I'd like to add that opioids are a huge problem nationwide, addicts come in all shapes and sizes, in fact the chances are high that one of your co-workers is themselves an addict and basically what it all comes down to, is:
don't be condescending.
Always ask about benzodiazepine/alcohol use.
Hydrocodone/APAP is like, the #1 most prescribed drug in the USA year after year, just follow the trail of pharmaceutical industry money/profit/investments.
In 2010,
over 131 million prescriptions of hydrocodone/APAP were written, according to the IMS Institute for Healthcare Informatics who survey the top 10 most rxd.
Many addicts fear the hospital or proper medical treatment due to the huge stigma associated with particularly opioid analgesics, and doctors who make patients feel worse about their situation and treat the patient like a junkie, well.... That's not what those doctors are being paid to do.
Keep personal bias aside and remember that you're treating a sentient human being who may have made a few wrong turns, and may obviously fear that their life/liberty/happiness could be taken from them as a result of seeking treatment for a complication from substance abuse.
TRAMADOL SHOULD NEVER BE USED FOR ANY OPIOID DEPENDENCY TREATMENT, IT IS NOT INDICATED FOR SUCH USE YET DOCTORS OFTEN FEEL SAFER WRITING PRESCRIPTIONS FOR TRAMADOL DUE TO IT'S DEADLY DOSE CEILING AND LOWERING OF SEIZURE THRESHOLD.
The Naloxone in Suboxone does not have enough binding affinity to deter abuse of the buprenorphine, the active ingredient in Suboxone/Subutex tablets. This means that there is no need to force patients to take an extremely expensive patented name brand Suboxone instead of the EXTREMELY cheaper generic buprenorphine hcl (no naloxone) tablets that have existed since the 1980's.
To spare addicts a HUGE financial break that may lead them to relapse on the much cheaper heroin, many doctors are starting to write on the RX slip, for example something like "buprenorphine 8mg tablets BID", instead of writing "Suboxone 2mg tablets TID" or just CONSIDER giving patients the right of access to the much more affordable generic buprenorphine tablets which do not contain naloxone and remember that
buprenorphine is NOT a new drug and it has been around for a long time, there are like half a dozen other manufacturers that manufacture the exact same drug for exponentially less money (Amneal, Midlothian, Teva, Roxane, Ethypharm, Actavis Elizabeth, etc.) than the brand name Suboxone, which is often going to be the first-line of treatment of the chemical dependency once they've survived their hospitalization and have that hospital bill to pay too.
The naloxone does absolutely nothing to deter abuse, injection of Suboxone tablets is an extremely common phenomenon, and the brand name Suboxone tends to be extremely expensive. This means that even on the black market, prices are high, so addicts are willing/forced to do more "bad" things like cheat/steal/lie/etc to pay for name brand Suboxone.
Suboxone is, IMO, an extra expensive version of a drug that already existed in cheap generic form which was then Evergreened by R&B when they added a tiny bit of naloxone and claimed that it would deter tampering and abuse with the tablets due to the naloxone, (
an opioid antagonist which when administered properly, can help rip other full-agonists off the opioid receptors provided it has the binding affinity, there are overdose cases with drugs like fentanyl involved, also, as you would have it, buprenorphine, these drugs both have higher binding affinities than the naloxone, making it difficult to impossible for naloxone to do it's job.).
R&B did not [for reasons unknown] mention or emphasize that buprenorphine has a much higher binding affinity for the opioid receptors than naloxone does; the naloxone does
not act to deter abuse as they told doctors, the FDA, and the media, and everyone. If you ask me, they took a pre-existing drug, added naloxone to one of them and called it Suboxone, indicated for treatment of addiction.
They also made Subutex, the mono product, patented and brand named yet again, indicated for addiction and it's use was supposed to be during the induction phase, or something??
The online certification credentials that doctors have to obtain in order to prescribe Suboxone seems to be contributing to the spread of misinformation and the continued misleading of doctors into thinking that Suboxone is somehow less abusable than Subutex.... or that the naloxone compounded version has any advantage over the mono-product... a myth that was busted by addicts and then by peer reviewed studies performed by a qualified, competent, independent party, not one sponsored by the manufacturer.).
The claims that the naloxone in Suboxone deters abuse have been proven to be false and is seemingly just another way to patent and sell a drug that had already been existing and in production on the market for years.
One last thing is the importance of teaching and spreading harm reduction to these addicts. Instead of just, reviving them and then throwing it in the face of the addict that they would have died if they didn't seek healthcare,
dedicate a good portion of time to followup care such as what they can do to not end up in the hospital again. Teach them the importance of proper hygiene, injection technique if they're IV users, and to avoid mixing CNS depressants. Because what's the point of reviving someone if and when they come back to life, they are just as ill-informed as they were in the first place that landed them in the hospital?
They'll probably go out and get some heroin... and who know's how they'll administer it. So
you have the power to change that make a difference that in the long-term can save an addicts life, like teaching them about proper micron filtration and why they should never re-use needles.
Many doctors get upset that they can't make the addict stop taking drugs, and they take this anger and stigma-induced-bias out on the patient/addict. But only the addict can quit when he/she is ready, and the degree to which you help them is often in direct correlation with the addict's willingness and ability to quit one day, if you work together as a team and make the patient/addict feel like they are on the same team as the healthcare professionals, which is rarely the case with the current system in place, and we teach them some basic harm reduction and how to best avoid complications when IVing, etc.... The addict just might actually be able to taper off and quit one day....
When you treat your patients like addicts instead of patients/human beings with feelings, don't be condescending and remember that everything happens for a reason, known or not. And in this case, I know that hospitals would benefit from knowing that addicts avoid seeking medical treatment because by social stigma, they feel ostracized and so you should be compassionate to their needs and try to work as a team.
Even and especially if you feel that your M.D. or D.O. PhD, degrees, etc, makes you more qualified to control all aspects of the treatment, consider this: most addicts I know,
rapidly stop complying with the physicians instructions if they feel like their doctor is not working in their best interests.
Don't dismiss an addict's claims or requests for certain types of healthcare because it just so happens that the PATIENT often knows their body best,
there's a high possibility they've already had experience with using it illicitly and they know their bodies unique chemistry better than any person holding any of the most prestigious/expensive degrees.
