Rolling Stone: Could CDC Guidelines Be Driving Some Opioid Patients to Suicide?

Orin

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Yes. It could, and I've already shared anecdotes of opioid refugees deciding it's easier to not have to struggle with the system anymore. You should write them a letter and ask them to use that "opioid refugees" phrasing.
 

Doctodd

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i was thinking about how far to the other side we have gone when i was asked to see 1 inpatient. When they heard i was not just eating lunch at the hospital, i was buried with 4 new inpatient consults. In my absence, the hospital hired NP's to run an "Acute Pain Service" and i noticed how all 5 consults were getting Robaxin, Neurontin, and a short acting opioid after recently having bilateral knee replacements or lumbar fusion/surgery. Robaxin? Really?
 
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i was thinking about how far to the other side we have gone when i was asked to see 1 inpatient. When they heard i was not just eating lunch at the hospital, i was buried with 4 new inpatient consults. In my absence, the hospital hired NP's to run an "Acute Pain Service" and i noticed how all 5 consults were getting Robaxin, Neurontin, and a short acting opioid after recently having bilateral knee replacements or lumbar fusion/surgery. Robaxin? Really?
In their partial defense, I’ve seen Robaxin work pretty well for back spasm/pain in the first few days after lami/fusion. We used to give a gram of it IV in the PACU. Obviously needs opiates too.
 
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Agast

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Robaxin, neurotin and immediate release PO opioid after laminectomy and fusion sounds pretty reasonable to me. What would you propose instead?
 
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DrSpine

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Don’t write opioids, send them to suicide. Write opioids, send them to addiction or death as well. Damned if you do, damned if you don’t. Just another trash article written by someone so they can fulfill their job commitments and produce content. They’ll write about anything.
 
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SommeRiver

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How about just be careful with your pen...Speaking of pen, I had a piece of trash patient during my internship say this to me in the IM clinic - "Get out your fu$$$ng pen."

Probably he was a poor candidate for opiates. He was asked to leave of course, but I promise you some doctor out there would have written for him.

I find it extraordinarily unlikely my geriatric spondylytics would show up looking to shoot me.

I think we're at greater risk of work comp spouses (I had a run in last week with one).
 

Ducttape

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first, we need a societal change to how we conceive of and approach pain.

second, why bring up an article printed in March 2019, almost 2 years ago?

third, in the intervening 2 years, where is the data of opioid denied patients committing suicide, if it is in the droves that opioid enablers say?
 

Doctodd

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In their partial defense, I’ve seen Robaxin work pretty well for back spasm/pain in the first few days after lami/fusion. We used to give a gram of it IV in the PACU. Obviously needs opiates too.
It’s hard to describe without writing a novel, but let’s just say people are scared of opioids now. The pendulum has swung too far. There were other pain medications also like diclofenac and mobic, which is riskier in older patients. Polypharmacy vs a simple opioid. I like the KISS method.
 

Agast

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I find it extraordinarily unlikely my geriatric spondylytics would show up looking to shoot me.
You can't assume older-aged people are reliable anymore. Maybe people who came of age in the 50s. But now you're seeing people who experimented with drugs in the 60s and cocaine in the 80s. The guy who shot up the clinic earlier this month was 67. I've had to let go senior citizens who refused to stop smoking pot and then don't want some whippersnapper telling them what to do.
 
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SommeRiver

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You can't assume older-aged people are reliable anymore. Maybe people who came of age in the 50s. But now you're seeing people who experimented with drugs in the 60s and cocaine in the 80s. The guy who shot up the clinic earlier this month was 67. I've had to let go senior citizens who refused to stop smoking pot and then don't want some whippersnapper telling them what to do.
...which is why we test urine and appropriately screen pts.
 
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SommeRiver

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yet urine tests and screening patients are far from infallible.
Infallible no, pretty good though and I would bet the vast majority of these pts who shoot up clinics and cause problems were neither screened adequately nor followed appropriately.

You will agree I'm sure there are ways to decrease risk.
 
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