Archive for Drugs

The Wonder Pills

Hospice is one of the rare times when all the medical professionals involved in caring for a patient are on the same page.

I wonder how this relates to medications.

Prior to hospice care, it’s not unusual for one doctor to prescribe a pill for your cranky prostate and another doctor to make sure you’re taking a blood thinner and a third doctor to suggest an antidepressant. You, the thoughtful patient, will mention the various pills you’re taking to each physician. If a new doctor claims that a new “wonder drug” is worth trying, you will also tell him or her about the other medications. The doctor(s) will assure you that everything is compatible. The nurse(s) are also reassuring when you worry about your growing list of pills, tablet and doses. The pharmacist(s), of course, will add insights.

So many voices! So many pills!

Nowadays, as we grapple with the illnesses that come with the accumulation of birthdays, our medicine cabinets can become chock-full of prescription bottles. We want to feel better. Take that pill. We want to return to what we once felt like. Try this pill. Grace Slick of the long-ago ‘60s rock band Jefferson Airplane, famously sang . . .

One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all
Go ask Alice, when she’s ten feet tall… Read More →

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(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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