Dr. Kube: Amid overdose cases, crash victim with drug abuse past declines pain meds

While working several overnight shifts in the Emergency Department (ED), I had noticed an increase in patients coming in for drug overdoses. We had received an alert from the health department that there was a “bad batch” of drugs circulating in the city. These “bad batches” are drugs that often contain fentanyl mixed in with heroin, cocaine and sometimes even prescription drugs, which leads to an increase in overdose deaths.

I had already seen a young woman named Melissa, who had overdosed on pills she thought were Percocet, stopped breathing, and was revived with an overdose reversal drug called Narcan administered by a bystander. She had come to the ED via ambulance and had started vomiting as she arrived in the ED.

I gave Melissa nausea medications and observed her for several hours to ensure she remained awake and was able to eat and drink. Ultimately, she was able to be discharged from the ED. Before she went home, she met with our team of counselors and social workers who assist patients who have overdosed or abused drugs and was offered resources for drug addiction treatment. Unfortunately, despite our best efforts to get her to commit to going to rehab and getting clean, she felt she was not ready to make that change in her life and she went home. I had really been hopeful that her near-death experience would have changed her outlook and made her realize the seriousness of her illness.

After Melissa, I saw another patient who had overdosed on pills he took at a party where his friends called 911 and the paramedics treated him with Narcan. He was not happy that he ended up in the ED, and requested to leave shortly after he arrived. He refused to talk to our ED social worker and said he had no interest in quitting his drug use.

One of my next patients was a young man named John. He came into the ED after being involved in a car accident. By how the night had been going, I wondered if he had been under the influence of drugs as well. There had been a storm that evening that caused a tree to blow over across the road. He swerved to try to avoid hitting the fallen tree, but the front of his car slammed into it. He managed not to hit his head or lose consciousness in the accident. But when he tried to get out of his car he realized his right leg was broken and he was unable to walk.

The paramedics immobilized John's leg in a splint and brought him to the ED. The paramedics offered him pain medications during his ambulance ride, which he had declined. I saw him immediately on his arrival to the ED and after quickly assessing his airway, breathing and circulation, I turned my attention to his leg. He had swelling and obvious deformity of his right lower leg. I ordered an X-ray of his leg and consulted orthopedic surgery for management of his leg fracture. I asked him if he had used any drugs or alcohol, and he assured me that he had not.

I offered him pain medications as I could see he was in pain. He declined, and I asked if he was sure he didn’t want something because I could tell he was miserable. He initially seemed reluctant to talk, but after I assured him that he could talk to me, he opened up. He told me that he had a history of drug abuse. He had a history of severe anxiety and PTSD, and despite his parents attempts to get him psychiatric help, he turned to drugs. He said the psychiatric medications he had been prescribed were not helping his symptoms. After experimenting with various recreational drugs, he began using them more and more.

It wasn’t until he had an unintentional near-death experience about a year ago with an overdose where he was revived with Narcan that he realized how out of control his life had become. He had been seen in the ED at that time by a drug treatment team, much like my patient Melissa. He decided that he needed and wanted to make a change in his life. He went directly to a drug rehabilitation program.

In the rehabilitation program, he received medication-assisted treatment for his withdrawal symptoms, started seeing a therapist and he attended group sessions with other patients who were in drug treatment. He said he felt more clear in his head than he had in years and was truly motivated to get himself better and to get his life back on track.

He had also started regularly seeing his psychiatrist and started psychiatric medications to treat his anxiety and PTSD. He recognized that he had started using drugs to self-treat his mental health conditions and knew that he would have to stay clean to continue his forward progress. While he was in pain from his car accident, he was very reluctant to receive narcotic pain medications due to his history.

I was grateful that John was honest with me regarding his history, and I praised him for overcoming his addiction and properly managing his physical and mental health. We discussed with him a plan for treating his pain that would not interfere with his drug treatment and contribute to further addiction problems and he was very relieved.

John was feeling a lot better after his leg was immobilized in a splint, was elevated on a few pillows, and had a large ice bag placed over the splint. Orthopedics evaluated John in the ED and planned to fix his leg fracture with a surgery the following morning in the hospital.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.

drerikakubemd@gmail.com

This article originally appeared on The Columbus Dispatch: dr-kube-grateful-for-honesty-of-past-addict-who-declined-pain-meds