New Jersey hospital emergency room becomes first in U.S. to end use of opioid painkillers

[rbrnmw]

This ought to be an interesting experiment.

http://pix11.com/2016/03/28/new-jersey-hospital-emergency-room-becomes-first-in-u-s-to-end-use-of-opioid-painkillers/

PATERSON, N.J. -- St. Joseph’s Regional Medical Center announced it has become the first hospital in the country to implement a program that will manage patients' pain in the emergency room without the use of opioid painkillers.

Painkillers most frequently used in the emergency room in the past were oxycodone, vicodin and percocet, according to Dr. Mark Rosenberg, the Emergency Department chair.

“Our job here together is to look at the whole equation and understand how we can stop people from going from a prescription, to an addiction,” he said.

http://pix11.com/2016/03/28/new-jersey-hospital-emergency-room-becomes-first-in-u-s-to-end-use-of-opioid-painkillers/

[zazen]

1. WTF? so if I leave with a broken leg, I'm supposed to manage it with Advil?

[rbrnmw]

2. I know WTF?

[RKP5637]

3. Likely they will tell you to pray to god for relief. This, it so F'en stupid in this supposed

country. Everyone that gets some help with pain does not become an addict. My advice to young people and a career? Get out of the USA if there is anyway you can. This country is spinning off its wheels!

[Coventina]

4. Yoga, meditation, mindfulness. It's all in your head, doncha know?

[AngryAmish]

7. They want to admit you and run up the bill

[Recursion]

12. So, advil and opioids are the two options?

I wasn't aware of that. I thought there were a lot more treatments available.

[zazen]

15. at home for a recently broken leg? please advise

I have a genetic condition that causes regular chronic and acute pain and am quite informed about the latest options for hospital- and home-based pain management.

And by the way, they send you home after a day for a mastectomy (I know), and while I managed on advil after a few days, that wasn't enough at first.

What else is available for home-based acute pain management?

[Recursion]

17. Well, as an example Austria uses device-based Tx inhibitors as well as capsaicin

Again, nearly every country uses orders of magnitude fewer opioids than the US does: they clearly don't simply ignore the existence of acute or chronic pain, though.

[Coventina]

19. You're assuming that insurance companies will authorize such treatments.

The thing about opioids is that they are both cheap and effective.

Such treatments like Tx inhibitors, nerve ablation, etc. are much more expensive.

My NSAID pain reliever (mefenamic acid) was not authorized by my old insurance co. It cost me over $1000 for a month's supply.
So what did I do instead? Merely took mega-doses of Advil.

Fortunately, my new insurance co. does cover my NSAID.

Somehow, I highly doubt that insurance companies will approve "fancy" pain treatments when there are cheaper meds available.

[Recursion]

22. No, I'm not, though the insurers in Austria do

My NSAID pain reliever (mefenamic acid) was not authorized by my old insurance co. It cost me over $1000 for a month's supply.

And Medicare also has problems with it. Which is why financing reform is a bad idea.

My point, though, was that Austria manages its acute and chronic pain problems with barely noticeable levels of opioid use.

[Coventina]

24. Apologies, but can you clarify for me? I'm not sure I'm understanding

what you mean by, "And Medicare also has problems with it. Which is why financing reform is a bad idea."

I just want to make sure I understand you properly.

Thanks.

[Recursion]

26. Medicare is often skeptical of any sort of chronic pain relief (nt)

[Coventina]

27. Oh yes, I certainly agree that the government-funded programs are just as guilty.

I have a friend on Medicaid, and her doctor has prescribed nerve ablations for her.
It has been a nightmare to try and get through the system.

This is why I am skeptical that patient-based pain needs will ever be seriously considered here in the US.
And that is why I am very disheartened to see opioids demonized when they are often the only effective treatment within reach.

It's great that other countries are more enlightened, but it doesn't help us.

[Recursion]

28. Right, but America is absolutely exceptional in reaching for opioids, is my point

The USA uses about 80% of the world's legal opioid supply, and 99% of the world's Vicodin supply.

I'm saying the rest of the world has ways of treating pain that do not involve a dangerous and addictive drug.

[Coventina]

29. And my point is that our government & insurance companies won't pay for them.

So where does that leave us?

[GeorgeGist]

5. The Stupid Runs Deep ...

in the War on Drugs.

[rbrnmw]

6. This is totally crazy

[gollygee]

8. A city with a minority white population

White people regularly underestimate the pain of people of color. I am not surprised, and I know it wouldn't have happened in an all white wealthy city.

[rbrnmw]

10. that is very true

[gollygee]

13. It feels like the message is

"We don't trust that these people are really in so much pain, and even if they are, we can't trust them with the medicine that will help them." It's horrible in two ways, the decision not to adequately manage people's pain, and the assumption that people can't be trusted. I mean, if I went to the ER in pain, they wouldn't know me, but I bet they'd still trust me with some pain meds.

[zazen]

16. I've seen white women's pain regularly minimized too, from all wealth b/gs

The men I know get offered more antibiotics and painkillers than any woman I know. It must be much worse for women of color.

And women live longer, may process pain differently (and more intensely), and certainly have hormonal influences on conditions (like relaxin that makes one more susceptible to harming joints and ligaments) than men do. So we're really screwed.

[gollygee]

20. There's truth to that. N/t

[JustABozoOnThisBus]

9. I regret the opiods I got for my kidney stone.

Wait, no I don't, not for a minute. I was actually able to get a little sleep.

Alas, my addiction to caffeine and chocolate-chip cookies has not been cured.

[moonbabygo]

21. I had kidney stones

last summer. Went to the emergency room 3 times. The first time by ambulance. OMG I would rather give birth to 10 babies at once than go thru that again. The gave me opiods and they made me sick to my stomach.

I don't agree with what NJ is doing.

[whatthehey]

39. My experience with opioids is limited

One kidney stone. One IV dilaudid. $2.80 on a bill that totaled $2500 from the ER. That stuff is freaking magical. Literally 5 seconds from fairly serious pain to absolute absence of discomfort with not a single side effect or diminution of faculties. I can in a way understand the restrictions because if that stuff were OTC I'd be on it most of the time. Not, at least initially, because of any physical addiction but because you don't realize how much low-grade background pain a middle aged guy with hemiplegia is in until you find something that just switches it off like a lightbulb. It's probably the only couple of hours in the last decade and a half I have been pain free.

I'm not in what you would call real pain and take absolutely no painkillers, but just the absence of the peripheral neuropathy is worth any putative addiction risk for me. I do not seek prescriptions and have no intention to do so, but I sincerely appreciate what opioids can do and very much hope they stay available if I ever need them again. Funnily enough I did getan Rx for Vicodin after an impacted wisdom tooth and it did absolutely bugger all for me, not that I was in great pain anyway. I have no idea how these two drugs compare in pharmacological terms but Christ the difference on affect for me was light years. I don't know if it's the substance or the delivery method. If I ever take a dilaudid tablet I'll find out I guess.

[rbrnmw]

41. Elvis was said to be addicted to dilaudid

[Iliyah]

11. Let's see how this works out.

[Recursion]

14. The rest of the world seems to do OK

We use, what, 99% of the world's supply of Vicodin? That doesn't make anybody else raise an eyebrow?

[Bluenorthwest]

30. Vicodin is a brand name. Austria is not Denmark, nor Estonia nor Finland each of which has opiate

prescription abuse issues. Costa Rica, Brazil and Chile have opiate prescription issues as well as issues around abuse of prescribed amphetamine and drugs of that type.

In terms of the use of opiates, not a specific American Brand, the countries with the most use are Afghanistan, Russia, Ukraine. The UK has a use rate of about 0.9% while the US is about .57% just a hair worse than Ireland.

[Recursion]

31. Right, but hydrocodone is not. And we use 99% of that

What does the rest of the world do without it?

[gollygee]

36. They use different opiates

https://en.m.wikipedia.org/wiki/List_of_countries_by_prevalence_of_opiates_use

[unblock]

18. volunteering in a e.r. in nj, i saw them set a broken arm. nothing but versed.

no painkillers of any sort, just versed, which is to some extent a sedative but the patient wasn't very sedate. mostly it's given because it's an amnesiac -- it blocks the transfer from short-term to long-term memory; i.e., the patient experiences all the massive pain, but later that day can't remember a thing about it.

to me, there's something highly immoral about being fine with the suffering of others, just so long as the don't remember it later.



separately, after I was nearly killed in a car accident (passenger in a cab that stalled out in the middle lane of a freeway at night, rear-ended, surprise, surprise) a different e.r. in nj sent me home with massive doses of ibuprofen(advil). that didn't do a whole lot for the pain, but it did lead to gastrointestinal bleeding problems that lingered for many years.

[ebbie15644]

23. I have Spina Bifida and

I don't take Opiates yet! I am 49 years old. I manage on Neurontin and Motrin. It is working less and less and have thought of asking for something stronger. I have always worried about addiction issues, which is why I haven't taken anything much. I am getting older and the the medication I currently take isn't working anymore. I worry that soon it won't be an option for me. When someone is in constant pain, what is worse? Pain or addiction? If they want to take Opiates away, they need to look at more effective ways to block pain.

[rbrnmw]

25. they really do need to find something to help people in pain

[lancer78]

32. There is a big difference

between addiction and physical dependence. I once read that out of 10,000 patients in Boston that took opiates, only 4 became addicted. As someone who has used opiates for years, my biggest piece of advice is take just enough to manage the pain. NEVER try to chase the "high". That is where you get into trouble.

I have been on "H" for 3 years because I live in an area where doctors have extremely limited access to Opiates. I suffer constant gout attacks, and even with maintaining my diet, I get at least 2 attacks a month. I also have RLS and 2 bad knees. The "H" is great for helping me sleep at night, and even though I have been taking it every day for 3 years, I am only taking 100 mg a day through snorting. You want to know how I did this? It is called NOT CHASING THE HIGH. I have never done enough to even come close to OD'ing, and because I have gout, I can't drink.

My point is, drug use is fine if you do it in moderation. But unfortunately, those of us who are in pain have to suffer for morons who just want to get high.

[reflection]

43. "There is a big difference between addiction and physical dependence."

Never was there a more accurate statement. During my back surgeries, I was dependent on opiates to get me back to baseline. When my body healed, I put them away.

You can be dependent on a crutch to walk if you have a broken leg, but that doesn't mean you're addicted to it. Just means you're not walking anywhere without that crutch.

[Jerry442]

33. The article is not too well written.

Part of the problem seems to be that the ER is treating a bunch of patients who would be better off being seen in a doctor's office, although I get it that the ER is the only place some people can go.

At one point, the article says, "While opioids will still be used by St. Joseph’s staff to treat chronic pain..."

'Scuse me. ER's are not supposed to be treating chronic anything.

I'd hate to think if I were transported there with a compound fracture of the femur, I wouldn't get morphine.

[Iggo]

34. I admit when I clicked this thread, my first thought was "Is this hospital called Saint Something?"

After reading through it, I see it goes deeper than that. (With my thought now being "They should try this at a white lady hospital.&quot

Still, that's where my head immediately goes nowadays.

[ScreamingMeemie]

35. This is disgusting.

Enough already. Make everyone suffer and increase heroin usage. Great idea.

[Coventina]

37. Not to mention the suicide rate. n/t

[Basic LA]

38. A cruel step backward.

A Jersey City ER thankfully gave me painkillers for a severe case of shingles on my face (dangerously near one eye) a few years ago. What would they give now, aspirin? This is the cruelest aspect of the drug war.

[CTyankee]

40. my neurologist told me that opiods don't work on nerve pain...

I'm on Lyrica and Cymbalta and they aren't working well. I went on a reduced number of pills a day, tho, and maybe I'll have to go back to the old dosing of twice a day. My shingles pain is worse. I'm looking into laser therapy. Hartford Hospital offers it at their Pain Management Center.

[Basic LA]

46. Thanks for that information

I wasn't aware of that. Best wishes for a full recovery.

[Vinca]

42. So it's screw the people with bona fide severe pain who need the stuff?

There must be a way to separate the junkies from patients who are truly suffering.

[rbrnmw]

44. It is sad that it is being done this way

people in chronic pain should be treated, it causes early death.

[Kaleva]

45. My youngest step-son got hooked on opiates after he got in a car accident

I know quite a few people here who were prescribed these medications to treat pain from surgery or injury and ended up with their lives destroyed by becoming addicted to them.

[Runningdawg]

47. Hubbies foot

was broken in 4 places and his big toe looked like a squashed bug. No pain meds. Take 2 advil and never call me again.
I am sure it has been mentioned before but seniors are the largest group of NEW users of marijuana. Coming full circle - we need new druggies to fill all those for-profit prisons. Geriatric wards, coming soon to a prison near you.

[rbrnmw]

48. That's horrible my aunt is on pain meds

she does need them, I have never seen her abuse them I hope they don't take them from her.