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Heroin anything you wish people at the hospital knew about heroin?

BonerJamz09

Greenlighter
Joined
Apr 12, 2013
Messages
10
Location
Boston
new to these forums today. i work at a city hospital where a lot of heroin users come all the time. the times when i talk to patients i've noticed that knowing some stuff from personal experience really helped, but i've never used heroin or done any drugs via IV. does anyone have any interesting stories about going to the hospital for something drug related? is there anything you wish people you dealt with at the hospital knew about using heroin? very curious.
 
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While i dont have personal experience with heroin, the one thing that always comes up in convos with friends that do have experience, is that they feel like they are treated as time wasters and drug seekers if their honest with staff about their habits.
This seems to happen even when the medical problem is completely genuine and healthcare is urgently needed.
For example, my father in law who is on bup treatment and before that methadone for about a year. Fell over at my daughters birthday party last november, and hurt his leg, bear in mind that hes 20 odd stone and thats an awful lot of weight to fall on one leg.
He was taken to hospital unable to walk and on arrival was at first refused pain relief because "he was already on strong painkillers and should be able to take some pain. Eventually after begging them for something , they gave him one shot of morphine.
They thendid an x-ray which they said was inconclusive because of his size and past injuries, gave him some crutches and told him not to come back for more morphine or they would put it on his records and told him to make his own way home......8 miles away and at midnight.
To this day hes still on crutches but is too afraid to go back for futher treatment incase he gets booted from his pain management and maintenance treatment.
Sorry if that became a bit of a rant.lol but this is by no means an exceptional story.
 
^ I have basically the same experience as posted above. I am an ex-addict who now suffer pain problems and I am afraid to say I have been on maintenance because I risk getting refused meds. This just ends up in me getting the usual dosages which are too weak for me so I have to buy extra painkillers illegaly. :/
 
Consider Not going through the standard IV hydration drip and extraneous blood analysis procedure when somebody tells you they don't have any veins left.

Also when we give advice where NOT to draw blood . please listen , people like me are so polite I will let you jab a vein of which I know 100% sure that it has collapsed just so you can feel like an authority figure and do your job , but afterwards I'll be in pain , you embarrassed and the vial still empty
 
Don't break out the succinylcholine just because someone uses drugs, is in pain, and agitated because they've been instantly labeled as a drug seeker. I've seen that happen, good god. Addicts are some of the most vulnerable members of society, please treat with compassion, care and respect.
 
anything else? like facts about how you live your life you think would be beneficial to have a perspective on in order to treat you?

and everyone should be treated with respect and have their pain taken seriously, addict or no, i agree.
 
What you're doing is counter-productive. On this site, people have written multi-million words worth of testimonials on Heroin alone, you can't ask them to say it again in this topic. What you can do however is do your own research and find those major Heroin topics.
 
anything else? like facts about how you live your life you think would be beneficial to have a perspective on in order to treat you?

and everyone should be treated with respect and have their pain taken seriously, addict or no, i agree.

I know the medical personnel in hospitals really don't have time for this, but providing referrals to low-cost care services, or just basic info on how to obtain such, might go a bit of a ways towards ameliorating future health problems. Information on how to obtain low-cost dental services, mental health and preventative care could only be a good thing. Some people would actually take advantage of it!

Information on how to contact patient advocacy services for those terribly ill or a bit mad could only be a step in the right direction as well.

If you could obtain and discreetly distribute information about local needle exchanges and MMT services, that could help as well.

I say give the guy a break, his heart is in the right place. I know my physician and RN friends with 80+ hour work weeks don't have time to be searching around drug boards for information about how to better treat addicts, they are in fact the most hard-working and dedicated people I know.
 
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I agree with everyone above as just not treating us as drug seekers. Before I was on suboxone, I was offered pain relief at the er as well as a script when I left, with two giant refills from my personal doctor, for five stitches. Once I got onto suboxone, I went in and needed almost 50 stitches and wasn't allowed anything for pain other than a local. Very frustrating - we still feel pain!!! And don't assume the drugs we take control our pain, addicts are dependent just to remain at baseline.

Also definitely agree with BingeBoy - I have repeatedly pointed out I had collapsed veins and still been stabbed over and over through scar tissue into an already sensitive area. If you can't hit a vein on an addict, call in someone who can. I was once poked trying for over a dozen different locations, so probably 20 or so actual pokes with a needle, to get an IV started. It hurts and it's embarrassing when we're suddenly second class citizens.
 
I would agree that while there's obviously a multitude of info about the hows and whys of opiate addiction on here, it feels wrong to turn away a healthcare professional who's asking for a better understanding in his own thread. We need more people in healthcare like this and less know-it-all doctors, nurses, etc.

One thing I ran into at the ER and also with general practitioners and dentists is a near complete misunderstanding of what Suboxone is.
It is not Methadone. It does fuckall for pain. It doesn't mean that I should be denied relief from severe pain. And no, a script for 12 percocet's probably isn't gonna help too much. What little help it would give will be BLOCKED.
I know that sounds like common sense to most of us, but it has happened to me. That level of ignorance.
Yeah, we're pretty dumb for abusing opiates. However, it is what it is. Our tolerance is what it is. We need to be treated in accordance with that.
I didn't place an abscess in the root of my tooth so I could get some painkillers. I didn't bust and separate my shoulder for some Vicodin.
I know there's crazy stories of where people have thrown themselves down a flight of stairs to get a script and be out of withdrawal. I would have to believe that that's pretty few and far between. We're not all the same. A blanket policy should not apply.
 
Consider Not going through the standard IV hydration drip and extraneous blood analysis procedure when somebody tells you they don't have any veins left.

Also when we give advice where NOT to draw blood . please listen , people like me are so polite I will let you jab a vein of which I know 100% sure that it has collapsed just so you can feel like an authority figure and do your job , but afterwards I'll be in pain , you embarrassed and the vial still empty

My veins are all in good condition but very difficult to hit, always been that way; blood draws are a nightmare for me, it's rare I walk out uninjured. I can hit myself no problem, and I'm always so tempted to ask if I can just do it myself rather than be jabbed at repeatedly. It's shocking to me how poor average phlebotomy skills are. At least in the US, haven't worked up the courage to try the Germans yet.
 
Known drug users immediately loose all respect and their words cannot possibly have any value or weight behind them. I have a BSc in Psychology (said not to show off , but to enhance my point), my gp was all like "we dont know the conversion rateS from this to that".

I was saying "Well I do, ive got them printed out here from a GP training website"

She didnt want to know. Druggies are worthless invalid thick fantastists in their eyes. God help them if they meet some druggie who is the most educated and knowledageable proffessionally trained one out there, who really knows their shit and sues their fuckin assess off. %)

Myself, I have spent many thousands of hours researching and discussing my own niche interests. (SSRIs, opiates, benzos, stimulants, brain chemistry)Have they done the same. Have they fuck. So frustrating that they wont listen. Im a druggy, i couldnt possibly understand. I must have the IQ of a moron. Pat on the head young man, patronising smile, "just do as say" :!

Im gonna write to my GP, apologising for being rude to her when all the above became too much, but explaining why, using all the above. Frustration and anger overcame my usual at least attempts to be tactful and polite. Thankfully im not the least violent or aggressive, but she was still intimidated her without me even trying bully her (must have been the mounting fury on my face). I dont get kicks out of intimidating females. But she was terrified when calling me to say they weren't going to do a medicated taper for me. :o

All this after my previous agency had been building up and selling me on the benefits of a medicated taper.

JOIN THE FUCKIN DOTS PLEASE FELLERS. YOUR LEFT HAND DOESNT KNOW WHAT YOUR RIGHT HAND IS DOING:|

Drug users seem to be one of the last remaining patient groups where no one cares too much if they dont get good, appropriate or even any treatment at all.

THEIR REFERNCE BOOKS ARE TEN YEARS OLD. I MEAN WTF, OMFG, NO WONDER THEY HAVENT GOT A CLUE. I'm sure with their 150k salaries they could afford to acquire some more up to date information....They dont seem to know how to use the internet. And this is supposedly 1 of the most developed countries in the world.8o
 
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As above posters have stated, this interest you are showing Bonerjamz09, is much appreciated. Dont let the words of a few put you off. :-)
It the biggest issue seems to be a lack of education amoungst health professionals about tolerance and addiction and even more worrying...about medication itself. Ive experienced this ignorance first hand many times in particular from GPs and not just regarding opiates/oids but with lots of medications.
I hope you can pass the things you learn here on to doctors and nurses, maybe then there will be more understanding in the future.
 
Also, if you could actually explain the patient privacy laws to addicts, they would be far more likely to seek treatment before serious complications from a minor problem occur. Your typical junkie isn't going to understand how patient privacy laws protect them, and they want to keep their families from finding out they needed to be treated for an abscess, etc.
 
I know the medical personnel in hospitals really don't have time for this, but providing referrals to low-cost care services, or just basic info on how to obtain such, might go a bit of a ways towards ameliorating future health problems. Information on how to obtain low-cost dental services, mental health and preventative care could only be a good thing. Some people would actually take advantage of it!

Information on how to contact patient advocacy services for those terribly ill or a bit mad could only be a step in the right direction as well.

If you could obtain and discreetly distribute information about local needle exchanges and MMT services, that could help as well.

I say give the guy a break, his heart is in the right place. I know my physician and RN friends with 80+ hour work weeks don't have time to be searching around drug boards for information about how to better treat addicts, they are in fact the most hard-working and dedicated people I know.

thanks, this is exactly the kind of info i was looking for. i guess i assumed that people who use needles a lot know where to get them, but you're right, if i know about services like a needle exchange, it's easy enough to just pass that info along to someone i think might be able to use it, just in case they don't already know. this is just one example, but very helpful for how i can do my job better.

also, i know it's not the same in every hospital, and in every part of the country, but at least in my hospital anyone who comes in without health insurance is offered the free state plan and can go to the financial office to sign up (i live in MA). anyone interested in detox can go down the hall and get set up with a bed that night. and anyone without a primary care doctor can get hooked up with one in the same office. my point is, healthcare people should be better about letting people know what's available out there, but also if you need something, really, don't be afraid to ask, because maybe ye shall receive. it's always worth asking, because at least from my perspective it's always satisfying when someone asks for some help and i'm actually able to give it to them.

just know that not everyone working in the hospital is necessarily going to be a jerk to you. just a lot of them are like me and feel like they don't know how to help. for example, i didn't know some of the stuff you guys are saying about how to effectively manage an opiate user's pain, etc. i definitely need to look into the whole issue of medicating people in pain who are on suboxone, had no idea how bad of an issue this was but of course it makes sense.

thanks for the input, and please keep it coming.
 
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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.

Needle-Reuse.png


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.
 
Don't break out the succinylcholine just because someone uses drugs, is in pain, and agitated because they've been instantly labeled as a drug seeker. I've seen that happen, good god. Addicts are some of the most vulnerable members of society, please treat with compassion, care and respect.

Wait what?? Are you saying that a patient was given suxamethonium in order to basically temporarily paralyze them, for the purpose of making them be quiet? That is outrageous, a clear human rights violation. I hope I'm misunderstanding this in some way.
 
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