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pain medication and addiction ethics
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pain medication and addiction ethics

I am a Nurse at a Nursing facility, and one of my residents is addicted to pain medication. He is paralyzed from a thoracic injury that happened 30 years ago, and has limited use of his arms and hands. He was admitted to our medicare unit a few days ago with 2 Stage IV wounds, one to the left hip and one on the right hip. Since he arrived, he's been demanding his pain meds the very second they're due, attempting to trick staff into an extra PRN dose, calling his doctor constantly for an increase in dosage, arguing every aspect of care, and calling state twice in the four day there. Management is involved over his constant complaints, and we are documenting everything but I can't help but wonder if all of complaints would go away if we just give him what he's seeking. Considering his circumstances, should we treat his addiction? After all, he's been taking these types of medications for 30 years, and his quality of life is dependant on them. If addiction is a side effect of the meds, is it ever an accetptable side effect? I'm not suggesting that he be chemically restraind, but to find a balance that meets his physical and mental needs and provides him with a quality of life he wishes. Or is addiction in any form intolerable? I can argue both sides equally, and I was wondering what the concensus was among other health-care providers
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Avatar_f_tn
Good morning
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Avatar_f_tn
Hello, welcome to the forum... and good morning.  I wish I had an answer to that question.  I just wanted you to know that maybe someone with some helpful information will come on here soon.  It's kinda early right now, that maybe why no one has answer this with some knowledge on this situation.  If he has been on these types of meds for 30 years, his tolerance is definitely increased to these meds.  I don't want to say go ahead and do it but if his tolerance is really high he may need a bigger dose and maybe try and taper him down?  That's just my opinion.  You are in my thoughts and prayers.  Have a wonderful day :)  Lil.
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Avatar_n_tn
Wow, that question could reach the depths of the best philosophy class and come out challenging all.......I don't know.  So many things have to be thought out.
Here we are trying to get off medication.   However, time and again some of us see the return of pain that brought us to pain pills in the first place.  Sometimes we must take pain pills to escape the pain and ask for help sticking to our dosage.  
Then there is the issue of tolerance building and the need for stronger doses.

Tough question.   I guess its a personal decision.   I, personally, do not feel that I have the right to say how much another human being should suffer and if in pain, that person has the right to pursue the best quality of life possible.

I know with hospice patients they give morphine on demand.  

Interesting question, don't know the answer, and am not really qualified to speculate.

Thanks for the thought provoking post.
tzt
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Avatar_n_tn
I just want to commend you for being so concerned about your patient. It seems as if you are going above and beyond for him.
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Avatar_n_tn
if i understand the patients physical condition correctly they are physicaly incapasitated?

most physically able people who want to take something, weather its a beer or a pill can typically just go and get it, if this person cant do that, they are dependant on someone else getting it for them, that must be very frustrating, when an addict decides to go into withdrawls its a decision made by themself, sounds like this patient is always on the brink of withdrawls at the mercy of others?

i woudnt want to live like that.

but, im no health care person. i do advocate eutinasia if the future looks hopeless.

if there is a cupboard full of pills, and the patient is uncomfortable, why need they suffer more?
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Avatar_n_tn
What are Stage IV wounds? How painful? How much and what are you currently giving him?

I'm a bleeding heart type, so I'd say give him what he needs to keep him comfortable. Not to get him high, but to keep him out of pain. However, it does sound like he probably could justify getting high?

And, I agree with justlikeyou. What a horrible situation to be in, depending on someone else to get your meds for you.

Of course, I guess you have to not only worry about the moral issues, but the legal ones as well. Is it legal to give your patient more pills than he is prescribed? Or, are you saying the doc will give prescribe more?

Should you treat his addiction? I would say that as long as he is mentally aware of what's going on, then no, you shouldn't treat his addiction unless he asks for help w/his addiction. You'd more than likely be wasting yours and his time. How long will he be at your facility? Is this a temporary stay or long term?

Interesting question!

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Avatar_m_tn
Welcome to the forum......

Recently in my life I got into it with a doctor when my terminally ill father dying of cancer suggested that he was worried he was addicted to pain killers......and my Mother agreed stating from her catholic faith your suppose to suffer before standing before God.........

I told them both if they stopped on inch of his meds I would go on the street and get him the best Heroin in Detroit and inject him myself.............

Quality of life........what a term in our lives......

How can others tell a us citizen what quality is acceptable and how he must live his or her life......

You mention 30 years of drug use........I hope that your not blinded by that fact and are looking at the patient health........

If your patient has true physical pain why would you not give him pain meds?

I cannot or would not put myself in a position to say how it would feel to be immobilized in a wheel chair for life...........my logical guess would be a counselor who deals with such matters..........but temporarily why not let him think hes the boss until you can totally evaluate his condition fully.......

Asking addicts and recovering addicts there views on this medical case is like our wonderful Governor Jennifer M Granholm how to get Michigan out of a trillion dollar deficit and keep business here instead of relocating to different states........
My post is nothing more then opinion..........


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Avatar_m_tn
Today and for some good reasons the medical profession is linked with the police department in many ways.....
suspicion of drug abuse is always a consideration when a patient goes to a doctor......
Patients lying and acting out  fraudulent medical issues.......
forging perscriptions all true and happening everyday................

But to me the ethics is to give the benefit of the doubt.....

There is an old saying I would rather see a 1000 guilty people go free then see ONE inocent person get convicted.......

I feel the same if you see 10 patients and 9 of them are addicts do you accuse the one innocent patient truly in pain as a potenial drug seeker and deny that patient pain meds ?
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Avatar_f_tn
you're right.. it's an ethical question.

so i don't think anyone here has the corner on what is right, or what is wrong.

the guy sounds clearly addicted and pretty unhappy.  personally, my guess is taking his meds away isn't going to make him a happy guy... (unfortunately, i am currently  watching someone in my family slowly die for very simlar reasons - not the same, but similar.)  and as much as i would like it to stop, i'm not sure he'd be happy anyway  - your patient, and my family member.  

the only hope i see for the guy ever "being happy" - and drug free - is counseling.  

but my friend, I think you gotta go with your gut on this one...  

...that's just one kid's 2 cents... good luck.. to you, and him.

very warmly,
mj
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Avatar_n_tn
I would assume that you are treating him for the class IV wounds he is suffering from and likely the disease processes that have reulted in those wounds.
I would also assume that you would likely treat any other disease condition he may be having a problem with such as hip flexor contractures,and other blood chemical imbalances such as diabetes, anamia, et.al. including any digestive systom breakdown as is common in patients such as these restrained in wheelchairs.

Therefore I wonder why we would hesitate to treat his disease of dependence or addiction to a substance that he has routinuely used under written orders for so many years.  At this point in his life why on earth would one allow this person to suffer on more syptoms (symptoms) and discomfort if it could be prevented.

I can tell you withdrawl (withdrawal) is nothing to sneezze at and will be very significant in adding to his daily distress level.  Why do it?  What is the benefit to the patient?

On the one hand we have a serious paraplegic for forever, and I know this is a vry painfull existance...frought with complications.  can we not justify the use and allowance of an acceptable amout of dependence for him.  HIs addiction/dependence is prettty  insignificant considering all his other health chronic levels of involvement.  

But it is a disease as we all agree upon and non-the less  should be treated as such.   If you can relieved his suffereing from that particular disease and shine some light on his surley horrific day...why wouln't you?

On the one hand we have a serious paraplegic for forever, and I know this is a very painfull existance...frought with complications.  can we not justify the use of allowance of an acceptable amout of dependence
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