I think it is better to err on the side of giving addicts painkillers than make innocent people suffer from pain. Why let the addicts make the innocents suffer?
I have a friend with severe neuropathy pain in her leg as a result of a blood clot a few years ago. She is currently on a variety of controlled medications. She was sick a few weeks ago, arrived at the ER in excruciating pain and was denied any painkillers other than a single vicodin. Since this was an after-hours ER visit, I recommended she talk with her pain management doc to avoid this lack of treatment in the future. Maybe he could pin a note to her shirt for the next time she presents in the ER…
So, you don’t think she should have been legitimately given painkillers for the other 5 times she had kidney stones?
Look, I don’t disagree she has a substance abuse problem (although I’ve seen no evidence in these two threads that she’s addicted to anything other than alcohol). I just think that a CAT scan showing crystals and blood in the urine are pretty clear signs that something is wrong. And I think that even junkies deserve pain relief when legitimately ill. As QtM says, there are other, better, non-opiate drugs he could have given her - better than Motrin, fer Chrissakes.
Hey, I don’t know what I believe about all the drama people are stirring up, but I’m sorry that you have a kidney stone, and that you are in unresolved pain. That really sucks.
I don’t know. But I think it’s grounds for suspecting drug seeking behavior the 6th time.
Addiction is pretty much all the same syndrome. Once the genetic switch has been thrown, its all just a matter of preference. There really isn’t such a thing as only being addicted to one thing. The addict isn’t really addicted to the specific drug (although they can become physically dependent, which is a different syndrome) so much as they are compelled to feed the brain’s reward system. All alcoholics will become opiate addicts if given the chance. That is the biological nature of addiction. An alcoholic who uses opiates is not considered “sober,” just like an opiate addict who drinks is not considered sober. Doctors don’t like to prescribe opiates for patients who they know are alcoholics or addicts because they know it undoes whatever sobriety they might have and feeds their addiction. They also know that addicts will lie to get drugs.
The issue wasn’t whether something was wrong but whether she had a condition which caused her pain. I’m not a doctor but apparently the tests did not show a condition which would cause enough pain to justify writing an opiate prescription for an addict – especially one who was demonstrating drug-seeking behaviors.
Why should he give her anything stronger than ibuprofin if her condition doesn’t warrant it?
As far as I can tell, drug addiction is a minor problem with a long-term solution. This is not a problem that an emergency room should consider at all. People go to the emergency room because they are in pain. The pain or the cause of the pain should be treated without moral judgement. If anything, for an emergency room visit, pain killers should be over prescribed.
Every rule has an exception of course. Inevitably this policy might develop nuisance patients that are repeat customers. These patients would be so obvious that no second guessing is necessary.
You’re saying everybody who asks for opiates should be given them without question? Why bother scheduling them then if we’re not going to impose any prescriptive criteria. Why not just make them available OTC?
Such patients already do exist. Some are obvious. Some are not. Some addicts can be extremely subtle and convincing. Some are idiots. It’s not always that easy to tell.
That’s …really an astonishing conclusion. Think about what you’re saying: if I visit the ER because I have six occurrences of kidney stones, by the time we get to the sixth, I’m probably drug seekng and… what? getting kidney stones on purpose?
When the kidney stones are not found in a location where they would cause pain, and when the patient is a known addict then you’ve probably got yourself a drug seeker. The kidney stones, in themselves, do not cause pain unless they’re obstructing the ureter. See USCDiver’s post. Just because someone has kidney stones doesn’t mean they’re in pain. A lot of stones get formed and passed with no symptoms at all. They’re not that big a deal. But if addicts know they’re prone to them, they can try to exploit them to get drugs.
Moreover, nothing I’ve heard about kidneystones leads me to believe that the pain is trivial. Whether the OP has been given narcotics for kidneystone pain before or not, whether she is alcoholic or opiate addicted or not, it’s not as if she went into the ER and tried to get a script by faking back pain with no visible symptons.
Maybe somebody needs to address the kidneystones, the root cause.
Just to jump in a little late and defend myself:
I actually don’t expect prescription meds for kidney stones ever. Nor had I asked for them…this time or the others.
What usually happens, or at least has been MY experience with acute stones that you are likely passing (I believe that’s when they become the most painful) is that they put me in a bed with a drip, give me some Toradol and sometimes something for nausea, and wait until the stupid things pass. At that point, you don’t need meds of any kind, because the pain is gone. Sometimes they give me morphine or something narcotic and I don’t know if that’s because they think the pain won’t be controlled by toradol or they don’t HAVE toradol or what. I just figure they know what they’re doing.
Once, when it was clear due to testing that I hadn’t passed a stone, but could have trouble with it later, I was given a script for narcotic pain relievers just in case I had trouble and wasn’t at the E.R. I only remember taking them once, for just that reason…then throwing the rest of the bottle down the toilet a month or so later.
Strangely, even though I’ve had problems with alcohol (though, I have gotten that under control…got beaten up quite enough with it and decided I just couldn’t take any more) I have never abused any prescription drugs. In addition, I’ve never even SEEN any illegal drugs except a bit of weed when I was in college.
I wasn’t detoxing when I went to the E.R., it had been quite awhile since my last drink, so there was no danger of overlapping meds with booze. Additionally, I did tell my doctor that I was fighting a binge drinking problem when he asked about alcohol or other meds I may have taken recently. The binge drinking is EVERY bit a problem as other habits, and still makes me a problem drinker, absolutely. However, since I am not a “daily drinker” and my binges last 1-2 days (every month to 60 days, typically) I’m not the kind of drinker who needs to be slowly detoxed. If you drink for two days, a week later, you don’t need to worry about having seizures. There was no alcohol on my breath when I went to see about my stones.
One last tidbit: I’m terrified of needles. There’s NO way I’d let someone put an I.V. in my arm while I fainted and whined just so that I could get some vicodin or whatever. I do anything and everything I can to avoid being “stuck.”
I am sorry to hear about your stones. I had one, but it was moderate compared to what I have heard tell from others. Good luck in recovery!