[smackingly]

5th vital sign is urine output :)

What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want.

I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin.

It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor.

I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin.

There's no easy solution to this problem.

[DanBC]

> 5th vital sign is urine output :)

US doctors began prescribing many more opioids after a campaign by the VA describing pain as the 5th vital sign. Doctors began having to ask people about pain, which meant they had to treat that pain. The VA also said that opioids are not addictive when used to treat pain. They're not so addictive when used to treat acute pain, but they're more addictive when used to treat chronic pain. Very many more people got opioids to treat chronic pain because of this campaign.

https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

> It's an extremely complex and difficult problem. I think doctors are taking too much of the blame.

A lot of americans get opioids from doctors.

https://www.cdc.gov/drugoverdose/data/prescribing.html

> An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings

> However, primary care providers account for about half of opioid pain relievers dispensed.

Some states have between 93 and 143 opioid prescriptions per 100 people!!

[smackingly]

Yeah it was kind of an inside joke, as urine output is really important in critically ill patients and I have to constantly remind my residents and nurses of that.

As for the VA's campaign: yes, I remember it. And it's why we have those emoji scorecards all over the hospital. Which doctors never use. My subjective opinion is that we still vastly under-treat pain in the acute-care setting.

And I could talk all day long about how stupid the VA health system is.

[Retric]

I was given strong Opioids (Hydromorphone etc) for less than 3 weeks after major surgery. They clearly worked, but even that much exposure IMO was not worth the risk as I very quickly started to get cravings.

Even without getting high, freedom from pain is a ridiculously powerful motivator. And because they have such strong peaks and valleys you make a very strong association with those pills.

[alexandercrohde]

I was given a 30 day supply of oxy-something when I had my wisdom teeth removed. I needed 0 of the pills.

[tylersmith]

People have different pain tolerances and if you wait until it's at that point to get a prescription you'll have a real bad time. But 30 days is certainly more than necessary. They should do a few days and make it easy to get more for a couple weeks. Then require seeing the patient again for evaluation.