Thursday, April 4, 2019

Midsummer's night dream, opioids.

Vince's drama club is putting on Midsummer's Night Dream tomorrow night.  I thought I needed to brush up on the plot a little before I went to the play, the language is going to be hard enough for me to follow, so I wanted to know at least the names and the general plot.  I struggled with The Real Inspector Hound, it would have been better if I had gone through the cliff notes first.  Youtube is awesome.  I wish youtube was around when I was taking differential equations.



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I've been rethinking my role in the opioid addiction crisis.  I have a small, but I think, semi-critical role.  Every surgical patient I discharge is given a prescription for opioids.  Sometimes it's oxy, sometimes it's percocet and sometimes it's vicodin. I don't decide whether they get the prescription, I only get to tell them about the prescriptions that they get.  I actually hate handing over the printed prescription, especially for people who might have had a couple of narcotic doses right after surgery, but for the last day or day and a half, they've been doing great on Tylenol or Motrin or even nothing.  A patient who has been on no pain meds for 18 hours is still sent home with an opioid prescription.  For the first few months I was on the job, I told them - this is a narcotic.  Take it only when you need to.  Then the second few months, I told them - this is a narcotic.  Take it only when you need to.  It is habit forming.  Just this week, after reading about the Sackler family, I changed my wording to say - this is a narcotic.  Take it only when you need to.  You probably don't need to given that I've only given you Motrin for the last 12 hours.  This is an addictive substance. 

I regularly have patients who are addicts.  I regularly have patients who refuse all narcotics even after major surgery and they are clearly in pain.  For the majority of patients, the narcotics work well for pain control in acute situation and they have no trouble transitioning to non-narcotic pain relief.  But I have had a few patients who have not had narcotics before and under my care discover that they like the narcotics and begin asking for them more frequently than I think they need.  I follow the dr. orders whether it's every 3, 4 or 6 hours.  But when a patient becomes aware of that dosing schedule and starts calling 15 minutes before the next dose or they might not call, but they kind of ask hopefully for the next dose, I have a sinking feeling about those patients. Those are the ones that I think about when I fall asleep at night. 

I took Percocet for my c-sections.  For Vince, I refused it for a long time not because I thought I'd get addicted, but because I thought it would get into my milk for Vince, but I did finally take a dose which did allow me to rest and regain strength.  For Edda, I think I took it right after the surgery for a day without convincing.  Edda took oxy? or vicodin? for 10 days following her spinal fusion.  Of course, I wasn't worried about her becoming addicted to it because she's unable to get it herself, it was more important to me that she was comfortable because I think she did not understand what was happening to her. 

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