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Opioids & the ER: How Doctors Struggle to Separate Patients from Abusers

November 25, 2017
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When a chronic pain patient enters a hospital for pain relief, he or she may be treated with the same precautions as drug addicts. Why is this?


Nowadays with the opioid epidemic, emergency room doctors and nurses think all pain patients are drug seeking, which I understand, however, it puts us actual pain people in a tough spot,” recalled a five-year nerve pain patient, Jessica Zapadka. “That's a story for another day, am I right?”

Yes.

Hospitalizations related to opioid misuse and dependence have increased so dramatically, the rate of adult hospital inpatient stays per 100,000 population has nearly doubled in the last 12 years. And, the U.S. has spent over $20 billion in emergency department and inpatient care for opioid poisonings —so no wonder why doctors and specialists are cautious. It still leaves those chronic back pain patients who aren't abusing the system, who actually need pain relief with nowhere to turn.

Nowhere.

Is there a way to make it fair? We are not sure. What we can do is take a walk inside the emergency room doors and find out what it's really like for a chronic back pain patient to find pain relief. 

Opening the Doors

Emergency room entrance.

“I remember one day, the pain was so bad, my family made me go to the emergency room at my local hospital. I explained that I couldn’t take any form of prescription opioid, which was the opposite of most cases these doctors and nurses had seen. They made sure I knew it,” Zapadka asserted.

Not only does she have fibromyalgia, widespread chronic pain, but she also lives with lupus and five other disorders including cluster headaches, chronic nausea, Polycystic disease, Graves disease, and Polycystic ovary syndrome. She needed to get rid of her widespread pain but painkillers normally increase her pain instead of relieving it.

Two Steps Forward

But nothing is ever that simple. Jessica's ER nurse, Cheryl* wouldn't let up about her not wanting an opioid as the two began a conversation.

“Five patients today alone, which is low for this time begged me to write them a prescription for the lowest opioid they thought they could get away with just to combat their withdrawal symptoms,” Cheryl said.

Jessica then asked, “Maybe they are in actual pain?”

Cheryl replied, “I think they are on heroin. I've seen them here before. I've seen the track marks on their arms when they aren't wearing sweatshirts.”

Jessica really couldn't rebuttal that one.

“I want to help but what they are asking for would only enable their addiction,” the nurse added as another hospital specialist called Jessica to the back.

After the staff reviewed her file, they gave her an opioid analgesic, Tramadol, which is a non-narcotic medication that's often prescribed as an alternative to opiate painkillers. Despite having varying side effects, Jessica took the medication and continues to use it.

One Step Back

Cheryl came back about 20 minutes later to check on Zapadka who was laying in the hospital bed as another family gathered around her roommate.

“How is everything going?” Cheryl asked. “Have any other patients bothered you. Are you okay?”

Ironically, Zapadka went to the restroom down the hall because hers was occupied and on her way back, a male patient asked her if she was getting any pills and if she could give him a few. She told Cheryl because she was a little worried he'd come find her in the hospital room.

Ironically again, Cheryl knew the guy she was referring to. “He hangs out here all the time. We kick him out when he harasses other patients for painkillers and then he always comes back.”

Apparently, the male had two back surgeries from a pretty bad car wreck. Ever since then, he's been on opioids but at the end of each month, he'll run out and come to this hospital, demanding a refill. Hearing this, broke Zapadka's heart because she knows that feeling all too well. 

Coping with addiction.Caption: When dealing the black horse of addiction, it can force addicts to become homeless or do anything to get their next fix — such as begging nurses or patients to sell them pills in an effort to combat the impending withdrawal symptoms.

“This opioid epidemic — it’s awful. I hear about so many stories, especially when people are 'forced' to take them after surgery,” she disclosed. “For me, I had surgery two years ago and right after, they gave me painkillers. I wanted to be pain-free and the consequences of surgery made me physically need them.”

This was the beginning to her opiate sensitivity.

“I tried to take them. I pushed through the nausea that was caused from the prescription pills because my incision site hurt worse. Eventually, I couldn’t take either or any more so I switched pills again,” Jessica said.

During her pill transition, she ended up going through extreme withdrawals, which is why she can relate to the male patient seeking pills — he's the accidental addict.

“And some days, I think I am too,” Jessica told the nurse. “I experience Tramadol withdrawals if I forget to take it or miss a day. I withdrawal — bad.”

Discharged

Cheryl reassured Jessica that there's a huge difference between abuse and a medical necessity — the addict versus the chronic pain patient dependent on their prescription.

“As long as you're not doing anything and everything to get high you're OK, Jessica. You're in chronic pain and you need pain relief. Don't discount that,” the nurse said, as she tucked her patient in. “I have to go check on a few others but just press the button if you need anything.”

Jessica thanked the hospital worker as she turned over in an effort to fall asleep until she was discharged.

As not all pain patients are drug seekers, not all nurses and hospital staff compare all pain patients to junkies. Yes, Cheryl could be the exception to the rule but if you're in pain, you are allowed to seek help.

Jessica realized that sleeping was only wishful thinking. She sat up and reached for her journal inside her pink Michael Kors handbag and continued where she left off.

Writing and reading a journal can be beneficial.
“When people ask me questions about my invisible diseases, I always tell them that this happened to me for a reason,” she wrote. “Clearly, I wouldn’t wish this upon myself, or my worst enemy, but it has brought me on a path that I know I am supposed to be on. It may not show where I’m supposed to be right this very second, but I’ve learned to be grateful for the things that I have right now.”

Jessica became rather emotional that this nurse took such a caretaking role with her today. Tears began to fill her eyes as she felt them drop onto her open journal.

Yes, sometimes Jessica has to force herself to put a smile on but sometimes people surprise us.

“This morning before I got here, I closed my bedroom door and cried since I try to only shed a tear behind closed doors. When I’m in front of others, I do feel like I have to put on a brave face,” she added.

As Jessica wiped another set of tears from her makeup-free face, she heard her mom and dad enter the hospital room as she scribbled one last line.

“But we are all allowed to be sad. We are all allowed to cry, as it doesn’t make us weak, it actually proves that we've been strong for too long.”


*Using only the Nurse's first name to protect her privacy

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