My Twisted View of Our Nation’s Opioid Crisis

patients suffering because of denial of pain medicine, emergency rooms not taking pain seriously, problems with managing the opioid crisis, ignoring patient pain, failure to treat pain, letting patients suffer in pain
We Cannot “Solve” the Opioid Crisis by Neglecting Patients with Acute Pain

The Opioid Crisis has become one of our nation’s biggest healthcare challenges in history.  More than two million Americans have become dependent on prescription pain pills and other opioids such as heroin and fentanyl.  Drug overdoses are now the leading cause of death for Americans under 50, and deaths are rising faster than ever due to opioid overdoses.  In 2015, more than 33,000 Americans died as a result of an opioid overdose.  In 2016, that figure increased to 42,249 Americans–approximately 115 died every day after overdosing on opioids.

The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

The country is pouring a tremendous amount of money and resources into tackling this issue.   Prominent healthcare centers are taking measures to do their part in thwarting this dramatic rise in mortality.  There is no question that as a healthcare community, we must be involved in controlling this crisis.

Many of our interventions to combat opioid abuse have been effective and life saving.  However, some of the new opioid protocols instituted by healthcare systems may be causing a tremendous amount of harm to patients with legitimate, serious medical conditions.

For example, in response to the opioid crisis, we have shifted the way we triage and treat patients with acute pain in many of our country’s emergency rooms in a direction that is becoming unnecessarily negligent and inhumane.

Several weeks ago, while getting ready to see patients for my Monday afternoon clinic, I suddenly experienced excruciating pain on my left side.  This pain started as a 5/10 and rapidly escalated over the next hour to reach 15/10 pain.  The pain was so intolerable that I could have easily imagined myself delivering four children at the same time with no epidural.  It was stabbing and radiated down my left leg which could no longer support my weight as it trembled from traveling bursts of searing agony.   The pain pierced my back as though a knife had penetrated me repeatedly through and through.  I couldn’t move.  I couldn’t stand.  I couldn’t walk.  I gulped down three Advils and two extra strength Tylenols.

The pills didn’t touch me.

I immediately called my office manager and told her that I was unable to stand up due to pain and I could not make it to work.  I then contacted my mother-in-law who came over and–with the help of a burly neighbor–bravely hoisted me into her car to take me to the emergency room (ER).  I moaned in agony.  I was in so much pain, I knew there was something seriously wrong with my body.  I am a stoic woman, so this was the first time in over 18 years that I went to an ER as a patient.

When we arrived at the ER, I was unable to stand up and nearly fell to the floor.  I told the triage nurse that I was in the worst physical pain of my entire life.  The receptionist directed me to wait in the waiting room.  I waited and a nurse checked my blood pressure, pulse, respirations, weight, and temperature.  Those Vitals were all normal.  I shrieked and moaned in distress for over two hours until a technician transported me to the ultrasound room in a gurney.  She couldn’t find a problem on the ultrasound.

“I don’t know what’s wrong with you.”

The pain got even worse and I began to plead with the triage nurse, “Please let me see a physician.  This is inhumane.  This is unnecessary suffering.”

I remembered all the nights—hundreds and hundreds of nights as a resident physician, and then as an attending physician, that I would drop everything at a moment’s notice to care for patients so they wouldn’t suffer.  I would cancel my own clinic….I would leave family events….I would jump out of bed at 1 and 2 in the morning night after night…..I would stop nursing my own infant children….to rush to be there for patients who had sudden, excruciating pain.

A technician approached, “We need your gurney.  You need to get off of it now Ma’am.”  “Now Lady…..we need this gurney.”  “Get off of it.  We don’t have any other available gurneys.”

I just couldn’t move.  I was in so much pain….I started thinking about how some patients pray for death–or even hire physicians to expedite their deaths–to relieve them of their intense physical suffering.  I started to relate to their hopelessness and desperation.

Had I become invisible?

Had my voice become inaudible?

My husband arrived at the ER and insisted that I be seen by a doctor. “Can’t you see that my wife is in pain?”  There is something wrong with her!”

“The head nurse responded.” “Yes.  But her Vitals are okay and frankly we don’t count pain as a Vital Sign anymore.”  “We can’t just triage patients by pain anymore…you know that hospital policies have recently changed when it comes to pain.  We have new protocols in place we must follow.  We can administer two ibuprofens, but she really needs to go back to the waiting room now.”

My husband said, “She is SHRIEKING.”

The nurse responded back, “We don’t have any rooms and we need the gurney….so just get her off of it and get her back to the waiting room until we are ready to evaluate her.”

My husband finally grabbed the gurney and pushed me into an empty examination room (there were two completely empty rooms!).

I had endured hour upon hour of the worst physical suffering of my entire life at a medical center that I had counted on to be my partner in health.  I felt the exasperation of someone being repeatedly and relentlessly stabbed with a sharp knife while being fully aware that the perpetrator is someone he has trusted and respected his whole life.

I finally got to see a physician who looked at my pelvic ultrasound, examined me, and became concerned.  He ordered the nurse to give me opioids to relieve my pain.  It had taken three and a half hours of desperate shrieks and my husband canceling work to come and fight for me to get to the point of receiving the appropriate pain medicationWith the medication–within less than two minutes–my horrific suffering was over.  My Ob-Gyn was paged to come see me and immediately rushed me into surgery.  I had Ovarian Torsion.  I had a massive 10 centimeter ovarian cyst in my pelvis that had twisted my ovary three times over and my circulation was being crushed by all the twisting.  I was a breath away from losing my organ which could have led to necrosis and septic shock.

No matter how bad our nation’s Opioid Crisis may be, pain should ALWAYS be considered a Vital Sign at hospitals.  Healthcare providers should not bother asking patients about pain, if they plan to ignore it.  We must look at each patient and exercise clinical judgement regarding the context of the pain.  Does the patient have collapsed veins, scars, and bruises from intravenous drug use and skin popping?  Does the patient have a history of abusing pain killers, or a history of unusually frequent ER visits?

I was a physician entering the ER with a badge wearing scrubs and a white coat.  I did not have a history of being a drug abuser.  The last time I had taken opioids was close to a decade ago.  I wasn’t a “frequent flier” (serial visitor) at ERs and Urgent Care Centers.   My last visit to the ER was over 18 years ago after a car accident.

YES.  Pain can be the only symptom that a patient is critically ill.  We must not let a widespread abuse of pain killers destroy our clinical judgement and allow us to neglect seriously ill patients with ominous, deadly conditions who must be treated urgently.  We cannot allow patients–who have legitimate illnesses–to needlessly suffer because of our nation’s new reluctance and avoidance in addressing pain.

Why are we spearheading changes in hospital policies to no longer consider pain a crucial Vital Sign?  This is not the answer to addressing the Opioid Crisis.  We need better solutions.  I am pleased to meet healthcare innovators, like Dr. John Hsu, who take pain extremely seriously and are also working hard to solve one of our nation’s biggest problems—the Opioid Crisis–the right way.  Dr. Hsu and others are building innovative solutions to help eradicate our nation’s deadly crisis without sacrificing appropriate pain control for patients who suffer with debilitating physical pain.

Neglecting or diminishing patients’ pain will never be the right answer to solving our country’s Opioid Crisis, unless of course, we are striving to replace it with a new “Crisis of Inhumanity” at our nation’s health systems.

The Twisted Surgeon MD–Editorial Contributor at DoctorCPR.com: America’s #1 Site for Physician Jobs and Practice Resources.  Join DoctorCPR Today!

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