Drug Dealer

Like most other physicians, I find it very difficult to treat patients with a history of IV Drug Abuse (IVDA) who are always on the "11 out of 10" pain scale, and commonly possess "allergies" to vicodin and all NSAIDs but do well on "that drug that starts with a 'd'". Like they don't know that it's called demerol or dilaudid... It's difficult to feel sympathy when you feel like you are being manipulated or swindled. Mind you, not every IVDA patient acts this way, but I would be lying if I said I didn't observe a certain pattern of behavior.

However, the situation gets even tricker when I perform surgery on IVDA patients and I am directly responsible for the pain that was inflicted. The trouble is that controlling the pain is incredibly difficult because of the low pain tolerance these patients have. The history of IVDA somehow overly stimulates their pain receptors to make them exquisitely sensitive to pain. These patients would have difficulties tolerating a papercut, let alone a huge flank incision for a nephrectomy (easily one of the most painful surgical incision). But alas, a history of IVDA does not preclude conditions like kidney cancer.

I've performed three nephrectomies this past year on patients with a known history of IVDA, and they have been some of my most challenging in-patients. The amount of narcotics needed to get them to calm down is scary, and their pain is never truly controlled. Certainly these are amounts that would normally easily kill (not just one person, but several people!!!), and it worries me immensely. Moreover, when I am filling out my discharge prescriptions, I am writing for obscene amounts of powerful drugs such as oxycodone and dilaudid, and I can't help feeling like a glorified drug dealer.