Uneasy alliance: pain, opioids and trust

January 13, 2016

We, as a society, can’t ignore these numbers: over 47,000 human lives lost prematurely in one year from drug overdoses, a 7% spike over the previous year, with opioid painkillers and heroin driving much of this tragic surge. If this trend isn’t disturbing enough, four out of five new heroin abusers began their habit by abusing painkillers.

These numbers have faces. Caring for patients who abuse and overdose from opiates and other drugs are a growing constant in my practice. Meanwhile, pain is a common reason why patients come to the emergency department and alleviating their pain, or making it bearable, might require an opioid painkiller.

This sets up a tense interior dialogue whenever I’m considering an opioid. Am I treating pain or feeding an addiction, or maybe both? Am I fulfilling a moral gesture by providing comfort to someone in distress or contributing to the supply chain in the illicit pill economy, or perhaps both? For this patient, on what side of the firestorm would I find the burn from being wrong most bearable?

These are often unanswerable questions, and stumbling to a response often leaves me sick with feelings of anxiety and inadequacy. Read the rest of this entry »


Healthy Selfies?

January 4, 2016

As a practicing emergency physician for the past 27 years, I have used technology to care for emergency patients in many different ways. Recently, I got a dose of technology from the other side.  A college student, who was so intoxicated that her friends thought she might stop breathing, was brought by ambulance to our hospital.  After a few hours, she sobered up enough to ask if she could take a selfie with me in the emergency department. Despite the great opportunity to be in a new realm of Facebook, Instagram, or Twitter friends, I politely refused. But, it got me thinking.

Surely, the mushroom cloud of selfies that is e-streaming around the planet can have more than a self-indulgent purpose.  Can selfies be used to educate about health and promote healthy behaviors?  Maybe I should have agreed to that selfie with the recovering college student while I held up a sign that said “Know Your Limits – Don’t Binge Drink!” Read the rest of this entry »