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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 44. Go back in thread:
Posted by bsj on December 9, 2003, at 22:28:07
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 9, 2003, at 21:40:50
"Most of the nurses I know who have entered the diversion program were addicted to heavy narcs like Demerol or Fentanyl"
Just a comment on Demerol:
I went to the ER once in excrutiating agony from a kidney stone; they gave me a Demerol injection and sent me home with a script for it. I don't remember the entire week following. I couldn't imagine anyone being able to work on Demerol; I sure couldn't. That's some seriously mind-warping stuff.
Posted by rxnurse on December 10, 2003, at 0:24:27
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 9, 2003, at 22:28:07
No kidding! We don't even give it anymore in the ER because people were coming in asking for it, straight up! One nurse I know was injecting up to 200mg, at work. That is A LOT of Demerol, not to mention a usual dose is 12.5 or 25mg intramuscularlly. Also, Demerol can cause a severe, life threatening reaction because of it's neurotoxic metabolite, normeperidine. Substance abuse among health care professionals is serious and quite scary. It's a really stressful job to take care of others all the time, but using strong drugs at worse is really scary.
Posted by bsj on December 10, 2003, at 4:21:24
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 0:24:27
"No kidding! We don't even give it anymore in the ER because people were coming in asking for it, straight up!"
That's funny. You have to wonder where these people come from.
I've experienced a good many opiates, but none ever had anywhere near the effect of Demerol. I can't even say it felt good--I don't remember; it was complete oblivion.
"Substance abuse among health care professionals is serious and quite scary. It's a really stressful job to take care of others all the time, but using strong drugs at worse is really scary."
I keep wondering how they could get away with it for any length of time. AFAIK, CII stuff has to be ridigly accounted for, and you think they'd install cameras in drug storerooms.
Posted by krazybirdlady on December 10, 2003, at 9:46:51
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 0:24:27
wow, rxnurse...i too have to wonder how even health care professionals can get away with this for any extended period of time? and obviously it must go on for quite some time to get to doses that high, as well as manage to function through it. these drugs must be accounted for somehow, right? or are there ways around it? i know that in a pharmacy it could theoretically be done, maybe for a short time...but not for long. are hospitals so swamped with work that this can go unnoticed? especially drugs like that, and injecting them to boot....such a stressful career you guys have, i know. no wonder they have programs set up, and i'm glad to hear that. not sure if we have any help like that here in Canada. i sure hope so...
Posted by bsj on December 10, 2003, at 11:17:59
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 9:46:51
"and obviously it must go on for quite some time to get to doses that high, as well as manage to function through it"
It would take about a year of pretty constant use to build a tolerance so massive that you could slam 200mg of Demerol and survive. That's amazing.
Posted by krazybirdlady on December 10, 2003, at 11:28:56
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:17:59
that's scary...once several years ago, iwent to the ER for a particularly agonizing migraine. as a last resort (after other meds did nothing), i agreed to an injection of demerol. slept for the next 19 hrs. had to call in sick to work the next day as i simply souldn't stay awake. can't imagine anyone coming back for more of this....
Posted by bsj on December 10, 2003, at 11:55:38
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 11:28:56
When I had the kidney stone, they tried hydrocodone first and it didn't do a thing. Another time, several years later, when I took an arrow in the calf, they gave me morphine; I could function on it fairly well. Supposedly, morphine and Demerol are roughly equipotent; but that's not been my experience. Demerol has far profounder effects than morphine--it produces far more sedation, not to mention swiss-cheesing your memory.
(Early lit on hydrocodone suggested it was also equipotent with morphine, but that's not quite so. I think the current lore is that 15mg morphine and 20mg of hydro are equivalent. That may be so where pain relief is concerned, but
morphine clouds my mind in a way that hydro doesn't.)
Posted by Mandybella on December 10, 2003, at 12:26:46
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:55:38
Apppreciate all the input. With the holiidays and all, I am afraid to take the steps to do something about this and I guess I am also afraid to give up my crutch. I get the drugs over the internet, surprisingly easy, but have been spending a fortune. I want to taper down, but every time I think I may be getting better, I take a whole handful again. When you have had long term sleep problems like I have, having a drug that really sedates you is so hard to give up
And I guess I would like to check into some nice hotel like place and have the thing all over. Guess that is not going to happen
Posted by bsj on December 10, 2003, at 12:46:50
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
"I get the drugs over the internet, surprisingly easy, but have been spending a fortune."
Unfortunately, the DEA has been cracking down on controlled stuff on the net. I only know of two places that still sell hydrocodone; though Ambien may be easier to get. I had to fax a photo ID and medical records to get what I wanted.
Posted by krazybirdlady on December 10, 2003, at 13:41:48
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
i can certainly imagine what you are paying out to support your use. also you are setting youself up to be seized by customs. no money, no ambien...i understand what insomnia is like, but 30 pills? please let yourself be helped, as i am sure you are living through hell with this. please check into rxnurse's advice...i know for a fact you are not alone...
Posted by krazybirdlady on December 10, 2003, at 13:55:06
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 11:55:38
"the current lore is that 15mg morphine and 20mg of hydro are equivalent." Lore is the perfect word...those equivilancy charts are very deceiving. actually downright garbage, if you ask me. you really won't know how any narcotic will affect you until you actually try it. i have seen people get violently ill on codiene, but tolerate oxycodone just fine. i do know that morphine and demerol can effect you very differently in terms of sedation, pain control, nausea, etc...each person is an individual with individual brain chemistry, hence, the lowest dose rule applies...
Posted by bsj on December 10, 2003, at 14:19:39
In reply to Re: What happens in treatment center-, posted by Mandybella on December 10, 2003, at 12:26:46
"And I guess I would like to check into some nice hotel like place and have the thing all over. Guess that is not going to happen"
If you got the cash, you can find rehabs that treat you like royalty. But ordinary rehab places are pitiful. Supposedly the lot of them subscribe to the addiction-as-disease paradigm, but they treat patients like criminals; it's like a doctor standing over someone in the midst of a heart-attack, chiding the victim for all the fried food he ate.
If you want to avoid rehab, take a few weeks off work and get your husband to help you. Let him control your Ambien supply. If you could get yourself down to 5 or so pills a night that would be a success. You could probably live with that for a while, then concentrate on finding other ways to deal with the insomnia.
Posted by rxnurse on December 10, 2003, at 14:24:46
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 13:55:06
Where I was working, all of the drugs including the narcs were dispensed through an ATM-like device called a Pixus. All you have to have is an access code, finger print, patient's name, and what meds you needed. So, nurses could enter false patient names or ones that have been transported to other units or even discharged. If there was any error at all when trying to get a narc out of the Pixus, it sends an alert message to the ER manager's computer and she comes looking for you for an explanation! Everything dispensed by the Pixus is on a database. On other floors the old fashioned narc log book is used which is easier to cheat because it gets passed around the floor and there are margins for error. My friend who used Demerol was mainlining it every day at work in the bathroom. She was never caught, officially. I can'not imagine being loaded at work, much less injecting myself with a needle! I have heard that Demerol in particular, is the most euphoric narcotic. It is a totally synthetic narcotic, and only used now for severe pain or for those who can't tolerate opiates. The major problem with Demerol is it's neurotoxic metabolite, which builds up in the liver. Other nurses choose Fentanyl, which is an opiate usually used during sugery. They say it produces a very pleasant high with some amnesiac effects. I guess anesthesiologists prefer Fentanyl as well. The whole thing is really very sad, for the professions as a whole. We are taught in school to give all to our profession and patients. I didn't learn a thing in school about how to take care of myself mentally nor physically when a work related crisis arose. Nurses in California are grossly overworked and underpaid. What happens when we all get sick from too much work and stress????? This is what's happening to Mandybella. Nothing is more important than your personal well-being and overall health! You can not take care of others if you are suffering. Your work must be somehow affected by the Ambien, someone is going to find out. Do not jeopardize your well-being, please seek professional help. There are lots of superb doctors, nurses and other professionals out there with your same problem. If they can do it, so can you!
Posted by krazybirdlady on December 10, 2003, at 15:02:34
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 14:24:46
wow, rxnurse..i am amazed that somebody could beat the system to that degree. i know that Dr.s and especially nurses are very overworked and stressed here in canada, much because of government cutbacks to our public healthcare system. but i can only guess as to the drug availability problem. my sympathies to those who succumb to the pressures. i can only imagine what it's like...
Posted by krazybirdlady on December 10, 2003, at 15:18:31
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 15:02:34
i am at a loss to describe to you what withdrawl or even tapering from ambien (called imovane in canada) is like as i personally have never seen it. i do know that it was once tauted as a relatively non-addictive drug, and that classification has now been changed. but from personal experience, most people who have taken it either complained that it doesn't work and stopped it, or managed quite nicely on their dose. i have never heard of anyone increasing it to the levels that you have. i guess most folks just give up and go back to good ol' benzos. please take rxnurse's advice and seek out the resources that are available to you. i think you already know that it won't be no hotel. no drinks by the pool. but it can be your lifesaver. i shudder to think of what might happen if customs cut you off cold turkey...
Posted by bsj on December 10, 2003, at 15:35:56
In reply to to Mandybella..., posted by krazybirdlady on December 10, 2003, at 15:18:31
It's said that Ambien is related to benzos; so I'd assume the withdrawal would be comparable. But a site on Ambien addiction lists these symptoms:
Abnormal extroversion or aggressive behavior
Loss of personal identity
Confusion
Strange behavior
Agitation
Hallucinations
Worsening of depression
Suicidal thoughts
Insomnia
Anxiety
Posted by rxnurse on December 10, 2003, at 15:59:54
In reply to Re: to Mandybella..., posted by bsj on December 10, 2003, at 15:35:56
Nothing on that list sounds like fun.
I have taken diphenhydramine or Benadryl for occasional insomnia. It worked well for me, and did not leave me with a hangover in the morning like benzo's do. However, the problem is what is causing the marked insomnia. Usually, this is caused by anxiety, depression or CNS diseases/dysfunctions. Also, once one weans off sleeping meds, many times your brain has to learn sleeping cycles again becaused they have been inactivated by the drugs for so long. Also, many of the old tricyclic antidepressants taken at night will help you sleep soundly.
Posted by krazybirdlady on December 10, 2003, at 16:17:13
In reply to Re: to Mandybella..., posted by bsj on December 10, 2003, at 15:35:56
hmmmm, no real physical withdrawl symptoms listed? not to say that the rest weren't nasty, but i really don't believe that at that dose you wouldn't have the major physical withdrawls..i.e. muscle spasms, vomiting, convulsions...etc...that is to say if you come off cold turkey...must investigate this..
Posted by krazybirdlady on December 10, 2003, at 16:21:07
In reply to Re: to Mandybella..., posted by rxnurse on December 10, 2003, at 15:59:54
> Nothing on that list sounds like fun.
> I have taken diphenhydramine or Benadryl for occasional insomnia. It worked well for me, and did not leave me with a hangover in the morning like benzo's do. However, the problem is what is causing the marked insomnia. Usually, this is caused by anxiety, depression or CNS diseases/dysfunctions. Also, once one weans off sleeping meds, many times your brain has to learn sleeping cycles again becaused they have been inactivated by the drugs for so long. Also, many of the old tricyclic antidepressants taken at night will help you sleep soundly.yes, but not after benzos...tricyclic antidepressants will work for people not aquianted with benzos, but if you are, they don't seem to have any effect at all for sleep. don't know about after ambien though...
Posted by bsj on December 10, 2003, at 17:19:22
In reply to Re: What happens in treatment center-Great Post!, posted by rxnurse on December 10, 2003, at 14:24:46
rxnurse:
There's something that happened to me with the Demerol that I've never been able to explain. After making me give up my breakfast, it caused 15-20 minutes of tachycardia--120bpm or so. This has never happened with any other opiate. Could this be some kind of rebound tachycardia from the CNS depression?
Posted by krazybirdlady on December 10, 2003, at 17:41:57
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 17:19:22
when you say "give up your breakfast", do you mean you vomited? the palpitations occured after that? this is not uncommon. adverse reactions to narcotics can cause nausea and an increase in BP and palpitations. true tachycardia is when the heartrate keeps increasing...upwards of 200bpm. then medication is required to slow it. did you receive any medication or did your heartrate decrease on its own? this would be a reaction to the demerol...
Posted by bsj on December 10, 2003, at 17:46:40
In reply to Re: What happens in treatment center-Great Post!, posted by krazybirdlady on December 10, 2003, at 17:41:57
"when you say "give up your breakfast", do you mean you vomited? the palpitations occured after that?"
Yes, and yes.
"true tachycardia is when the heartrate keeps increasing...upwards of 200bpm."
I've always seen it defined as any sustained heartrate greater than 100bpm.
"did you receive any medication or did your heartrate decrease on its own?"
It slowed after 15-20 minutes.
Posted by rxnurse on December 10, 2003, at 18:21:25
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 17:19:22
If Demerol is given IV, it may cause palpitaions and tachycardia. Besides being an excellent analgesic for some, it also provides as an anxiolytic. I have not idea why it would produce cardiac excitation, usually the opposite occurs. Maybe it has something to do with it's metabolite???? I have given it so infrequently these days, and most patients display the same side-effects. Everyone reacts differently to narcotics, but as long as their pain is more tolerable then the job is done. I have seen with my patients that Demerol is an excellent analgesic, more so than morphine.
Posted by krazybirdlady on December 10, 2003, at 18:22:02
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 17:46:40
again , i have to say that it was a reaction to the demerol. vomiting will raise BP and heartrate for a short period of time...was this for your kidneystone? that as well can cause vomiting..., as far as BPM, anxiety can cause sustained BPM upwards of 100, true tachycardia is a medical emergency as BPM's keep rising to the point that the heart can literally explode..
Posted by KimberlyDi on December 15, 2003, at 12:45:43
In reply to Re: What happens in treatment center-Great Post!, posted by bsj on December 10, 2003, at 4:21:24
There was a guy in a treatment program who would purposely break fingers and toes to get a prescription for pain medication. All the hospitals in a 200 mile radius knew about him.
> "No kidding! We don't even give it anymore in the ER because people were coming in asking for it, straight up!"
>
> That's funny. You have to wonder where these people come from.
>
> I've experienced a good many opiates, but none ever had anywhere near the effect of Demerol. I can't even say it felt good--I don't remember; it was complete oblivion.
>
> "Substance abuse among health care professionals is serious and quite scary. It's a really stressful job to take care of others all the time, but using strong drugs at worse is really scary."
>
> I keep wondering how they could get away with it for any length of time. AFAIK, CII stuff has to be ridigly accounted for, and you think they'd install cameras in drug storerooms.
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