I have recently been made aware of a situation that shines a light on just how far the opioid pendulum has sailed to the restrictive side. A young mother and wife (who is otherwise very respectable) had the extreme character flaw of growing a kidney stone. She presented to the emergency department at a large local medical center. To make a long story short, she was given intravenous ketorolac (NSAID) and an anti-nausea medication during her very brief stay. She was then discharged home with a urine strainer and encouragement to “drink lots of fluids”. She spent several days in excruciating pain that was unnecessary. We wouldn’t treat our pets this inhumanely!
The hospital providers have become “heartless” but surely your trusted PCP with be more compassionate. Maybe not… Some primary care providers are choosing to stop prescribing narcotic pain medications all together. It’s just easier that way right? This is inconvenient for the patient that has been compliant with a stable chronic pain condition but it’s not totally unreasonable. Hopefully said patient finds his way to a pain management provider and not the street pharmacist or even worse loses hope and turns to suicide. This may sound shocking but I’ve heard this sentiment from more than one patient.
And finally I learned of a horse of a completely different unreasonable color! While chatting with a health care provider I was taken aback to listen as she bragged that the neurosurgeon she works with does spinal fusion surgery and prescribes only acetaminophen and gabapentin post operatively! (I will add however she practiced in a state that allows recreational marijuana so perhaps her patients were finding relief elsewhere)
So to sum up the issues at hand; providers are decreasing opioid doses, discontinuing prescribing them all together and otherwise making broad generalized decisions instead of treating each patient as an individual. I wonder what the magic number is. How many people need to die from street drugs or suicide before the pendulum can begin to swing back to a more reasonable middle ground? What famous or influential person will need to develop a painful condition to convince the powers that be that we need a little more soundness of mind when it comes to pain relief?
Nurse Meesh 