This is a discussion very close to my heart and am curious as to what other medics do when they encounter these type pt's. Is addiction a disease or self initiated problem-or both?
Doesn't really matter, but probably both. I think most (all?) of us judge a lot (all?) of our patients. But ultimately, why this person is a drug addict, and whether it's an issue of dopamine neurobiology or free will, is largely irrelevant.
Should EMS be able to treat and addicts pain/anxiety,
Yes. But I think most of us are going to be less willing to give pain medication / benzodiazepines to these patients if we judge their symptoms to be minor / borderline.
Part of the problem is that many systems have narcotic analgesia or nothing. When there's an option for po tylenol or IV toradol, it's probably a much better choice for some presentations.
or should we assume they are faking only to "score" narcotics, and possibly leave someone who is actually having pain and or anxiety untreated?
I don't think that should be our default assumption just because someone's an addict. That being said, I don't think you're ever going to get in trouble for denying a known addict analgesia, unless there's a clear fracture, or some sort of objective evidence of injury / disease.
The danger here is in the borderline cases, where the paramedic has a "suspicion", or a "feeling" that the patient is drug-seeking. Here it's easy to let other factors bias the decision. It seems like some providers are more likely to call someone a "drug seeker" if they're poor, live in a bad part of town, have psychiatric issues, etc. Or if they ask for a specific narcotic by name, e.g. "last time I had kidney stones, morphine worked really well". This is both potentially drug-seeking behaviour, or a reasonable thing for someone who has had chronic kidney stones to be telling a healthcare provider.
Personally, I think we should have a fairly low threshold for analgesia, and accept that we're going to get caught every now and again by someone seeking drugs.
Should EMS have a role in education of the public as well as EMS personel on treating these very common pt's that we come in contact with frequently?
Well, right now, most paramedic programs are taught by paramedics, so I think it's likely we'll continue to teach each other. And, I imagine a lot of us have been involved in talking to high school students or parents about the risks of drug use or drink driving. I think some of this is valuable. The average person is more receptive to an emotional story about a paramedic's personal experience than looking at a range of confidence intervals and t-tests.
But I don't think we have any need to be doing more than that. I'd argue that we don't have any particular expertise in this area. I remember spending a day or two at an addictions center, and an inner city homeless shelter during paramedic school, but I can't say that we talked about addiction counselling or treatment in any depth.
Like I said this is very close to my hear and I have a keen intrest on this subject, as I have seen these problems with friends and family members. Even when you are a medical professional, things like this still hit you on a personal level, leaving you asking your self, how can I actually help?
I don't have much to suggest beyond the normal, not being judgmental, treating everyone with respect until they give you a reason not to, sort of platitude.
Some of the better run programs for school kids or for parents seem like a decent investment of time. But I've seen some of them run very poorly.
