Ilicit drug

[schmee90]

is anybody doing axial injectin on patients who are using illicit drugs (heroin cocaine etc). This has alaways been a no no for me for multiple reaons. I told my PA no to a patient who admitted to using cocaine and to see addiction med. She asked my colleague as this was his patient to make sure he was ok with this and he said this no problem. I have multiple reasons why I say no but wanted to here the groups thoughs? I was in shock. is it me or him lol

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[soccrwz]

discharge

 

[geauxg8rs]

is anybody doing axial injectin on patients who are using illicit drugs (heroin cocaine etc). This has alaways been a no no for me for multiple reaons. I told my PA no to a patient who admitted to using cocaine and to see addiction med. She asked my colleague as this was his patient to make sure he was ok with this and he said this no problem. I have multiple reasons why I say no but wanted to here the groups thoughs? I was in shock. is it me or him lol

Just say no. No good can come from it

 

[callmeanesthesia]

Just say no. No good can come from it

Why? You get paid just the same, and if they get a spinal abscess obviously it was from the drugs and not the shot. Easy win for your attorney.

I agree it’s a risk, but so is injecting diabetics or people on immunosuppressants. Counsel and document risk. Document that patient was advised to quit using illicit substances. As long as you’re not prescribing them controlled substances I don’t see why it’s so bad.

 

[Laryngospasm]

The problem is these patients are typically problem children and not worth the 1.8 rvu or whatever. At least to me. But if someone doesn’t mind I guess there’s nothing wrong with it.

 

[BobBarker]

I do procedures still. Maybe 1 in 20 will want to stick around for procedure only.

 

[Ducttape]

Most big time druggies don't want injections anyways. Pills.

If they are intoxicated - no injection.

If they are not intoxicated but admit to illicit drug use (including opioid pills) - well, that's like 30% of this population....

 

[Laryngospasm]

Most big time druggies don't want injections anyways. Pills.

If they are intoxicated - no injection.

If they are not intoxicated but admit to illicit drug use (including opioid pills) - well, that's like 30% of this population....

True, I’ve found they only want them if they think it’s a way to get opioids.. not prescribing opioids really cuts back the number of them.

 

[Baron Samedi]

You're now their pain doctor. They get some surgery done. Patient tells surgeon that they have a pain doctor. Surgeon tells patient to go to their pain doctor for their pain meds since they won't write them due to drug hx. Patient calls you on POD #2 in crisis. You say no because you had talked about it previously. 15 phone calls later between you and Patient, office staff and Patient, and you and Surgeon and it results in all parties being angry, a 1 star Google review, and a medical board complaint.

 

[Orin]

Addiction is a comorbid disease in my population. I manage the pain contributing to it. I set expectations and boundaries around narcotics. I don't deny them an intervention because their brain chemistry sucks but I definitely set a much higher barrier to do something for those patients. I'd rather kypho them than see them on opioids for a VCF, but an ESI is harder for me to justify as I don't believe that strongly in them. I've put SCS and pumps in them if they're well controlled and through treatment. I've done the celiac neurolysis when they have pancreatic cancer. I'm not jumping up and down to do TPIs though.

I don't think anyone would fault you for punting. Active intoxication is a no go if people are clearly symptomatic, but people that are struggling in treatment or on MAT I'll work with as best as I can, until they piss my staff off.

 

[bubaghanush]

It makes me less likely to proceed as anxiety and catastrophizing do, but not a hard pass.

Use your judgment and take is case-by-case. I don't ask about illicit drugs routinely so I'm sure I've injected plenty who are on cocaine. Do you inject those drinking four beers a day?

I make it clear we are multimodal but steer away from opioids whether or not the injection works. If they seem high functioning and earnest, etc and have a hx of cocaine use, I'll counsel them briefly and likely proceed. If they are agitated or shaking in clinic, then no procedure.

I find if these patients actually went to PT it is a good indicator of their effort to improve.

 

[1 Up]

Just so long as they understand they aren't getting pain pills when the injections don't work, I don't mind doing them. Some of them are fishing for an excuse - an "exacerbation" caused by your injection - to pressure you into giving them pills.