdoses. Time, healthy liver, and kidneys are the best reversal agents. Time meaning you get intubated and a machine breathes for you until your hypothalamus wakes up and your autonomic drive to breathe returns.

If you want new drugs, new medical ideas and procedures then tell the government to walk away and cut regulation. Profit isn't always evil. It's the driving force behind innovation. Quit demonizing doctors. Pain is subjective, if you go into an office and lie about pain and that NSAIDs and acetaminophen don't work. Then how is it the doctors fault he wrote you an opioid?

Self account goes a long way. At the end of the day they swallow pills, they inject into their arms. The pill bottle States how you are to take the medication. Once a patient leaves the office you can't control how they use. Outpatient Doctors aren't writing pain pill rx as much. If they do, it's for like 2-3 pills. Just enough to get then to their next appointment.

Methadone clinics don't help. Addicts will go there until the end of time and sell the methadone illegally. Can't stop it.

Best way to stop is to never start. Bring 4th graders to a methadone clinic and an icu. Might scare them out of doing it.

Otherwise I have no idea. Build a wall. Stop in flow of drugs. I know I said cut regulation but maybe the answer is to over regulate. Death penalty for possession of heroin. Death penalty for sale of heroin. That wouldn't work either.

I dont know if there is a right or wrong answer. On the human side I agree cw, you dont' want to see a kid slumped over in a chair dead. And on the other side how do you Stop it before it's too late. How do you differentiate whats too harsh? And what isn't harsh enough.
 
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1. Unfortunately, you're right, it's impossible to quantify someone's pain level.

With heart attacks, professionals can do catheters, EKG's, ECHO, etc that gives an appropriate idea to the extent of pathology going on that textures a doctor's impression, etc.
Pain on the other hand, is a vulnerable area for the doctor to be easily taken advantage of by the patient. How do we truly know a patient that is faking to one that is in agony?

I have no idea. It will take someone much more intelligent than I am to figure out some novel way to stop it.

2. You're right! Get the government the hell out of the way!

3. Lastly, I think there's a crop of people that will have to, as morbid as this sounds, die out from the population. Some (or many) are beyond the point of no-return and help is futile.

Definitely a crisis of our times though! Would love to hear more of your thoughts on the topic.
 
You can determine pain. Generally you see a spike in blood pressure and heart rate with acute pain.

When they're in-patient you can monitor this. When they tell you I'm having pain 10/10 and their heart rate and blood pressure is trending the same as when they weren't in pain....a clinician should think: "hmm. Let's maybe not give them an opioid. How bout a non narcotic, or even...placebo."

Usually a patient in 10/10 pain is restless and not functional. So when that patient is tapping away on their cell phone asking you for for wifi password while they state the pain is 10/10...you gotta think...."prolly not."

Unfortunately placebo is unethical. However, there are instances where ive seen one 10cc push of normal saline (does nothing for pain)and the patient claims to get pain relief because they think they're getting dilaudid. I really think placebo should be ok in the hospital system. It could be a great tool to help over prescribing opioids. But you get one shitty prescriber who just uses placebo and walks away you risk sentencing patients--who truly are in pain---a very miserable life.

However in patients with chronic conditions after a while the body adjusts to pain the heart rate and blood pressure won't spike when they're experiencing an episode of acute pain. In this case a placebo would yield no positive result from the patient. So giving a pain medication would be explored. And if it works, then generally the pain is true. Unless your patient is savvy and lies. And states they never have pain relief with any medication.

It's so hard, you just have to really slow down and look at the patients history, current problems and make a determination and hope your right. Last thing doctors/ clinicians want is for someone to suffer in agonizing pain.
 
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The only time in my life I've ever felt mildly addicted to something was after my knee surgery. Every time I'd go see the ortho he'd write me another script for 100 pills. I was on ~6-10 a day for 4 months or so. I ran out at one point and had a few days before I could see the doc and get my next script. They offered to call it in but I had an appointment already and didn't think it was a big deal.

I didn't sleep for those 3-4 days. Just tossed and turned all night (slowly.. remember bad knee), staring at the clock, mildly concerned about if I would ever sleep again. Was a zombie at work, PT was miserable. When I finally got the next script I mulled over if I was going to start taking them. Fortunately I didn't and by the end of the week I was able to fall asleep. Was the best sleep ever lmao.

I've heard from other people that Dr's are getting very stingy with pain medicine. Every time I've gotten hurt that couldn't of been further from what I experienced.
 
Yea you are having bone pain.

Bone pain, bowel pain and cancer pain are crushing.

I was taking 2 percs every four hours after my recent collarbone for 3 weeks. And I had a nerve block in for 7 days of that. I felt 60 years old. I looked it too.

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My wife took that to show me how I looked. And I was still hurting. Couldn't sleep without the Percocet. Finally the pain started to subside and was manageable after 7 days. But I went from every 4 hours with a nerve block infusion to cutting the infusion but taking perc every 8 hours to only taking 1 perc just before bed to get me through the night. That constant nagging throb would be worse when laying down.

The other side of this is I HATE FEELING STONED/knocked out. Some people love this feeling. So they continue to take the meds not to kill the pain but to elicit the stoned feeling. That's when you become addicted. Or if the pain never truly goes away. How to treat people with pain is so tricky.

But Narcotics are designed for these types of situations. Major bone/bowel/cancer exploration surgeries. They're not for someone that comes in for pain that a X-ray or scan comes up negative.

The orthos wrote for 80-100 percs because they expect you to be in pain post op. 12/day gets you less than 10 days on a 100 script. If he's still doing that 6 months post op then that's a problem unless the X-rays show that something still ain't right.
 
Bill480 said:
The only time in my life I've ever felt mildly addicted to something was after my knee surgery. Every time I'd go see the ortho he'd write me another script for 100 pills. I was on ~6-10 a day for 4 months or so. I ran out at one point and had a few days before I could see the doc and get my next script. They offered to call it in but I had an appointment already and didn't think it was a big deal.

I didn't sleep for those 3-4 days. Just tossed and turned all night (slowly.. remember bad knee), staring at the clock, mildly concerned about if I would ever sleep again. Was a zombie at work, PT was miserable. When I finally got the next script I mulled over if I was going to start taking them. Fortunately I didn't and by the end of the week I was able to fall asleep. Was the best sleep ever lmao.

I've heard from other people that Dr's are getting very stingy with pain medicine. Every time I've gotten hurt that couldn't of been further from what I experienced.
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From what it sounds like, your body was definitely becoming accustomed to it. Fortunately for you, you recognized it and chose not to continue taking them. For others, they continue and before they know it, they've got an issue.

Kudos to you.
 
CW95 said:
From what it sounds like, your body was definitely becoming accustomed to it. Fortunately for you, you recognized it and chose not to continue taking them. For others, they continue and before they know it, they've got an issue.

Kudos to you.
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I could surely see why someone would want to keep taking them. Getting no sleep + constant pain really sucked.

For someone with chronic back pain or chronic whatever pain.. I'm not sure what else your options would be. Be addicted to opioids, surgery that may or may not help, nerve blocks, etc. Shitty
 
Bill480 said:
I could surely see why someone would want to keep taking them. Getting no sleep + constant pain really sucked.

For someone with chronic back pain or chronic whatever pain.. I'm not sure what else your options would be. Be addicted to opioids, surgery that may or may not help, nerve blocks, etc. Shitty
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Therein lies the issue...there really isn't an alternative that doesn't carry with it troubling terrible side effects or future risks for greater harm. Given that and the fact that true chronic pain is a hell that'll break anyone, many are left without a solution.

Example: I've always known my dad to be a man that can tolerate physical/mental anguish better than anyone I've ever met. Classic tough guy.

He had a collapsed cervical vertebra in his neck that was impinging upon nerves and readily admitted that he couldn't have tolerated it for much longer. He would have taken or done anything to rid the pain. He said not only was the pain unbearable, but mentally, he said a life enduring that on a daily basis wouldn't be worth living.

It completely changed his perspective and impression of people enduring chronic pain.
 
Nerve pain is terrible. It doesn't show up on a xray.

It's crazy. Comes and goes. Or stays. People say lyrica helps, buts its a Narc and addictive. But honestly, there are many functional adults on pain killers. Can't blame them. You don't truly appreciate pain until you're the one in crushing pain--layin in the hospital bed. Your nurses/doctors are looking at you like a drug seeker.

Lol, maybe to work on a pain management team the prerequisite should be for them to break a long bone in the last year of residency and deal with the healing process. Might make them better clinicians.....
 
We've had a bunch of Drs down here getting busted for pill mills. I can definitely see how pain killers can be addictive but can't stand when people say being addicted is a disease......

My buddies girl friend is a nurse and had a girl come in OD and they bright her back to life, then tried to scare her into getting her life back on track and her words were "this is my 5th shot of Nathan they'll give it to me again" she said the girl was like 22 with a couple kids.

I just don't see how that's fun for people but it's almost to the point where the younger generation won't know any different and it'll be normal
 
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