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Opioids Opiate Addicts and Pain Control in the ER or hospital? What do/have you done?

ReversiblePulpitis

Bluelighter
Joined
Jul 8, 2011
Messages
180
I got off on a tangent and began this discussion in a thread over in Drug Culture. Mod suggested I move this over here, as my curiosity is still peaked. I'm going to copy/paste my comments, questions:

1st Post:

Ive always pondered...

How can you peeps that are shooting 100mg morphine IV, even the guy who shot 1MG Fentanyl....even the 8mg Dilaudid IV
if you were in an emergency situation (trauma, kidney stone, pancreatitis, the list goes on of fairly common stuff)...

how would you expect your pain control at the hospital to be controlled, explained, etc, etc?
That said when "avg" IV shots for pain control at the ER are: 50mcg Fent, 2mg Dilaudid, 3-6mg morphine (mind you the ER can give drugs a lot more liberally than when you're an inpatient unless otherwise ordered by the doctor)

2nd Post:

Would/have you admit your addiction and subsequent tolerance to try and obtain more adequate doses to relieve the pain from a car crash or lodged 8mm kidney stone? Would/have you expect any success from this approach?

I wonder if anyone has or would have someone bring in their own stash of dope and load it into the IV port when hospital staff isn't looking?

From some experience, a couple of kidney stones ago, I was Rx'ed 3x 15mg Opana ER/day (the generic that could still be nasal'ed), but was abusing and taking 5-6/day. I believe at this time I also was Rx'ed 4x 4mg dilaudid/day for BT pain. Usually saved those until I was out of Oxymorph, which considering the shitty half-life, never lasted that long.
At this particular time, I believe I was a week out from refill and was actually out of my oxymorph. Because I was afraid that they would ask that my wife bring in my pills for the hospital to dispense as I was inpatient for a couple of days until they could do the surgery... I didn't even tell them that I took the med. From a past experience prior to that, the hospital's pharmacy didn't even have oxymorphone/opana tablets to dispense. And it's not unheard of for a hospital to arrange for you bring your own pills in where they lock up and dispense as indicated on the bottle. Coincidently, I didn't mention the Dilaudid either. Part of me was also embarrassed to admit to these people why a 28 year old otherwise healthy young man was on so much pain medication. Granted it was for legit CP, but I felt like I was Rx'ed a huge amount, and being in health-care industry, I know the judgement passed upon folks like me.

I should have taken the risk, made up an excuse if necessary, and or just hoped that they used the info to adjust my doses of pain medication due to tolerance. It was a shitty Urologist, and Rx'ed me a shitty amount of morphine even for a naive patient. I believe my wife bitched and finally got me something like 6mg once every 3 hours.
The kidney stone pain was intensified 10x due to the withdrawal. 6mg Morphine or not, the IV route's DOA was less than 30 minutes, experienced zero euphoria, only a slight break from restless legs and extreme nausea for about those 30 minutes and 30 minutes only.
The Nausea got so bad (and at this time the hospital had already withdrawn the use of straight IV Phenergan) that I was MAXed out on nausea meds, being given the maximum allowed doses of Zofran, the shitty IV infusion bag of Phenergan, benadryl, even Ativan, and then as a last resort - Halidol. Still puking my guts up until all those meds finally allowed me to pass out for a couple hours. By the time I left the hospital post-kidney stone extraction, I had actually detoxed slightly and despite it all, felt a little better for it.
Still would never like to do that EVER again, and have been completely honest with my RX'ed pain mngmt meds ever since. And as a result, have gotten much more appropriate meds and doses, ie last kidney stone over thanksgiving: while in the ER... 4mg IV Dilaudid, 100mcg Fentanyl IV. Followed up as an inpatient, was allowed 8mg morphine per hour and was eventually sent home with an Rx of 5x 100mcg/hr fent patches (I wear 50mcg regularly, no more pills from pain doctor) and 7.5 percs.

Anyway, unfortunately -- those taking illicit opiates dont have the luxury of legitmately disclosing Rx'ed meds and being treated accordingly.
Now THAT said, the hospital did not ask to see any paperwork to verify my Rxed fent patches. I mean, I had one on... but still.

Makes me wonder if someone could say they were prescribed X amount of this or that (probably shouldnt be too extravagant with the lie), to maybe help match their illicit tolerance?
 
i shoot 300 to 450mg of oxycodone per shot and i recently got in a car crash and lied and said i didn't hurt that bad to avoid having to explain my tolerance
 
so what did they do for your pain then? i would assume they wouldnt give you what your tolerance could han dle so they wouldnt get in trouble.

really i dont blame them because if i was a doctor and someone was like " yeah my tolerance is 450-500 mgs of oxy" and you give them that much and they pass out and die etc then thats on the doc

so really i see the whole reasoning behind not giving people what there tolerance can handle cuz you dont know whose lying and whose not. it sucks but thats the way it is.
 
i shoot 300 to 450mg of oxycodone per shot and i recently got in a car crash and lied and said i didn't hurt that bad to avoid having to explain my tolerance

Interesting tactic. Not that they could have "detected" your tolerance other than your complaints of inadequate pain relief, which happens all the time in an ER anyway, and they would have probably fed you a decent amount of morphine/fent/dilaudid before just telling you that they couldn't give you anymore at that time. They would monitor your Oxygen saturation levels to make sure that you weren't experiencing too much respiratory depression as well as your BP, which you obviously wouldn't show any sign of being administered too much...
So, I dunno. If you truly were in enough pain to not be able to lie, it would have been worth your effort, IMO, to try by just requesting more -- I mean, unless they could tell that your injuries weren't that severe -- the worst they would probably do, as I said, is just tell you that they just cant.

Referring back to my story where I told the truth about my Rxed 50mcg fent patch, while the Urologist who supervised me as inpatient took my tolerance into consideration, and was super concerned about me getting my pain controlled (he was awesome)... still, the ER staff seemed a little oblivious to my tolerance. Except maybe one ER doc whom did allow 2mg dilaudid injections, two of which were within a few minutes of each other, at which point I did experience some respiratory depression (like 94% at its worst) so the Nurse got all uppity about that - but that was the only time in the ER that my pain was actually very well controlled. No real euphoria because of the horrendous pain, but definitely analgesia and a nice warm blanket sensation.
 
so what did they do for your pain then? i would assume they wouldnt give you what your tolerance could han dle so they wouldnt get in trouble.

really i dont blame them because if i was a doctor and someone was like " yeah my tolerance is 450-500 mgs of oxy" and you give them that much and they pass out and die etc then thats on the doc

so really i see the whole reasoning behind not giving people what there tolerance can handle cuz you dont know whose lying and whose not. it sucks but thats the way it is.

Oh, most definitely the doctors are more concerned about giving you too much rather than too little, selfishly - but also for good reason, as you said they are responsible if ANYTHING were to happen. The worst that happens if you get too litte? You call and complain to the patient advocate, and...well, nothing.

But it does get in the way of say someone in my situation, a CPP with a legit tolerance left suffering b/c of a doctor who is ill-informed on opiate tolerance.

I'm not sure if its because I wear a fent patch, but this last time at the ER and in pre/post-op, they were giving me mostly 50mcg shots of fent. I did feel ignored during those time, as I wear a fucking 50mcg fent patch. I wanted to shake them and say, I receive 50mcg of fent every hour 24 hours a day 7 days a week to feel normal, and you're going to give me a 50mcg shot? wtf.
 
Never admit your addiction to them. It will go in ur medical file and every doc will see it & you'll never get another painkiller again. Just keep telling them ur still in pain
 
I'm a CP patient but might as well be an addict because 70% of the time I am treated this way. Now that i have some well known surgeons/specialists (and recently my gorgeous anaesthetist) it has been much better. Before this I have been given a. 25mg tablet and told to fuck off (doctors words) even though I couldn't walk...that was horrible pain wise (and humiliating) until 2 days later a scan showed a new herniation - my lovely neuro made the ER doc apologize and the unit take CP training. Sorry to digress, wins are so rare when you use opiates and even with docs on your side 99% of nurses treat you like absolute shit.

If I have to go to the ER i take a double dose of BT meds before (please don't judge I know my tolerance and I know how they dispense and titrate pain meds for CP). I tell them I am tolerant and I ask if its necessary to call my PM or another if she's not available to make sure I'm treated 'safely' (word I use). I've heard an addict who'd had a car accident ask for an addiction specialist when the ER doc refused to give him relief for a broken femur, what a bastard. Usually everything works out ok provided I am very careful about what I say/do (i have trouble not getting snarky with the nurses who are openly bitchy though).

I have had problems with short admissions where my anaesthetist hasn't been called or where a different one is a bastard. In this case I have my partner sneak in extra meds. Not honest, not great but better than screaming the place down or getting really upset and complaining. My anaesthetist does know I do this so now if I have someone else then my partner also puts a call in to him.

Addiction is no different to CP when it Comes to tolerance and it's unforgivable when you aren't treated properly. There really isn't a massive risk - they monitor oxygen, HR, responsiveness and always have naloxone on hand. Would love to hear what others do.
 
Oh, most definitely the doctors are more concerned about giving you too much rather than too little, selfishly - but also for good reason, as you said they are responsible if ANYTHING were to happen. The worst that happens if you get too litte? You call and complain to the patient advocate, and...well, nothing.

But it does get in the way of say someone in my situation, a CPP with a legit tolerance left suffering b/c of a doctor who is ill-informed on opiate tolerance.

I'm not sure if its because I wear a fent patch, but this last time at the ER and in pre/post-op, they were giving me mostly 50mcg shots of fent. I did feel ignored during those time, as I wear a fucking 50mcg fent patch. I wanted to shake them and say, I receive 50mcg of fent every hour 24 hours a day 7 days a week to feel normal, and you're going to give me a 50mcg shot? wtf.

its pretty sad aint it bro? i mean i can see them saying no to someone who abuses meds for the fuck of it (no offense if ya do, i forgot the story cuz i havent read it in awhile) but if your a CP paietnet id be pissed cuz they should hook you up with what ya need if you take your meds prescribed and if they dont its sorta fucked up. no offense tho but if you abuse your meds just because then i dont have much sympathy for you cuz you would have ruined it for yourself

if you have a legit toleramce due to chronic pain then yeah that sucks dick

i was a part of a different forum where the guy that was a chronic pain patient would get horrible pain and when it was bad enough would get a shot of dilaudid at the ER but he wouldnt need over 4mg.

idk what to say to you except that if your pain tolerance is over 2-4 mg dilaudid IV then maybe you should try to get it lower somehow
 
its pretty sad aint it bro? i mean i can see them saying no to someone who abuses meds for the fuck of it (no offense if ya do, i forgot the story cuz i havent read it in awhile) but if your a CP paietnet id be pissed cuz they should hook you up with what ya need if you take your meds prescribed and if they dont its sorta fucked up. no offense tho but if you abuse your meds just because then i dont have much sympathy for you cuz you would have ruined it for yourself

if you have a legit toleramce due to chronic pain then yeah that sucks dick

i was a part of a different forum where the guy that was a chronic pain patient would get horrible pain and when it was bad enough would get a shot of dilaudid at the ER but he wouldnt need over 4mg.

idk what to say to you except that if your pain tolerance is over 2-4 mg dilaudid IV then maybe you should try to get it lower somehow

Yes, I'm a legit chronic pain patient, with 10:1 bad experiences to good at the ER when it comes to pain control, despite them knowing up front that I am in pain management and am Rx'ed dependent chronic opiate user.

But, you're actually right on about the Dilaudid - it's the ONLY IV med that does work, at a bolus of 4mg or 2x 2mg within 5-10 min of each other. Thats weird you said that, bc it literally is my magic number as well. Last kidney stone episode from ~3 weeks ago, after getting 50mcg shots of fent, some morphine... it was until the 4mg Dilaudid that I was finally comfortable. As I said in the big long story, my oxygen saturation level actually went down to the low 90%, which told the Nurse that it was obviously working as well due to the respiratory depression.

Anyway, the real point of the thread, was to target the addicts, as I was reading a thread in the drug culture forum... reading people's stories of what they take in the morning. Common responses were 100mg IV morphine, 8mg IV dilaudid, heroin, and even one guy said 1MG IV Fentanyl!!!!

So my question was how in particular do THESE people, or at least have they even considered, pain control in an emergency (car crash, kidney stone, pancreatitis, gall stones, broken bones, etc) situation.
If said addict is shooting 100mg IV morphine every morning to get out of bed, what in the HELL would he do whenever he actually needs legitimate pain relief, in a setting at the ER where they would be prepared to only dispense 3-6mg of morphine IV (a dose suitable for the avg opiate naive person in need of emergent pain relief).
(folks like wrongdose are welcome too, since like me as a CPP, we're in a similar boat with addicts as he said)
 
What I normally do is just let my tolerance speak for itself.. if you flat out tell them you're an addict and therefore have this huge tolerance you aren't going to get shit... but if they start pumping you up with pain killers are you are still completely awake/alert/and in clear pain, they will give you more. There are people out there that naturally just have a higher tolerance to narcotics.. Just don't sound like a junkie.. don't complain at all.. They will notice how the pills aren't affecting you and seek to correct that. But if you start acting like a fiend, constantly bitching and shit, they'll realize what they are dealing with and shut that shit down cold.
 
that shits gotta suck but to be honest maybe the car wreck or situation wasnt your fault but in the end you did that to yourself, ya know? if you didnt touch dope or whatever in the first place you would have been taken care of. its one of the downs and price you gotta pay to play.

also, as scagnattie said just let the pain speak for its self. when your naturally crying cuz the pain is so bad im sure they will hook you up
 
that shits gotta suck but to be honest maybe the car wreck or situation wasnt your fault but in the end you did that to yourself, ya know? if you didnt touch dope or whatever in the first place you would have been taken care of. its one of the downs and price you gotta pay to play.

also, as scagnattie said just let the pain speak for its self. when your naturally crying cuz the pain is so bad im sure they will hook you up

LoL

I appreciate your feeling on people put in this situation, but I was really aiming to hear from moderate-severe illicit opiate users/abusers whom have had experience dealing with moderate-severe physical trauma/condition, and needed emergency intervention and emergency pain control.

PURE curiosity.

What Mr Scag said is exactly what I was looking for, and it came from an opiate addict.

This thread kinda died tho and am getting no replies on what any addict has done in this situation. I was expecting some interesting, grueling stories!!
 
oh well im sorry i couldnt accomodate to your needs. ive had opiate problems off and on for the last 7 years which resulted in 2 detoxes and 2 rehabs in 1 year. my tolerance is not moderate to severe since i can never get it to go up anyways but thats not a bad thing.

i tried to help you and contribute what i could. im sorry ive never had to be to the er for my pain. i have seen orthopediac doc s for knots in my back but i have no insurance anymore so im cut off from that and im sure if i want to the emergency room i wouldnt get shit even when my pain had me in tears and i was gonna go to the emergency room with no insurance but im sure i wouldnt have gotten anything anyways cuz my chart only shows that i got doctor treatment and PT for 2 months so they wouldnt help me out.

i was just trying to help you, you dont have to come off as being rude whether that was your intention or not
 
This thread kinda died tho and am getting no replies on what any addict has done in this situation. I was expecting some interesting, grueling stories!!


It's only been up today.. It'll probably pick up. I know a bunch of BL'ers who have had to deal with this and have some crazy stories about needing pain meds with a severe tolerance... so once they see it I'm sure they'll have something to say.
 
and for the record when i said you ruined it for yourself that wasnt directed at you thats directed at abusers who hav e to get pain under control. (tried to use the edit button but it wouldnt load)
 
oh well im sorry i couldnt accomodate to your needs. ive had opiate problems off and on for the last 7 years which resulted in 2 detoxes and 2 rehabs in 1 year. my tolerance is not moderate to severe since i can never get it to go up anyways but thats not a bad thing.

i tried to help you and contribute what i could. im sorry ive never had to be to the er for my pain. i have seen orthopediac doc s for knots in my back but i have no insurance anymore so im cut off from that and im sure if i want to the emergency room i wouldnt get shit even when my pain had me in tears and i was gonna go to the emergency room with no insurance but im sure i wouldnt have gotten anything anyways cuz my chart only shows that i got doctor treatment and PT for 2 months so they wouldnt help me out.

i was just trying to help you, you dont have to come off as being rude whether that was your intention or not


Yea man I didnt mean to come off rude, I just used your comment to help re-define in a few short sentences what it was that I was looking to hear, since my first post is rather lengthy and may not have gotten read in its entirety to read the exact questions. I blabber wayy too much in my posts generally.

So - Im sorry if I sounded abrasive. But you're right, I also couldn't tell if you were telling me "too bad you did it to yourself" directly. Which again, is why I said what I did - to just define my question as plainly as possible.
 
It's only been up today.. It'll probably pick up. I know a bunch of BL'ers who have had to deal with this and have some crazy stories about needing pain meds with a severe tolerance... so once they see it I'm sure they'll have something to say.

Thanks Mr Scag, I'll cool my jets :) Holidays have got me bored.
 
alls good, i was just trying to contribute and help you out buddy. no hard feelings on this end.

hope you get the answers your looking for
 
Never admit your addiction to them. It will go in ur medical file and every doc will see it & you'll never get another painkiller again. Just keep telling them ur still in pain

^ This is probably the best advice.

There was a guy next to me bitching about how they basically gave him nothing for severe pain (broken leg I think) because he admitted to becoming addicted to the pills and eventually Heroin. He bitched so much the doctor finally gave in and prescribed him a bunch of Percs. I just sat there with my mouth closed and he came over to me after still upset from the patient bitching and goes "What about you, how's your pain?" It was almost too easy ;)

Anyways, when I was actually staying over night for a few nights after my surgery they knew I had a tolerance to opiates because what they were giving me was obviously not working and I was in horrible severe pain. I guess I just got lucky because at the peak of it all my nurse came in and told me not to tell anyone and told me she had fixed a fat shot of Dilaudid for me %) The rush was unbelievably amazing.
 
^ This is probably the best advice.

There was a guy next to me bitching about how they basically gave him nothing for severe pain (broken leg I think) because he admitted to becoming addicted to the pills and eventually Heroin. He bitched so much the doctor finally gave in and prescribed him a bunch of Percs. I just sat there with my mouth closed and he came over to me after still upset from the patient bitching and goes "What about you, how's your pain?" It was almost too easy ;)

Anyways, when I was actually staying over night for a few nights after my surgery they knew I had a tolerance to opiates because what they were giving me was obviously not working and I was in horrible severe pain. I guess I just got lucky because at the peak of it all my nurse came in and told me not to tell anyone and told me she had fixed a fat shot of Dilaudid for me %) The rush was unbelievably amazing.

Good looker er' not that nurse is an angel...
 
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