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Sedation Nation and Other Crazy Drug Combos


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All the alcohol in him was pushing the urine out is my guess...seen nyquill or benylin used here alot.  We have one regular whose favorite thing if he can escape the halfway house is to scream over to Walmart and pass out in the hair section after drinking a bottle of Finesse...and then snore it off in our ER.  On the bright side, he seems to have picked the one thing that hasn't tried to kill him, other than the facial injuries from hammering in of course.

 

SK

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Best dirty UDS story recently:

 

"The suboxone made me tired so I had to smoke some meth to stay awake"

 

Getting bored with all the people who tell how much pot helps their anxiety yet still feel that they need lots of benzos.  Yeah, pot helps your anxiety....

 

And you screwed up when you told me you need your adderall to stay awake on the night shift.

 

And your BAC is five times the legal limit because you took "a few sips" of someone's drink last night.

 

And still I love psych.

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Had a laugh - had a teenager a few weeks ago with such bad anxiety he was smoking weed equivalent of a pack a day smoker...comes in with cyclic vomiting syndrome, which is caused by the weed...which he is trying to quit, but gets anxious due to his GAD but also the W/D...so literally mommy and daddy and honey bring him back daily for his vomiting, because he can't quit smoking dope, which causes his vomiting...but he's suffering weed withdrawal with GAD, so he keeps lighting up.  Clonidine helped keep him away until getting to his doc (Thank F&ck).

 

I'm not a big weed fan, medical or otherwise.  It's main proponents are stoners themselves who want to be able to feed their habits free of charge by legally growing and who think if a little is good, lots must be better...God forbid if you go to the gym or for a walk or something to burn off your steam.  The tw@ts out there that think it's a benzo replacement are f&cktards of the highest level, IMHO.  I come from a place where it literally grows in people's yards and like a weed, and where there are a lot of addicts to it.  And thank you to our mentally challenged government who said that medical dope is legal, but it's up to the prescribers to sort out how it should be prescribed...without any guidance or professional oversight...or even what's considered an adequate dose, frequency, etc ad nauseum.  It's always fun when the folks we've started on Nabilone come back and say it doesn't work...since it doesn't hit them like smoking up does - one of my addict tests.

 

Sorry had to rant - have a drug addict kid.

 

SK

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  • 1 month later...

Just saw the largest morphine equivalent dose I have ever seen on a patient.

 

Managed by rheumatologist. Ankylosing spondylitis and RA in a 50ish female.

 

MED ----- 345

 

300 mg of Morphine daily and 30 mg of oxy daily.

 

SMOKES - "sort of" according to her and drinks an ale every few days to keep her bowels moving. WTH?

 

HOLY COW! 

 

She somehow still poops regularly and takes Lyrica too. 

 

She is close to my age but looks like she is 75+.

 

WOW - what does her future hold? 

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WOW...and let me guess, no exercise prescription.  Exercise is actually the best thing for AS - keeps the joints loose and lubed.  I have 5 huge exercise Rx pads in my locker at work from Exercise is Medicine Canada for folks just like that...and the fibro patients too.  I had a rheumatologist I used to send all my fibro patients to (until the Canadian Rheum Association decided it was actually a primary care issue) that would really upset them because she prescribed a whole pile of exercises and only tweeked their meds.

 

SK

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  • 2 weeks later...

So,  my normally ultimately supportive doc got angry with me this morning.

He was gone last week, I was flying solo. No big deal.

 

The front desk (who has no one driving the boat) scheduled several of his controlled substance 6 month recheck appts with me even though I had never seen them and they were due to see HIM.

 

I saw a few of them. I don't necessarily agree with them being on controls  - Benzos, ADHD, narcotics, ambien, testosterone - He is too liberal with them in my opinion.

 

So, I said something to the office manager - spineless and pretty useless - and she acted all supportive of me while he was gone but turned on me today and told him that I "copped an attitude" about seeing controls.

 

He was pretty much a jerk this morning and said that I am here "to see his patients when he can't and they are easy and shouldn't be a problem". 

 

I am supposed to see that they are using the meds properly and basically certify them for the next six months. Maybe even sign an Rx in his absence.

 

So, what if I don't agree with him clinically? What if they aren't taking them properly or taking too much or have no evidence to support why they take them?

 

I am not a robot. I don't just sign my name and DEA to a controlled substance because "he would want me to". 

 

The patients have a responsibility to see THE SAME PROVIDER on the set schedule to continue on these meds. Something called Continuity of Care......

 

So, I am disheartened that he has become more possessive of "his PA" and thinks I will do his bidding.

 

Very disappointed indeed.

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  • 2 weeks later...

Just watched this: https://youtu.be/fYN14UfO-Uc

 

So powerful and a truthful look at addiction. I know a lot of prescribers aren't contributing to this problem because of the dollar as the video says, but some are. Others are just pawns of a money-making healthcare system that doesn't allow sufficient time with patients to address addiction issues properly.

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Just watched this: https://youtu.be/fYN14UfO-Uc

 

So powerful and a truthful look at addiction. I know a lot of prescribers aren't contributing to this problem because of the dollar as the video says, but some are. Others are just pawns of a money-making healthcare system that doesn't allow sufficient time with patients to address addiction issues properly.

 

 

There are also docs (like mine) who truly believe that there is not a problem with chronic benzo use and that folks on controls aren't scum. Well, duh, they aren't all scum.

I am more concerned with providers who chronically prescribe controls and NEVER address the concept of an exit strategy with themselves or with the patients.

My doc thinks he is helping people - well, he is enabling them to live in a fog and not actually address a potential lifelong issue - but I don't think he is helping them.

 

Benzos do NOT go with narcotics or sedatives.

 

A 40-50 year old person should not be on chronic narcotics for the next 50 years. There is an endpoint, there is a point where it no longer works. There is a point where pills and chemicals are not the answer.

 

The public expectation of a pain free, hassle free life is a myth.

 

I fully expect benzos to become category II soon and I fully expect pharmacy boards to push legislation to stop dispensing benzos with narcotics due to perceived liability. Plus, it is dumb.

 

Pain is real. Mental illness is real. Personal responsibility is dead and drowning. 

 

Sometimes better living is NOT through chemistry.

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There are also docs (like mine) who truly believe that there is not a problem with chronic benzo use and that folks on controls aren't scum. Well, duh, they aren't all scum.

I am more concerned with providers who chronically prescribe controls and NEVER address the concept of an exit strategy with themselves or with the patients.

My doc thinks he is helping people - well, he is enabling them to live in a fog and not actually address a potential lifelong issue - but I don't think he is helping them.

 

Benzos do NOT go with narcotics or sedatives.

 

A 40-50 year old person should not be on chronic narcotics for the next 50 years. There is an endpoint, there is a point where it no longer works. There is a point where pills and chemicals are not the answer.

 

The public expectation of a pain free, hassle free life is a myth.

 

I fully expect benzos to become category II soon and I fully expect pharmacy boards to push legislation to stop dispensing benzos with narcotics due to perceived liability. Plus, it is dumb.

 

Pain is real. Mental illness is real. Personal responsibility is dead and drowning.

 

Sometimes better living is NOT through chemistry.

YES!!

 

Planteater: that certainly is my genre of music, but WOW!!! That song is powerful nonetheless.

 

One negative is that it does paint doctors/healthcare as something bad (i.e. drug dealer), and there certainly cases of this happening without a doubt - but I would like to think that overall we are helping

Yes- not my genre either (I think that's what you meant). My friend posted this on Facebook and tagged me because we've had some good conversations about this issue. She is a recovering alocoholic, who has needed surgery and had injuries, and was appalled at how freely people wanted to prescribe her narcotics even AFTER she told them she was in recovery and would like to avoid them. I had the same experience- I've had issues with anxiety at my job that causes my BP and HR to spike. I went to an urgent care one weekend because my BP wasn't coming down at home like it normally does. The Dr immediately tried to prescribe me Ativan. I told her "I don't like benzos. I'd rather do something else." I have my own past addiction issues, but I didn't fill her in. Anyway, she proceeded to try to convince me to take an Ativan Rx. We settled on propranolol (my suggestion) that I now use PRN (only 10-20mg) and it works great for what I need. Moral of my story- if I wasn't an educated provider, I would have walked out with benzos that were not indicated. I think most of us are more helpful than harmful, but the harmful ones have a definite presence.
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So,  my normally ultimately supportive doc got angry with me this morning.

He was gone last week, I was flying solo. No big deal.

 

The front desk (who has no one driving the boat) scheduled several of his controlled substance 6 month recheck appts with me even though I had never seen them and they were due to see HIM.

 

I saw a few of them. I don't necessarily agree with them being on controls  - Benzos, ADHD, narcotics, ambien, testosterone - He is too liberal with them in my opinion.

 

So, I said something to the office manager - spineless and pretty useless - and she acted all supportive of me while he was gone but turned on me today and told him that I "copped an attitude" about seeing controls.

 

He was pretty much a jerk this morning and said that I am here "to see his patients when he can't and they are easy and shouldn't be a problem". 

 

I am supposed to see that they are using the meds properly and basically certify them for the next six months. Maybe even sign an Rx in his absence.

 

So, what if I don't agree with him clinically? What if they aren't taking them properly or taking too much or have no evidence to support why they take them?

 

I am not a robot. I don't just sign my name and DEA to a controlled substance because "he would want me to". 

 

The patients have a responsibility to see THE SAME PROVIDER on the set schedule to continue on these meds. Something called Continuity of Care......

 

So, I am disheartened that he has become more possessive of "his PA" and thinks I will do his bidding.

 

Very disappointed indeed.

 

 

 

answer is simple

 

give them a one month script - book them a follow up

in chart just document that you are merely continuing the treatment plan as determined by Dr so and so....

 

you are not commenting on anything

 

If high dose poly pharmacy - would consider doing just one week -  then refer your doc to the society of addiction medicine to do some CME when he complains about you....

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