Archive for Drugs

(No Way I’m) Using Methadone for Hospice

Methadone should be lumped with the “opioid crisis,” right?

If asked about methadone before working in hospice, one image would have immediately surfaced for me: people lined up at a clinic, anxiously awaiting their dose.

The image included a rundown neighborhood, a mix of scraggly men and weary women angling around a building. There would also be protestors with handmade signs (“Keep drugs away from our children!”). And maybe—if depicted by a Hollywood film—a black and white police cruiser would patrol the street. Those crowding the clinic are lowlifes, bums, and losers, addicted to a terrifying opiate like heroin, but now feeding their vile habits with a “safe,” prescribed substitute.

Grim, eh?

What comes to your mind when you consider methadone?

Maybe nothing.

But if you do have a thought, it probably is based on a movie. It’s a story on the mean streets of New York with old Al Pacino or young Ryan Gosling as a loner cop. If your thoughts weren’t from a film, then it was a 60 Minutes piece, a Law & Order rerun, or a hazy recollection when you were lost in the rundown side of chilly Milwaukee or sunburned Miami searching for a college roommate’s address. Regardless of the source of your fragmented memory, you “know” about methadone: it’s for drug addicts. Sure, people may need a physician’s prescription to get a dose, but it’s not much different than the various illegal or over-prescribed drugs that are currently wrecking far too many lives. Methadone should be lumped with the “opioid crisis,” right? Read More →

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Morphine: the Best Drug at the Worst Time?

The hospice nurse has strongly suggested using morphine for the patient’s increased pain.

You are the patient, still alert and oriented, able to make your own decisions. What will you say to the nurse?

You have the authority—the durable power of attorney for health care—to make decisions when your loved one is unable to choose. What will you say to the nurse?

Every person and family is different. Some, when faced with the toughest decisions in hospice (like starting morphine for pain management), surprise themselves when they are all in agreement. Other families, who may easily agree on whose house to go to for Thanksgiving, or the right gift for Mom and Dad’s fortieth wedding anniversary, either debate or procrastinate about morphine as an option. And nearly every hospice professional has encountered a chaotic, angry, opinionated—yes, over-the-top dysfunctional—family that seems to go to war when a drug like morphine is a loved one’s suggested next step.

Morphine is an effective, scary, and powerful medication. It often becomes the tipping point for resisting or accepting hospice’s comfort care philosophy. Read More →

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Drugs, Doses, Dread & Delivery Options

pills

Around breakfast time, I usually shake out several pills into the palm of my hand . . .

The nurse arrived and sat beside my mother in the dimly lit hospital room.

One of the first things he said was, “This won’t hurt.”

He lied.

He was there to place a peripherally inserted central catheter (PICC, or “pick”) into Mom’s upper right arm. She’d been offered Dilaudid—a brand name for hydromorphone, a narcotic stronger than morphine—for pain management. The medication would be housed in a CADD pump (Computerized Ambulatory Drug Delivery) connected to her PICC line. The linked pump and the catheter would give a predetermined, regular amount of medication to ease her physical agony. A “button” could be pressed on the CADD pump for additional dosages.

Are your eyes glazing over with all the medicalese?

Mom’s body was riddled with cancer and the two surgeries undertaken to “relieve” discomfort had added complications. As I calmly write this three years after her death, I understand why she said “Yes” to that PICC line: she wanted the wrenching pain to end and she was ready to die.

But the nurse, who seemed rightly weary in the near midnight hour when he entered Mom’s room, first caused more pain.

He swabbed her arm with disinfectant and inserted a needle.

She grimaced.

I held her left hand. Watching her tore my heart apart. Read More →

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