Dangerous pain meds, OD's and pill organizers

[mmglobal]

I recently heard from a friend of mine who has been a spiney for many years. He’s very well educated and has taken a very reasonable and conservative approach to his spine problems and his medications. He told me about a very severe problem he encountered weeks before.

He’s not exit exactly sure how he did it, but he wound up in the ER with an overdose. It’s even much more serious than this as he went from the ER to the ICU. It’s not like he just spent a day or two in the ICU as he was there for more than a week. Several of his systems were shutting down. He damn near died.

I’m not putting any of the details in, because they are not relevant to the discussion I want to have. Based on what I have written, you all understand the seriousness of this issue. Any of us who take high dose opiates could be writing this. The person who this happened to has no history of substance abuse and was NOT abusing his medications.

While the big scary warning about high dose opiates is important, the discussion here will be about a much more mundane topic. Like most of us here, I am constantly battling the balance between medications, activity levels and pain levels. I’m not sure it’s the best way to go, but I believe that I under-medicate most of the time. I don’t believe it’s possible to take enough meds to be comfortable and functional. I don’t take higher doses on a daily basis because I fear the consequences of continuing to ramp up my opiate levels. Because I do this, if I have an activity that I really need or want to do, I can increase (or even double) my meds without being drowsy or would have difficulty driving or functioning. If my baseline does was higher increasing my meds and trying to function would be dangerous.

I can’t take my meds without a pill organizer. Maybe its age, maybe its years of chronic pain and medications, or maybe I’m just an airhead; but if I can’t look to see what’s remaining in my one day supply, I am at risk for making mistakes with my meds.

I’m lucky that my pain levels are low enough that I can get by on smaller doses. Many of my clients take three or four times what I take (and even more) everyday. On these high doses taking the even one extra dose can put you into a stupor. If you were to make this mistake, the risk of mistakenly taking another extra dose is even higher. It’s easy to see how dangerous this can be and how even the brightest of us can get into trouble.

Unfortunately, nobody makes a childproof pill organizer (that I can find.) With a toddler in the house I worry about the meds and would feel too unsafe without childproof containers, but I still need the organizer. I fake it by the organizing a week’s worth of meds at the time into ”daily” childproof bottles. It’s not the best system in the world but it works for me.

All of this seems so obvious that we shouldn’t have to discuss it. But my friend almost died and we both think it’s an important topic that should be discussed. Years ago a member of the BrainTalk spinal disorders forum died because it of a mistake in her meds. I’m surprised we haven’t seen more of this through the years.

OK… off my soap box for now. I look forward to what the community has to say about this.

All the best,

Mark

[Maria]

Mark,
I think when one is taking multiple medications and/or is taking higher doses of pain meds esp.opioid pain meds or is having difficulty remembering if and when a dose is taken the daily medicine containers are very helpful It would be good they had a lock feature however one can put the container in something that locks if necessary.

I take a great deal less than I used to take of Neurontin so now I know a half a 600mg pill and I bite it so I know when I do that daily. I take two 5mg pain pills and I'm very good about remembering now if I've taken them or not because I take it every 24 hours and usually wait until I start to feel GI symptoms that start when I haven't taken the drug w/i the last 24 hours.

What I'm trying to say I don't use the daily containers. I take considerbly less medicines than just several months ago. Still would it be possible for me to double my dose if I were preoccupied or just overwhelmed w/life and daily occurences, in a rush or something of this nature.. probably. Would it be better if I used the containers, probably.

What you're advocating makes perfect sense and is a good thing do do. For someone living alone and on a number of medications it might not be a bad idea to get something like "Life Alert" and have a lockbox on the door with extra set of keys and Life Alert people know combination to lock box should paramedics need to get in.

Also if living with someone like husband, wife, partner it's a good idea to have a typed up list of medications and conditions taking medication for available should paramedics have to be called with list of any allergies and medical history.

One can wear a medical band w/conditions/allergies if they want to do this or some kind of attractive medic alert necklace even.

There are potential for interactions of medications so even before popping an OTC remedy for itching, cough, or ?? we should remember to ask the pharmacist and also check a list of interactions. It's our responsibility to report prescription medications and OTC meds/supplements as well to pharmacist/doctor/treating provider. Various drugs can have a synergistic effect or potentiate the effect of a drug we are taking so it's important to know if that might happen. Talk to the pharmacist when planning to start any new medication and make sure to ask about potential interactions of these nature.

When starting any new medication if possible start it in the presence of another person or let someone else know if you live alone that you are going to start or stop a medication just in case you're not seen for a period of time and could someone check in to make sure everything is OK.

If one drinks remember there are certain types of alcohol that pack more of a wallop than others and may really do a number on that surpressing the resp. center along with an opioid medication/pain meds. Mixing alcohol and drugs can be lethal.

Even tho we may take all these precautions some oddball situation can happen however we have to make our best efforts to minimize this which I think is what you are getting at esp. given we are taking some "mind altering" medications.

I've had 2 near experiences happen to me in the past and the first was dehydration while walking (didn't realize that Morphine would dry me out that much while walking by the beach in the hot sun) and the 2nd was nearly burning my house down by falling asleep while cooking (had sat on the couch in the living room and fell asleep).

I do remember the Braintalk person that passed away because of the dose discrepancy in meds that she was taking and what it was supposed to be. That was really tragic. I am so glad that our person here ultimately was Ok tho what he went thru was of the most serious nature so it is extremely important that we are as careful as we can be with our meds and set up a system of checks and balances that help us out as we may tend to be forgetful (as well as other things).

[dshobbies]

I began using pill organizers because I take so many on a daily basis. I find them invaluable, organizing a whole month's worth upon refilling. When taking Neurontin, I used one for each day, organizing by time of day.

I also keep a list of current meds on the computer to keep in my purse. They're always asked for at every doctor's appointment - I just give them my pre-printed list and print myself a new one. Very easy.

Also, I may be a little anal on this one - I keep my medical history on the computer and print it on labels when visiting a new doctor. While filling out all the paperwork, I stick my preprinted personal info, med history and current meds on the doctor's form. (Should mention I use shipping sized labels).

[Maria]

Re print outs of medical history/meds and so forth. Can really make it clear and concise that way and make sure the correct info is entered w/ea practitioner.

[marijo]

Today I've felt wiped out for some reason. I think its medication related. I dont find that my pain is very well controlled at all, but I can't really go any higher with anything or I would spend my whole day asleep, or feeling ghastly, which is what happened today. Fortunately I was able to take a day out. Hopefully tomorrow's better. Ideally, I'm trying to lessen the doses of some of my medic ations. Not sure whether this is a good idea though.

[Maria]

With permission of a friend posting her experience.
On Methadone 40mg/day, Neurontin 1200mg/day, and Fioricet up to 6 pills/day (sometimes more) and switched from Fiorinal because of aspirin component (can no longer take).

She had several episodes of becoming irritable, confused, talking but not making sense, slurring speech, very dizzy, falling. Was hospitalized the first 2 times tho no real diagnosis even tho medication list given. She says that she didn't think her lab testing included testing for prescription pain meds.

After first discharge from hospital seen in PM's office complaing of continued high pain levels despite current Methadone dose. She had lost 30 lbs w/in several weeks (was tested in hospital for various conditions that might explain weight loss and symptoms but all testing negative).

PM not there however NP covering office switched her to 10mg Methadone every 6 hours vs. every 12.

Monday she was diagnosed with overdosing on Methadone in ER.

I'm not a doctor and certainly not a PM however I was an NP for a number of years and have taken Methadone myself for 9 years. My recommendation would have been not to increase the interval/frequency however to perhaps after reviewing all labwork and history to increase her dose by 5mg intervals and keep medication at every 12 hours.

I'm sure there are persons that can be increased that much or that dose at least however I just don't think it prudent overall with a drug of this catagory and potential for resp. depression/side effects.

Personally I think she's taking too much Fioricet and as a friend I've advised her to "cut down" as she uses it for her back pain vs. migraines and her doctor prescribes up to 200 count which she has used all in one month. She was advised medically to cut down on the use of these as well. What she did cut down on tho I don't think was warrented was Neurontin as she has siginficant neuropathies but I'm not sure she was thinking clearly when making that decision in terms of self treating and thought it might her as it has helped me ( I'm not experiencing neuropathies or I would take it as I've explained to her a number of times but I think her comprehension had been affected).

This is an educated person who worked as a nurse all her working career however I think got caught up in pain control and self treating on her own schedule with some meds tho the lastest Methadone increase seemed wrong to me.

And BTW ~ she was using pill organizers so she would not take Methadone more that 4x/day. An increase of 20mg/day is alot to me and it's confusing to take it 4x/day vs. 2 as far as I'm concerned.

Talked to her yesterday and she's doing OK. Advised her to f/u with her PM STAT because they need to know what happened instead of waiting 3 months from now until she's seen again. I would hope this is not common practice in that office tho ??? Again maybe I'm incorrect but that didn't seem like a well thought out prescription increase/plan to me. In any event letting our physicians know the outcome of something that didn't work out well for us or could have had fatal or a very bad outcome definately has to happen~ that continues to be our responsibility as well as long as we're still breathing.