Check out this interactive map: Prescription Narcotic Consumption.
It is more than fascinating, it is mind-blowing. The sheer amount of presciption narcs out in circulation, based on this map (which I can’t vouch for the validity of, but…) is any wonder why we have drug seekers sowing up ERs daily, or why our post-op patients are requiring higher doses of more potent narcotics, and even why they are now running anti-prescription drugs ads aimed at scaring families with children (my favorite is the one with the sleazy guy who says, “I used to be your kids’ dealer, now they just steal it out of your medicine cabinet.).
According to the map, we’re (Oregon, that is) is #2 in Methadone consumption (better than, ahem…Lousiana), #16 in Oxycodone and #18 in Hydrocodone. The statistics are just left as that, numbers with no explanation. No in-depth reasoning or analysis, just straight up numbers. I guess we either have many, many ex-heroin addicts, or an astounding number of fibromyalgieurs or other chronic pain condition sufferers being treated with methadone. Personally based on what I’ve seen on the floors, it is the latter.
I think that if nothing more, it shows a marked shift in the prescribing habits of doctors with a more liberal attitude towards narcotics. In relation to that, is the societal aceptance of said narcotic uses. It appears more acceptable these days to be on prescription pain medication than it ever was before, showing a shift in cultural mores and attitudes.
Does this translate at all for nurses? You better believe it. First, there is more access, bringing on the occasional spate of OD’s and the frequent drug seekers to our doors. And second, there is the tolerance factor for folks undergoing surgery, planned or unplanned, requiring higher doses of pain medication to remain comfortable. I’m sure there are more than that, but this is what came to mind. We try to ease pain in our working lives and sometimes dealing with a set-up where nothing, except the total abscence of pain, will make a person happy, it gets frustrating. I guess what my point is here, is that we have been set-up in a way by the liberal prescribing of narcotics, illustrated (in my opinion) by the graphic above. Since we nurses are the front-line, we take the abuse. We can’t just tell our patients to “cowboy up” and not treat their pain. But what does one do when treating the pain becomes physiologically dangerous? And what happens when expectations are that there will be no pain at all? We have all seen it where the patient is getting enormous amounts of narcotics and still complaining of pain, but to give more would be akin to completely knocking out their repsiratory drive. It’s a conundrum with no easy solution. Sometimes a little pain is the reminder that is needed that something has happened to our bodies. I always try to let my patients know that odds are, I won’t be able to reduce their pain to nothing, but try my damndest to get them comfortable. Maybe this is what the docs are doing: just trying to get people comfortable. Maybe we need to be a little uncomfortable at times. Maybe a little pain is a good thing.