IV opioids for self-administration at home

[Timeoutofmind]

I am being asked to review a case where a doc ordered IV narcs for a pt to self-administer at home.

Is there any standard of care or precedent/guidelines in the pain community regarding this for cancer or non cancer care? Any resources you could point me toward?

I have never come across it before...

Ok to move to private forum if that’s preferred but I thought it would get more traffic here.

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[Ducttape]

yes, I have heard of something similar SQ not IV though.

had a consult, patient looking for someone to continue his therapy.

was getting injectable morphine drip and prn hydromorphone through a SQ pump.

MED was roughly around 300.

had to get a new doc because, per the patient, the prescribing doc was, er, getting license revoked for "unclear reasons".

 

[SommeRiver]

yes, I have heard of something similar SQ not IV though.

had a consult, patient looking for someone to continue his therapy.

was getting injectable morphine drip and prn hydromorphone through a SQ pump.

MED was roughly around 300.

had to get a new doc because, per the patient, the prescribing doc was, er, getting license revoked for "unclear reasons".

Haha...

OP - I've heard of this for Hospice level care, but definitely not for longterm care. Highly inappropriate and deviates wildly from normal practice.

 

[geauxg8rs]

yes, I have heard of something similar SQ not IV though.

had a consult, patient looking for someone to continue his therapy.

was getting injectable morphine drip and prn hydromorphone through a SQ pump.

MED was roughly around 300.

had to get a new doc because, per the patient, the prescribing doc was, er, getting license revoked for "unclear reasons".

But my last doctor was okay with it, why won’t you do it????

why won’t your last doctor do the refills then????

oh he’s “retired .”””

 

[Ferrismonk]

No. IF opiates are appropriate, and IF they "need" that dose, then they should have an intrathecal pump.

I have seen ketamine powder Rx for home vaping and wildly inappropriate buccal/sublingual fentanyl products.

 

[Orin]

I am being asked to review a case where a doc ordered IV narcs for a pt to self-administer at home.

Is there any standard of care or precedent/guidelines in the pain community regarding this for cancer or non cancer care? Any resources you could point me toward?

I have never come across it before...

Ok to move to private forum if that’s preferred but I thought it would get more traffic here.

I have seen it in some settings for patients being palliated with GI absorption issues in the community. They generally are on TPN.
I have not seen it as PRN IV push though.

 

[callmeanesthesia]

I’d say that’s palliative care only (truly palliative care situation where the patient is expected to die within a few weeks, maybe months at the most).
For chronic pain, I’d say that’s way outside standard of care.

 

[DrSpine]

When I did a Palliative/Hospice rotation as a Fellow and Resident, I saw PCA Pumps. For chronic non-malignant, sending home with opioid IV pump is pure insanity.

 

[mid|ine]

I have heard of a few cases of this. At no time have I ever felt it fell within the standard of care.

 

[lobelsteve]

No bueno.

 

[Laryngospasm]

So many reasons this is wrong. Bad bad bad bad... definitely way below standard of care. The only way I could see it making sense would be if there was 24 hr care and someone assisting and supervising the therapy.

 

[TheLoneWolf]

When I did a Palliative/Hospice rotation as a Fellow and Resident, I saw PCA Pumps. For chronic non-malignant, sending home with opioid IV pump is pure insanity.

Same

 

[Mman]

I am being asked to review a case where a doc ordered IV narcs for a pt to self-administer at home.

Is there any standard of care or precedent/guidelines in the pain community regarding this for cancer or non cancer care? Any resources you could point me toward?

I have never come across it before...

Ok to move to private forum if that’s preferred but I thought it would get more traffic here.

I am sure it is well within the standard of care for your local drug dealer on the street corner.

 

[Ligament]

End of life care for a hermit?

 

[painfree23]

had an oncologist refer to me for ''pain management'' after she was giving patient (young, breast cancer) self administer diluadid IV through her home PICC and now she was in remission so needed other options. I said no, thank you, u created the problem , u can solve it

 

[NJPAIN]

The last pump that I trialed, implanted with surgeon and managed was about 15 years ago. It was a patient given all sorts of incorrect neurological diagnoses in the community and finally a correct diagnosis of copper deficiency myeloneuropathy (post partial gastrectomy) at a major teaching hospital. I was out marketing to local PCPs and her PCP told me he had a patient he was prescribing IM Demerol for self-administration. I was able to get her off of all systemic opioids. I think it was one of the few ideal cases for a pump I have seen. She did great with the therapy. However, I was called emergently every time she had a change in mental status due to urosepsis and ultimately a CVA.

In the 90s we saw pain docs chasing "adequate" pain relief with all sorts of crazy regimens frequently involving parenteral administration particularly in patients claiming "malabsorption". I can't tell you how many times patients said " I find the pills whole in my stool" as an excuse to ask for parenteral meds. I'm moderately surprised that anyone is willing to get involved with this type of prescribing these days. However, there is always someone seeing this as an opportunity to scoop up desperate patients and make $$$$.