Drug seeking patient signs?

[Handsome Robb]

@Handsome Robb, here's a question I have for you. If you decided to not try opiates first and move directly to ketamine but justified the reasoning in your narrative, would you still get a QI flag?

The process would basically be to do it, justify it in your chart then after the call you're obligated to self report for a protocol deviation. That entails calling a specific phone number and speaking with the shift's Senior Medical Officer who would then take a report, file their own report so it's documented then that's usually the end of it unless you did something grossly negligent or incompetent then you may have some sort of a conversation with our clinical staff or potentially a conversation with our MD.

Either way you wouldn't be in trouble, provided you followed the proper channels and self-reported.

I've had to call more than a few times and beyond the conversation I had with the SMO, which usually goes something like "well that seems reasonable, ok thanks for reporting it have a good day", I've never heard anything else from anyone else in our clinical department.


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[EpiEMS]

@Handsome Robb, is the SMO a physician or another medic?


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[Giant81]

It's amazing how people can be allergic to one phenanthrene but not another.

This is going to be off topic, but I'm looking for information on why someone would be receptive to one opiate and not another. I can move to it's own topic if preferred.

I've found that morphine and hydrocodone do little for me, but oxycodone and dilaudid work wonderfully, and in rather small doses. When I burned my arm, they kept hitting me with morphine in the hospital, and it did nothing. Eventually they moved to dilaudid, and in one small dose, my pain had come down from an 8-9 to like a 5, and another small dose in the ambulance during an IFT to the burn center, brought it down to a 4 or so.

While at the burn center the Dr looked over my chart and even asked me "have you done drugs recreationally" which I have not. I then asked the nurse what that was about, and he peeked at my chart and mentioned that the amount I'd been given would probably be enough to knock him out for 24hrs. I suspect the fact I was not only consious but also coherent was worrying.

I've also found that when given hydrocodone for pain, it did little more than the tylenol alone did. When given oxycodone for pain, it was normally perscribed 5-10mg as needed. And it only took one dose at 10mg to realize 5 was plenty.

So I've been up and down the internet looking for an idea why. Why does one have no effect on me and another a rather strong effect. This thread seems to be full of people that could help point me to a reason.

It's left me in a couple uncomfortable positions where a Dr wanted to Rx me hydrocodone for something and I requested oxycodone, only to see them taken back a bit. Contemplating if I'm drug seeking. It would be much easier to be able to place something in my chart or have an idea of what it is so I can tell the Dr instead of getting looks of concern.

tldr; don't seek pain meds, don't take drugs recreationally, trying to figure out how to explain to a Dr why oxycodone and dilaudid works great, but morphine and hydrocodone don't do anything without getting the look of "do I need to call the sherif"

 

[EMT9396]

This is going to be off topic, but I'm looking for information on why someone would be receptive to one opiate and not another. I can move to it's own topic if preferred.

I've found that morphine and hydrocodone do little for me, but oxycodone and dilaudid work wonderfully, and in rather small doses. When I burned my arm, they kept hitting me with morphine in the hospital, and it did nothing. Eventually they moved to dilaudid, and in one small dose, my pain had come down from an 8-9 to like a 5, and another small dose in the ambulance during an IFT to the burn center, brought it down to a 4 or so.

While at the burn center the Dr looked over my chart and even asked me "have you done drugs recreationally" which I have not. I then asked the nurse what that was about, and he peeked at my chart and mentioned that the amount I'd been given would probably be enough to knock him out for 24hrs. I suspect the fact I was not only consious but also coherent was worrying.

I've also found that when given hydrocodone for pain, it did little more than the tylenol alone did. When given oxycodone for pain, it was normally perscribed 5-10mg as needed. And it only took one dose at 10mg to realize 5 was plenty.

So I've been up and down the internet looking for an idea why. Why does one have no effect on me and another a rather strong effect. This thread seems to be full of people that could help point me to a reason.

It's left me in a couple uncomfortable positions where a Dr wanted to Rx me hydrocodone for something and I requested oxycodone, only to see them taken back a bit. Contemplating if I'm drug seeking. It would be much easier to be able to place something in my chart or have an idea of what it is so I can tell the Dr instead of getting looks of concern.

tldr; don't seek pain meds, don't take drugs recreationally, trying to figure out how to explain to a Dr why oxycodone and dilaudid works great, but morphine and hydrocodone don't do anything without getting the look of "do I need to call the sherif"

I have wondered the exact same thing. I was prescribed hydrocodone for my broken arm when I was 13 or so and it helped tremendously. about 6 months ago (I'm now 20) I was prescribed hydrocodone again after I had a hernia surgery and it did literally nothing for me. and about a month or so ago I had my wisdom teeth pulled and I was prescribed 600mg ibuprofen and that got rid of most of the pain in my mouth. the ibuprofen helped much more then the hydrocodone did.

 

[Carlos Danger]

This is going to be off topic, but I'm looking for information on why someone would be receptive to one opiate and not another. I can move to it's own topic if preferred.

I've found that morphine and hydrocodone do little for me, but oxycodone and dilaudid work wonderfully, and in rather small doses. When I burned my arm, they kept hitting me with morphine in the hospital, and it did nothing. Eventually they moved to dilaudid, and in one small dose, my pain had come down from an 8-9 to like a 5, and another small dose in the ambulance during an IFT to the burn center, brought it down to a 4 or so.

While at the burn center the Dr looked over my chart and even asked me "have you done drugs recreationally" which I have not. I then asked the nurse what that was about, and he peeked at my chart and mentioned that the amount I'd been given would probably be enough to knock him out for 24hrs. I suspect the fact I was not only consious but also coherent was worrying.

I've also found that when given hydrocodone for pain, it did little more than the tylenol alone did. When given oxycodone for pain, it was normally perscribed 5-10mg as needed. And it only took one dose at 10mg to realize 5 was plenty.

So I've been up and down the internet looking for an idea why. Why does one have no effect on me and another a rather strong effect. This thread seems to be full of people that could help point me to a reason.

It's left me in a couple uncomfortable positions where a Dr wanted to Rx me hydrocodone for something and I requested oxycodone, only to see them taken back a bit. Contemplating if I'm drug seeking. It would be much easier to be able to place something in my chart or have an idea of what it is so I can tell the Dr instead of getting looks of concern.

tldr; don't seek pain meds, don't take drugs recreationally, trying to figure out how to explain to a Dr why oxycodone and dilaudid works great, but morphine and hydrocodone don't do anything without getting the look of "do I need to call the sherif"

There are lots of individual physiologic factors that might explain why one opioid works better for you than another. It's actually not at all uncommon for people to say that.

But the simplest and most likely explanation is that oxy and dilaudid are simply more potent drugs than hydrocodone and morphine.

It also sounds like you might have gotten an additive effect when the second drug was given. In other words, give someone a few doses of morphine, they still have pain, give them dilaudid, they feel better. It isn't just that dilaudid is more potent, it's that you are giving it on top of the morphine that you already gave them.

You are right; you will always run the risk of sounding like a drug seeker when you state up front that "the one with the D" is the only drug that works for you.

 

[Handsome Robb]

@Handsome Robb, is the SMO a physician or another medic?


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Another Paramedic. They're basically the equivalent to a Lieutenant but on the clinical side instead of operational. Still work a normal Paramedic shift but do training, chart reviews on certain types of calls, things of that nature.

We have 100% peer review of our charts.


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[EpiEMS]

Another Paramedic. They're basically the equivalent to a Lieutenant but on the clinical side instead of operational. Still work a normal Paramedic shift but do training, chart reviews on certain types of calls, things of that nature.

We have 100% peer review of our charts.


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Ok, gotcha - sounds pretty reasonable to me.


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[jaeems]

I would have filed right back at them for abandonment, negligence, malpractice, and being an AH.

Most likely none of it would have gone anywhere, but I really would like to have seen them squirm in the chair trying to explain how pain management in a long bone fracture with extrication is a waste of ALS.

Now the ALS people were not performing their care standards. Yes, and I do agree with you, I would file right back at them.