Transcript Types of Painkillers (synthetics typically give better highs)

ISSUES IN OPIOID ASSESSMENT
 Types of Painkillers (synthetics typically give better highs)
 Short acting: Lortab (very common), percocet, vicodin
 oxycontin lasts 12 hours; ms contin – morphine sulphate;
lasts 12 hrs.
 24-hr ms contin now available(kadian?)
 duragesic fentanyl patch lasts 3 days; check used patches
for tampering (can get patches on the internet)
 ultram (not an opiate)
 some may combine soma (a muscle relaxer) and lortab
gives good pop
Assessing Need for Narcotics (opioids)
 realize very few chronic pain clients are “addicts”
 assess for prior and current alcohol/drug problems
 assess for self-medicating of psych disorders
 do drug screen; do they already have drug in them? Are
they diverting their meds to the street? (oxycontin going for
about $1 per milligram)
 check pharmacies for multiple rx
 assess pain level on and off meds – are they helping
functioning?
Assessing Need for Narcotics (opioids)
 check compliance with medical tx – if client only wants
narcotics, be suspicious…are they willing to sign a
“medication use” agreement/contract?
 are there secondary gain issues involved? (e.g., workmens
comp.) poorer pain tx outcomes are associated with those
in litigation.
 type and dosage of drug currently taking; in some,
tolerance is so high that withdrawal symptoms (increased
pain) may occur when taking a typical dose
 rural vs. urban setting: rx drug abuse worse in rural areas
Assessing Need for Narcotics
 chronic opioid tx not appropriate for:
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those with active addictions
those who use etoh (liability)
those who refuse other types of tx
when QOL not improved after use of meds
 for those with previous narcotics problems
 opioids not given for lengthy amounts of time
 need to be in tx / NA
 client may underestimate risk of relapse
Other Forms of Pain Management
 epidural nerve blocks
 Biofeedback
 radio frequencies; zap
 physical therapy /
nerve and deadens for
up to 6 months
 electrical stimulation:
blocks pain signals
 relaxation techniques
chiropractic
 Acupuncture
 morphine pump in body
 other medications
 Antidepressants
 Neurontin