Concerns over pain relief and opiate tolerence

[poppy]

In common with most people apart from death, one of my greatest fears is experiencing immense pain,like worse than childbirth type pain. Therefore I wonder what would happen to me if(God forbid) I was involved in some sort of accident which left me in raging agony and requiring pain relief. Firstly there's the tolerence problem, obviously as someone who still uses on top of a pretty large methadone maintainence script, my tolerence to opiates is far greater than your average man/woman on the street, so would the paramedics/docs or whatever give me enough pain relieving drugs to manage the pain,or would they just leave me to suffer, saying I should have thought about this when I was abusing myself with smack. Should one carry something to alert people to this tolerence,and what medication I take, a bit like those necklace things which tell people that you are a diabetic or alergic to penicillin or whatever. Secondly as someone with totally fucked up veins in her arms how would they administer the necessary pain relieving drugs. A couple of years ago I had to have some minor surgery and it took the anethnetist(excuse bad spelling) almost an hour to find a vein and that was a tiny thing in the top of my foot, so how on earth would someone find a vein in an emergency situation. If I really think about this it worries me to death ( I should point out that I have had the sense to leave my groin veins alone, the big one in my neck and my feet, but my hands and arms are well and truely fucked) Its also something for anyone considering IV use to think about before they embark on it and end up with no veins, particularly women who generally have much shittier veins than men (typical, us girls always get the raw deal). Your ideas on these issues would be appreciated thanks Poppyx

[katomic]

Poppy you shouldent worry so much. I dont know about meth but morphine has no celing dose.:)

[candy]

Hey Poppy,
I imagine that pain control is a concern some have and it is true that those with a tolerance may be harder to treat as far as pain control. But, worrying yourself sick is not worth it. If this is something that you are really having trouble with, then it may be a great excuse to stop using. I don't say that with any sarcasm, just being sincere.
I have had thoughts about someone needing to get an IV on me as well, but usually when I was trying to find a place to hit. Being a girl myself, I don't have great veins either.
But, in an emergency, you would be surprised what they can do to get an IV.
Just popping someone in the Trendelenburg position and boom, you have an IV in the neck. Of course this helps if you are experienced and know how to locate the jugular. I really try to have those looking for sites to avoid using the jugular veins or any area in the neck. Risk of hitting an artery are great and because these veins are closer to the lungs, the chance of an emboli are greater.

I have not known many injectors who were experienced enough to hit the femerol vein. But, in the case of an emergency, most medical personal who will start an IV are familiar with these sites and are pretty good at getting an IV in. You would be surprised at the areas on the body that most of us are not aware of.

Your concerns are real and if they are bothering you or causing you distress, then maybe it is time to stop using and getting into shape. It may help to alleviate some of your fears and get your circulatory system back into shape.

[duke_nemmerle]

I won't pretend to be the utmost authority or anything and maybe Candy can help me out here. But I could've sworn that I read(I think it was in a meth pamphlet or info site) that abuse of opiates only gives a tolerance for the euphoric affects of opiates. I was under the impression by this unremembered info source that the analgesic effects of opiates was almost untouched by abuse?

This very well could be wrong though since opiates have more of a psychologically (ie the buzz is so good you don't care) induced analgesia rather than actually blocking pain receptors like an NSAID. I wish I could remember where I heard this and if it was reliable. Anyone else?

[candy]

Hey Duke,
First off, let me say that opiates as we know change our perception of pain. NSAID's work by actually going to the site of pain and decreasing inflammation at the site, thereby decreasing the pain. Generally anytime you have pain there is usually an inflammatory response as well. So, when you decrease the inflammation, you decrease the pain. Opiates work by changing our emotional and physical perception of pain by binding with opiate receptors. That emotional component is where I would imagine the euphoria comes into play and why we find it so damn enjoyable. Hell, when I was using, I rarely could care less what went on around me. Basically I was numb.
But, your right, we do lose that euphoric feeling and along with it our tolerance grows. I would say that as our tolerance grows, we do need more of the analgesic effect as well.
What generally happens in a medical setting is that most of us who are using opiates are undermedicated when it comes to pain. Either the physician does not understand the mechanism of pain and how opiates come in to play or they just figure we can tolerate pain because of our long history of abuse.
Regardless of how long we have used, we still feel pain. But medicating someone who has used can be tricky, but it can be done.
Take those who are on Methdone. Most docs feel that they are already getting enough of an opiate or opioid to cover their pain. Untrue as most of us know. But, someone on Methadone can still be relieved of pain and have good control. It just takes some patience and maybe trying a few stronger faster acting opiates. Unfortunately, most docs just are to impatient or lack the understanding of pain management.

You would think by now most docs would understand how pain management works. Take someone hooked to Vicodin because of poor pain management. Instead of changing the patient to something stronger, they continue to increase the dose to the max and the patient begins to self medicate or double up on their meds to meet their needs. Now their relying only on Vicodin and still dealing with pain. With good pain management, you can control someone's need to self medicate and give them good pain control. Weening them if that becomes an option can be easy as well, if done right and with a doc who knows pain management.

Does that answer your question! Generally the rule is that we require a stronger, faster acting opiate to deal with moderate to severe pain. If NSAID's work for minor pain than go with those.

[duke_nemmerle]

Hey Duke,
First off, let me say that opiates as we know change our perception of pain. NSAID's work by actually going to the site of pain and decreasing inflammation at the site, thereby decreasing the pain. Generally anytime you have pain there is usually an inflammatory response as well. So, when you decrease the inflammation, you decrease the pain. Opiates work by changing our emotional and physical perception of pain by binding with opiate receptors. That emotional component is where I would imagine the euphoria comes into play and why we find it so damn enjoyable. Hell, when I was using, I rarely could care less what went on around me. Basically I was numb.
But, your right, we do lose that euphoric feeling and along with it our tolerance grows. I would say that as our tolerance grows, we do need more of the analgesic effect as well.
What generally happens in a medical setting is that most of us who are using opiates are undermedicated when it comes to pain. Either the physician does not understand the mechanism of pain and how opiates come in to play or they just figure we can tolerate pain because of our long history of abuse.
Regardless of how long we have used, we still feel pain. But medicating someone who has used can be tricky, but it can be done.
Take those who are on Methdone. Most docs feel that they are already getting enough of an opiate or opioid to cover their pain. Untrue as most of us know. But, someone on Methadone can still be relieved of pain and have good control. It just takes some patience and maybe trying a few stronger faster acting opiates. Unfortunately, most docs just are to impatient or lack the understanding of pain management.

You would think by now most docs would understand how pain management works. Take someone hooked to Vicodin because of poor pain management. Instead of changing the patient to something stronger, they continue to increase the dose to the max and the patient begins to self medicate or double up on their meds to meet their needs. Now their relying only on Vicodin and still dealing with pain. With good pain management, you can control someone's need to self medicate and give them good pain control. Weening them if that becomes an option can be easy as well, if done right and with a doc who knows pain management.

Does that answer your question! Generally the rule is that we require a stronger, faster acting opiate to deal with moderate to severe pain. If NSAID's work for minor pain than go with those.

Thanks candy, that's sort of what I was going for but you said it 100 times better :)

[GMorris]

...Secondly as someone with totally fucked up veins in her arms how would they administer the necessary pain relieving drugs.

Uhh, maybe you're forgetting that not ALL pain medication is administered IV. In fact, with paramedics you're more likely to get
an IM or SC shot if they administer one at all. It might take a little bit longer, but it WILL still work about the same!

[poppy]

You're right I hadn't thought of that, cheers it gives me some reassurance. Actually thinking about it, long before by heroin addiction problem, I was given pethidine during childbirth IM, when I already had an IV drip set up, and whilst it didn't seem to do a great deal for the pain at the time, it did allow me to gauch between contractions. Thinking about it that was my first opiate experience!!!

[candy]

Hey G-Morris,
Not to contradict you, but in my experience, most often an IV is established out in the field. Meaning, if not always, an IV is established to give meds through. I really have not heard of paramedics giving IM's or SC injections when out in the field. Because of the many problems that can go wrong, an IV is always established, unless absolutely impossible, but those guys are trained to start them just about anywhere. Most emergency meds cannot be given IM or SC and need to be given IV because of their action and how fast they work.
When I first started working in the ER, I did work transport and on LifeFlight and I did not see many if any drugs given IM or SC. One of the first things we do is establish an IV line and in the case of someone who injects, I always used the jugular vein. It's a large vein and rarely gives you any trouble. Not to mention, it is easy to hit. And the paramedics are trained to hit the jugular as well, if needed.

So Poppy, don't worry. If you ever do need emergency care, remember that those who reach you first are trained to deal with all sorts of things.