The Opioid Epidemic – Have you ever been in a place or situation that seemed perfect in the beginning, but as time passed, you noticed red flags that caused you to question your choice?
In March 2017, I thought that I had finally landed my career of choice as a pain management nurse practitioner. In my mind, this was the perfect specialty because growing up and throughout college, I had endured a lot of sports injuries; luckily, I never broke any bones or needed surgery. I spent a lot of hours in physical therapy. Ice, heat, a transcutaneous electrical nerve stimulation (TENS) unit, an occasional massage, and ibuprofen were my pain management treatments.
With my diverse life experience in healthcare and my ability to establish rapport with anyone, I was motivated to help people manage their pain. I never imagined that I would become an insider to one of America’s nightmares: the opioid epidemic.
During my first few months, I spent time with each patient by getting to know them and the root causes of their pain. Moreover, I learned that many of them were dealing with mental health issues. As the months passed, I discovered that their pain was not improving, and in some instances, their pain was becoming worse. Many of the patients were taking high doses and quantities of methadone, fentanyl transdermals, morphine, oxycodone, and Norco (hydrocodone). And they were asking for more. At the annual Texas Pain Management Conference in October 2017, my supervisor and I learned that the CDC had issued a new guideline, “Soma used in conjunction with narcotics increases the risk of addiction and death.” When we returned to the clinic, I became responsible for weaning patients off Soma (carisoprodol), a very addictive muscle relaxer. Though I repeated the dangerous side effects to the patients who were taking Soma, so many times that I began to feel like a robot, their resistance to losing Soma was overwhelming. As a person who has experienced a lot of pain, I understood their arguments.
They wanted to be pain free and saw Soma as their solution. They argued that they weren’t the ones abusing their medications; they had been taking this medication for several years; and they never had any side effects. For the most part, they were telling the truth. They weren’t abusing their medications.
Though I empathize with their arguments, this continued treatment was not the path to their wellness.
So, despite their pleas, I had to stop administering a medication that had helped them cope with their pain and insomnia. It took several months to wean every patient off Soma and find an alternative muscle relaxer as an effective replacement.
By the end of 2017, thousands of people in America had overdosed on narcotics and illegal street drugs. The 833 opioid-related deaths in West Virginia are always on my mind. Maybe it’s because I care and that I have a conscience. It was unconscionable that medications designed to help people had resulted in their deaths. “It will never happen to me” was the response I heard from all the patients that I had weaned off their medications or decreased the dosages beginning in March 2018. During this time, the CDC issued a new guideline to help combat the opioid epidemic. Now, we needed to wean every patient off opioids or decrease their dosage to 90 Morphine Milliequivalents (MME) by January 2019.
The experience of weaning patients off Soma prepared me for the ranting and intense discontent. Being empathetic and allowing the patients to state their concerns were the keys to my success. However, it was a struggle. Each month, I witnessed and listened to patients complain about increased pain, severe insomnia, and withdrawal symptoms. Some patients felt compelled to use marijuana, methamphetamines, and cocaine to help manage their pain. These patients were discharged from the clinic for illegal substance abuse; however, steroid injections were offered to help manage their pain. To support my efforts to convince patients that they should accept the new guidelines and follow my recommendations for their treatment, I cited several timely headlines that appeared almost daily.
For example, I discussed the fentanyl-laced synthetic marijuana in Connecticut (https://www.npr.org/2018/08/16/ 639133355/dozens-overdose-in-connecticut-park-on-tainted-synthetic-marijuana). Eventually, we reached our goal and every patient’s narcotic intake was reduced to 90 MME per day by New Year’s Eve 2018.
In 2019, patients continued to complain about pain; they still asked for an increase in their pain medications, and they chose other methods to manage their pain including Spinal Cord Stimulators (SCS), Intrathecal Pain Pumps (ITP), CBD oil, and sometimes opting to have surgery again. Many of these techniques resulted in low to moderate success in improving their pain.
While employed at the pain management clinic, I discovered challenges that made me question how I viewed patient care. There was no easy remedy for the daily pain of my patients. The solution was much more complex than I imagined. I realized that this job would not be a career choice; however, me being me, while I was there, I gave my patients the very best version of myself. I taught them about the causes of their pain, suggested alternative medical treatment plans, listened to them, enabled them to vent, and offered them words of encouragement. When the medications that had enabled them to live pain free lives were cut off, they became victims of the solution to the opioid epidemic, America’s nightmare. Though I realize that a solution to the opioid epidemic was necessary, I wonder about the method used to solve the problem. During my two years working in pain management, I came to realize that chronic pain can take a toll on people both emotionally and physically. Moving forward, I came to a deeper understanding and appreciation for the role healthcare workers play in the well-being of their patients, no matter who they might be.
References
CDC. (2019). CDC Guideline for Prescribing Opioids for Chronic Pain. Retrieved from https://www.cdc.gov/drugoverdose/prescribing/guideline.html
CDC. (2019). Prevent Opioid Misuse. Retrieved from https://www.cdc.gov/drugoverdose/patients/prevent-misuse.html
National Institute of Health. (2019). West Virginia Opioid Summary. Retrieved from https://www.drugabuse.gov/opioid-summaries-by-state/west-virginia-opioid-summary
Neuman, Scott. (2018). Dozens Overdose In Connecticut Park On Tainted Synthetic Marijuana. Retrieved from https://www.npr.org/2018/08/16/639133355/dozens-overdose-in-connecticut-park-on-tainted-synthetic-marijuana
Zacny, J. P., Paice, J. A., & Coalson, D. W. (2012). Subjective and psychomotor effects of carisoprodol in combination with oxycodone in healthy volunteers. Drug and alcohol dependence, 120(1-3), 229–232.doi:10.1016/j.drugalcdep.2011.07.006