ER physicians can start patients on the road to opiate dependence

[MillCreek]

http://www.nejm.org/doi/full/10.1056/NEJMsa1610524#t=abstract

https://www.nytimes.com/2017/02/15/health/long-term-opioid-use-doctors-prescriptions.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

If you are seen by an ER physician with a liberal attitude towards prescribing opiates, you are at higher risk of becoming opioid dependent.

[T.O.M.]

A couple of years back, I separated my left should pretty bad.  Doc in the ER called in a Class 2+.  Class 3 is where they start talking surgical repair due to impaired function.  Anyways, he wrote me a script for 10 Tylenol 3 (codeine) pills, and said that should be plenty to get me through the rough days when sleeping hurts.  Surprised me he didn't write a bigger script, in a good way.  Still have 8 of the pills in my medical supply cabinet.

[Hawkmoon]

Over the past few years I've had three episodes in which the docs at the VA hospital gave me bottles of pretty strong painkillers -- complete with a strip of red tape across the cap. Two were last year, at different stages of my gallbladder problem. I was going through the medicine cabinet a week or so ago and I found all three of them, red tape still intact.

When the VA admitted me with the acute gallbladder infection, they put me in the ICU on morphine without even asking if I wanted it or needed it. And it's quite possible that I did need it -- I was pretty out of it for a couple or three days. I didn't want to open those pill bottles, though.

[MechAg94]

I think I have a bottle of pills somewhere also.  Last time was when I got a crown.  The dentist actually prescribed pain killers.  I never took any of them.  Just because they prescribe them doesn't mean you need to take them.

[T.O.M.]

Just because they prescribe them doesn't mean you need to take them.

Much truth here.  I think I've posted before.  When I broke my arm and has the plates/screws installed, I got a bottle of 120 Tylenol 3 pills.  Ortho surgeon told me to take as needed, no more than 2 every 8 hours.  I took two before the six hours drive home, and 2 before my first therapy session.  Turned the rest in at one of those medication disposal drives.  Wish I had kept them in my SHTF kit, but I wasn't prepping for the zombies 10 years ago.

[RoadKingLarry]

My wife is on a long term chronic pain management program. One of her meds is an opiate, hydrocodone. I suspect there is some level of addiction., she's been taking them for years.
I can't take hydrocodone, tears me up, I'll be puking up my toenails  after the 2nd dose.

[MillCreek]

My wife is on a long term chronic pain management program. One of her meds is an opiate, hydrocodone. I suspect there is some level of addiction., she's been taking them for years.
I can't take hydrocodone, tears me up, I'll be puking up my toenails  after the 2nd dose.

The CDC and other medical authorities are now recommending that we get all chronic opiate patients below 120 MED (morphine equivalent dose) given that higher doses can be dangerous to the patient and may not do a lot of good anyway.  Geez Louise, the number of angry and threatening patients I have had to deal with over the past several months as we are decreasing their drugs, or telling them they cannot combine marijuana and opiates. 

[RoadKingLarry]

I was mistaken, not hydrocodone, tramadol, still an opiate.
Just looked at her current pharmacopeia, I need to write them all down again and see just what the hell she is on...:(