Methadonian?
What a lot of commotion over this term. I never encountered it before in my sheltered life, but I like it.
Is it disrespectful?
It suggests that the methadone is in control of the person. And that’s bad.
We must do everything to empower those battling addiction to free themselves from their opiate dependence.
It isn’t the recovering addict’s fault – the addict is powerless. 12 step 101, first day of class.
So, it seems to me that those claiming offense are not stating that the term is inaccurate, just that it is not respectful enough of the addict’s predicament.
GuitarGirlRN (GG) describes the patient (in the original post and comments) as sleeping soundly and requiring naloxone to be awoken. This sounds like someone who has taken an opiate dose that is a little bit above what he normally takes. Addicts develop tolerance. Tolerance means that more is needed to produce the same effect as the original dose. For addicts (including habitual users of methadone) this can mean a dose that would kill a non-addict.
This seems to be the primary reason for 911 calls for heroin overdose,or whatever opiate of the day was consumed at a greater than therapeutic dose). TRA (The Recovering Addict), this one entering the relapse stage of recovery, has not had any heroin for a while. In the spirit of Oscar Wilde, TRA decides that “the only way to get rid of a temptation is to yield to it.” Our TRA is only an amateur pharmacologist and is dealing with a less than pharmacy grade supplier. TRA self-prescribes a dose that is consistent with his daily dose when tolerant. This tolerance no longer exists.
TRA does not have a syringe of naloxone handy when his breathing slows to a dangerous level and/or stops. TRA is accompanied by someone who would be able to inject naloxone into TRA‘s calcified veins, but without any naloxone the only ethical recourse for the fellow more than recreational drug user is to call 911. Tolerance changes the response of the addict so much that it can mean the difference between breathing (something that appears to be essential for life) and not breathing.
For a methadone tolerant individual to get to the point of requiring naloxone to wake up requires significantly more than his normal daily dose, probably several times the dose he needs to get to his therapeutic level. This might occur if he were to consume several days worth of methadone, but this is only speculation and not meant to suggest that anyone in the methadone-dependent stage of recovery would do this.
As was mentioned in several comments – methadone does not get you high.
Good to know. Tell the Methadonian. He appears to have consumed all of his methadone in an attempt to get high. Maybe he consumed heroin, or fentanyl, or some concoction of a little from column A and a little from column B. He is presenting as one who has overdosed on an opioid. He was assessed by GG, treated for this assessment with naloxone, and he improved to the point where comorbidities could be ruled out, then he was discharged.
Prior to leaving he was observed engaging in criminal activity. Stealing hospital supplies that might be needed in that room for the treatment of a true emergency patient. If the resuscitation bag is not present, you hope that the emergency patient is not so hypoxic that the emergency patient actually needs ventilation right away. After all, that is not what an emergency department is really for. The ED exists to cater to those who think only of themselves, but deserve respect while engaging in their monomanias.
GG could have called the police, there might have already been an officer in the ED dealing with one of the methadonian’s ethical brethren.
Can methadone get you high?
I do not have any direct experience consuming methadone, but my experience with people telling me that a drug cannot do A, or only does B, is that they do not know what they are talking about. That individual might be accurate in stating that taking methadone – at the doses that they are accustomed to using – never made them high. Generalizing from that to eliminate the possibility of anyone getting high is a mistake.
Some people like their intercourse with whips and chains, others find this ruins the mood. For one to insist that the other could not possibly derive enjoyment from their particular style would be wrong. Just as it is wrong to assert that one cannot get high from methadone. If methadone does not get the person high, then the apparently common practice of adding a benzodiazepine seems to help create a high.
Perhaps TRA had mixed a benzodiazepine, an opioid, and whatever adulterants might be mixed in. The result was apparently not what TRA was looking for.
Was there anything inappropriate about GG’s post?
Only some of the comments accusing GG of less than exemplary treatment of a patient. A patient treating GG far worse than he had any right to treat anyone. A patient who should not be encouraged to frequent the ED to stock up on methadone.
Sorry for the harsh tone, but GG did not deserve any of the abuse directed toward her. Nurses receive more than enough abuse on a daily basis and a little editorializing about the rough day is a healthy thing.
Updated formatting and links 10-27-10 – 22:40
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Welcome. I pretty much stay away from most of the medical blogosphere since I need no reminders of why leaving the bedside was the best thing I ever did.That said, I gotta ask:What do you think of the state of EMS education and the role of physician medical directors?*grin*
Great inaugural post, sir. As I suspected, those who were chastising poor GGRN either were addicts themselves or live in a world teddy bears cure cancer, and “can’t we all just get along.” Idealism is great but one should not abandon reality to be idealistic. ‘Methadonian’ as a label that refers to someone on methadone doesn’t seem all too disrespectful to me. People are FAR TOO DELUDED in this world of PC nonsense anyway (if you ask me). GGRN is well within her rights to write whatever she likes and if she wants to call them Junkie Scum Sucking Oxygen Bandits… well that’s ok with me too. But I’m not judgemental
Seriously, what most of those idiots who responded fail to realize is that calling someone a name or categorizing them (in a blog mind you)says nothing to her ability to act professionally. One can remain compassionate and caring even when you think the recipient of that care is a total loser. Elitism and compassion are not mutually exclusive characteristics.Assholes get sick too.It has been my experience that those individuals who are in the throes of addiction are, by definition, very self-centered and often manipulative. Understanding this helps the astute clinician sort through the presentation and make more informed decisions. At the same time, most of us treat them with great care despite being rewarded with the occasional lying, stealing, spitting, and threatening behavior.
Holy moly! Most people go through the usual stages of starting a blog, but not you! You canon-balled straight into the deep end of the blog pool. Outstanding.
Whoa! Great post and thanks!I’m flattered that you thought my crazy comments section mention-worthy.Welcome to the blogosphere!
You may not have ever consumed methadone, but I have. (One pill, one time.) It sure felt like what I would imagine taking a whole handful of percocet all at once would be like. Now, maybe that’s not what heroin users consider “high”, but it sure as hell had an opioid effect.
So it had an effect perhaps similar to what you would expect from a potent, long acting opiod?I have been so gullible.
You have a great site here. I hope you don’t mind my stopping in. Good posts!