It is amazing...

[spyderdoc]

How many people have suddenly become "allergic" to Vicodin.

About 2 years ago, California did away with the triplicates and now require the use of a standard prescription blank that is made from security paper to write for all narcotic medications including Percocet. Previously, the only narcotics that could be written for on a standard prescription blank was codeine, Darvocet, and Vicodin. Percocet had to be written on a triplicate, and physicians were given only a limited number of triplicate each year. Physicians were therefore very selective to write for any narcotics on a triplicate form, so as to not use them all up. Most patients were happy to get either of the "big" three.

In the short two-year period, it is amazing how many people have suddenly become "allergic" to Vicodin, codeine, and Darvocet. It seems that people seem to be allergic to everything now but Percocet.

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[sdn1977]

I dunno - could be...I'm 10 min north of you & I dispense the same amt of Percocet I always did.

The big one now is Norco - Watson brand only....high street value.

I've also had a recent run on Dilaudid & for pain pts - not terminal CA. The patch abuse seems to have leveled off some.

I'm think about doing a Patient Activity Request on a couple of new pts receiving rxs from MDs who are closer to you than me..makes me wonder if they're Dr jumping.

 

[beyond all hope]

Guy comes in, says he's the president of Sony with a migraine. Jet's waiting for him, Immitrex and Zofran aren't cutting the headache, just wants to load and go. He's got nice clothes and he's well spoken and I almost believed his story.

Then I talk to the guy, and he's allergic to everything except....da da da! Demerol. 'What they usually do is give me 125 of IM Demerol with 50 IM Benadryl.; I told him we didn't have any Demerol in the hospital (I lied), but since he had all of the allergies and I didn't feel like messing around I gave him Dilaudid. He said, well okay, how about 5 IM Dilaudid.

Every time I walked in he was on the phone about his helicopter or his plane. I think the guy was full of crap, probably talking to a dead line. Gave him 2 IM Dilaudid then wrote his papers. First he wanted to talk to the supervisor to find out if they had Demerol. He wanted another shot before he left and I told him no. I think he realized I wasn't buying his story.

I think when I come in seeking I'm going to be the President of the Hair Club for Men.

 

[Apollyon]

Guy comes in, says he's the president of Sony with a migraine. Jet's waiting for him, Immitrex and Zofran aren't cutting the headache, just wants to load and go. He's got nice clothes and he's well spoken and I almost believed his story.

Then I talk to the guy, and he's allergic to everything except....da da da! Demerol. 'What they usually do is give me 125 of IM Demerol with 50 IM Benadryl.; I told him we didn't have any Demerol in the hospital (I lied), but since he had all of the allergies and I didn't feel like messing around I gave him Dilaudid. He said, well okay, how about 5 IM Dilaudid.

Every time I walked in he was on the phone about his helicopter or his plane. I think the guy was full of crap, probably talking to a dead line. Gave him 2 IM Dilaudid then wrote his papers. First he wanted to talk to the supervisor to find out if they had Demerol. He wanted another shot before he left and I told him no. I think he realized I wasn't buying his story.

I think when I come in seeking I'm going to be the President of the Hair Club for Men.

Was he this guy:

Or this guy:

Or this guy:

(In order, Ken Kutaragi, President of SONY, Sir Howard Stringer, Chairman of SONY-USA, and Ryoji Chubachi, PhD, President of SONY-USA.)

If he was none of the above, then you were right. At the same time, if I was the head of a giant corporation such as SONY, I would call the corporate shill/doc for my Demerol.

 

[southerndoc]

Guy comes in, says he's the president of Sony with a migraine. Jet's waiting for him, Immitrex and Zofran aren't cutting the headache, just wants to load and go. He's got nice clothes and he's well spoken and I almost believed his story.

Then I talk to the guy, and he's allergic to everything except....da da da! Demerol. 'What they usually do is give me 125 of IM Demerol with 50 IM Benadryl.; I told him we didn't have any Demerol in the hospital (I lied), but since he had all of the allergies and I didn't feel like messing around I gave him Dilaudid. He said, well okay, how about 5 IM Dilaudid.

Every time I walked in he was on the phone about his helicopter or his plane. I think the guy was full of crap, probably talking to a dead line. Gave him 2 IM Dilaudid then wrote his papers. First he wanted to talk to the supervisor to find out if they had Demerol. He wanted another shot before he left and I told him no. I think he realized I wasn't buying his story.

I think when I come in seeking I'm going to be the President of the Hair Club for Men.

If a big wig has use of a corporate jet and helicopter, it can wait. An airline isn't going to hold up a jet for him, but his own pilot and own jet will.

I think the guy was FOS.

 

[streetdoc]

This makes me think of a pt I had (just a 4th yr here) that was "allergic" to everything but nubain and tordal-she was a 20 something MR pt. Those didn't touch her chronic ab pain and her mom mentioned that maybe she wasn't really allergic to dimerol since it was given with morphine when she broke out in hives. dimerol was given and she got hives. Her mom basically said she was faking and took her home. I'm curious what would have happened if she had still had real pain. Do you admit (but what for?)? send home with po tordol (it wasn't working)? would you ever give her the pain meds and treat the reaction (or is that just completely out)?
thanks
streetdoc

 

[ntubebate]

If a patient comes in REQUESTING Nubain and Toradol, that is exactly what they get.

These drugs have almost NO abuse potential.

ntubebate

 

[streetdoc]

If a patient comes in REQUESTING Nubain and Toradol, that is exactly what they get.

These drugs have almost NO abuse potential.

ntubebate

This question still bothers me so let me expand a bit. She wasn't requesting anything, we were just without other options (as far as i understood). But what do you do when you are out of optins? do you admit for pain control--but what would the IM guys give?
In my VERY brief experience I have seen many people "in pain." I know i'm still "ideal" but what else could we have done for a pt with continued pain and all these allergies?
thanks again,
streetdoc

 

[RuralMedicine]

This question still bothers me so let me expand a bit. She wasn't requesting anything, we were just without other options (as far as i understood). But what do you do when you are out of optins? do you admit for pain control--but what would the IM guys give?
In my VERY brief experience I have seen many people "in pain." I know i'm still "ideal" but what else could we have done for a pt with continued pain and all these allergies?
thanks again,
streetdoc

-From my perspective if you're truly allergic to opiates then you should avoid all opiates. In reality a lot of allergies are related to the side effects of the medicine (nausea, vomiting etc) and not true allergies. Also IV opiates (especially Morphine, Demerol) can induce a histamine response right at and shortly after the time of infusion that may be mistaken for hives.
-I enjoyed training at an institution that didn't carry Demerol on it's formulary because it's safety profile didn't warrant it. Now I have admitting privileges at a hospital where for some reason it's the narcotic of choice in the ED. I am beginning to wonder if their ED shift is sponsored by the letter D because on the rare occasion that they don't receive Demerol they get Dilaudid. Perhaps I should tell them about Dolobid.
-Chronic pain responds poorly to narcotic analgesia. Untreated depression makes everything worse. What was different about her chronic pain that brought her into the ED in the first place? Also consider constipation/ileus/fecal impaction in worsening pain when patients are on chronic narcotics without a good bowel regimen.

 

[ntubebate]

-Chronic pain responds poorly to narcotic analgesia.

I have found chronic pain, when treated properly DOES respond very well to opioid analgesia.

ntubebate

 

[Roadie9]

It's my understanding that mepiridine (Demerol) is kept on formulary at many institutions purely for its effect on post-anesthesia rigors.

The abuse potential is said to be phenomenal. I have never used it but I have had at least a couple of patients ask for it.

 

[deleted109597]

I have found chronic pain, when treated properly DOES respond very well to opioid analgesia.

ntubebate

I've found it responds better to SSRI's and CBT.

 

[The White Coat Investor]

I have found chronic pain, when treated properly DOES respond very well to opioid analgesia.

ntubebate

Yes, the problem is those anesthesiologists running the pain clinic "doing the proper treatment" just aren't available at 3 am when the patient's magically run out of their 30 mg MS IR tablets. Not a dig, I appreciate having pain clinics around at all, just an observation that I see a lot of chronic pain patients in the ED despite the fact that their pain is "managed" by a pain specialist.

I agree with you, of course, and have found that even chronic pain does respond very well to the proper dose of opioid analgesia. Whether that is the best way to treat it in an acute care facility is another matter.

 

[Sessamoid]

How many people have suddenly become "allergic" to Vicodin.

About 2 years ago, California did away with the triplicates and now require the use of a standard prescription blank that is made from security paper to write for all narcotic medications including Percocet. Previously, the only narcotics that could be written for on a standard prescription blank was codeine, Darvocet, and Vicodin. Percocet had to be written on a triplicate, and physicians were given only a limited number of triplicate each year. Physicians were therefore very selective to write for any narcotics on a triplicate form, so as to not use them all up. Most patients were happy to get either of the "big" three.

In the short two-year period, it is amazing how many people have suddenly become "allergic" to Vicodin, codeine, and Darvocet. It seems that people seem to be allergic to everything now but Percocet.

I think it's completely due to your change in hospital and thus, change in patient population. I'm working in the same setting now for several years, and I've seen no such increase in weird "allergies". I can count the number of percocet prescriptions I've written in the last year one the fingers of both hands... maybe only one hand... and all those were for fractures.

When I practiced in St. Petersburg, FL, the drug-seeking population was orders of magnitude higher than here in middle-class LA. Not sure why that was, but it was insane how many drug-seekers we had and the amazing stories, acts, and even props they'd use to try to convince us of their increasingly bizarre stories.

 

[vtucci]

I had bariatric surgery this summer and learned that morphine does nothing for pain in me (I actually told the staff not to give it to me as it had no effect and did not see the point) and am allergic to vicodin (also PCN and ceclor), which we found out in the hospital. The only thing that works for me was demerol. My father had his gallbladder out a month after my surgery and had the same reactions to morphine and vicodin. It might be pharmocogenetics.

It is a standing joke now amongst faculty-- we all have heard the story of the patient coming in and asking for demerol-- if I was ever seriously hurt, I guess that would be me.

 

[spyderdoc]

I think it's completely due to your change in hospital and thus, change in patient population. I'm working in the same setting now for several years, and I've seen no such increase in weird "allergies". I can count the number of percocet prescriptions I've written in the last year one the fingers of both hands... maybe only one hand... and all those were for fractures.

When I practiced in St. Petersburg, FL, the drug-seeking population was orders of magnitude higher than here in middle-class LA. Not sure why that was, but it was insane how many drug-seekers we had and the amazing stories, acts, and even props they'd use to try to convince us of their increasingly bizarre stories.

Hey Sess! Long time no hear! Hope all is well...Haven't been to LA since the baby was born, but next time we go down there I'll look you up and we'll hit Father's Office for a great burger and brew....Ahhh I sure miss the good ole LA days....