Prescription Drug Abuse

[scubanurse]

OK personal question here. Besides toradol. What is a great pain reliever that isn't a narcotic? My kid is sick of the narcs. Is there something stronger she can ask about that won't make her dopey? She's going back to finish her nursing degree in January.

I prefer Ultram...some consider it like a narc but it does not make me loopy. It does make me a cranky b!*&$ if I take it long term though. It has an extended release version as well that works wonders on some of my pain.

[MariB]

Well she can't take narcs during clinical or on ambulance duty. We can cross our fingers she won't need them, but its been a year and she needs them on occasion still.

[ERDoc]

It amazes me the doses of morphine that are given in some places. I think there is a large cultural influence on pain perception by pts. When I was in NY, we would give 4-5mg of morphine with complete pain relief. Here in MI, it is usually multiple doses with minimal relief (this excludes those with drug seeking behavior). Most people just get dilaudid and require multiple doses. In my 3 year residency, I used dilaudid twice after morphine didn't work. It would be interesting to see a study comparing the required amount of pain medicine needed for certain diagnoses and comparing them across different regions.

[Kiwiology]

I am greatly intrigued; every second person and their dog in US seems to have "chronic pain" of some sort and be on a bunch of narcs and it seems that it also includes adolescents/young adults plus their cat also has diabeetus and is metformin.

[ERDoc]

I agree with that. In NY, I hardly ever took care of someone who was on chronic narcs. I moved here and I am more surprised when someone over the age of 8 ISN'T on narcs.

[Just Plain Ruff]

I am greatly intrigued; every second person and their dog in US seems to have "chronic pain" of some sort and be on a bunch of narcs and it seems that it also includes adolescents/young adults plus their cat also has diabeetus and is metformin.

Kiwi, the reason why every second person has chronic pain of some sort and is on narcs is that they are so easy to get.

I can walk into any urgent care clinic in the US and probably walk out after giving them some sob story about having chronic back pain or sciatic pain with a script for at least Norco. it's just too easy. And with E-prescribe, it's even easier now, all the prescriber has to do is hit a couple of mouse clicks and bam, whammo, script for you sir.

[ERDoc]

Narcs are one thing that the great state of Michigan will not allow us to eprescribe. Apparently they think it is safer to hand the pt a paper script than taking the pt out of the entire equation. I'd like to see the reasoning on that. It also comes from current movements in regulations. We have made pain the 5th vital sign and various regulatory/credentialing bodies force it upon us. Soon, our pay will be linked to pt satisfaction which will be linked to the amount of pain meds they get. For independent groups like mine, our contract and therefore our survival depends on meeting the hospital's definition of happy pts. The ones with the least amount of say in this is the people that actually see the pts and prescribe the meds. I could go into several stories where docs have been bullied into giving narcs but I won't delay this thread for that.

[paramedicmike]

I don't believe Colorado allows eprescription of narcs. The State in which I'm working won't let us eprescribe them from the ER, either. Actually, we currently aren't eprescribing anything. I print out a paper Rx for everything.

Discussions with several of the docs with whom I work and in my area seems to point to a trend of pain management docs moving away from just blanket prescription of narcotics. I'm seeing more chronic pain patients, who are routinely followed by a pain management doc, undergoing some sort of procedural method of pain control (e.g. blocks, trigger point injections etc...).

[Richard B the EMT]

Unless a patient history is known, or accurate, no matter what drugs my Paramedics administer, I would also be wary of bad interaction with unknown meds the patient has already ingested, injected, or applied via a transdermal patch that isn't on the patient during patient surveys.

Disclaimer: As a NY State EMT-B, only allowed to administer o2, "baby" aspirin, Albuterol, 2-Pam in a disaster/attack scenario, and awaiting the pilot programs for pre-loaded self-injector epinephrine to be completed.

[Just Plain Ruff]

I may have misspoke the eprescribe part, now that I remember, the last Urgent care visit I went to I left with a paper script for narcotic cough syrup so I was wrong at least for the state of missouri. I don't have personal info and knowledge of Maryland yet though.

Is anyone familiar with the vending machine style prescription machines that when the provider writes the medications to go home orders that the vending machine right outside the ER will have their prescription ready for them if it's in the system. I was at a hosptial in nebraska that had this system and they said that the system did have several narcotics that were dispensed directly to the patient via this machine, norco being one of them. The nurses said that the machine dispensed up to 30 pills in a pre-packaged bottle to patients.

Thoughts on this?