Important Warnings: I am in no way minimizing the risk to patients and physicians and the general public with the issues that the opiate epidemic has on almost all of us.
I learned though the hardest way possible, of how dangerous that opiate bias has on patients who aren’t abusing opiates or in my case, my last hospital admission that I was discharged after a week last Wednesday,could’ve cost me my life in no relation for admitting diagnosis.
I’m in no way trying to minimize again the risk to patients, prescribing physicians and the general public as well as being sensitive to not wanting for those still struggling with any kind of addiction issues to put them back in denial, unnecessarily.
But how patients in the hospital and who suffer from chronic pain including and especially myself but am motivated as an activist which I’ve been trying to address being collateral damage in the opiate epidemic due to pervasive opiate bias from everyone everywhere, this can’t continue to go on the way it is.
Something has to change and it has to change now.
IF I’m not clear about something, please ask for clarification before making assumptions.
Also as potential trigger warnings, talk about fatal drug overdose and suicidal ideation will be included in this blog, so if that could be hurtful to someone, please don’t read.
thanks.
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On Monday, August 7th marks the 11th anniversary of my friend’s passing from an accidental heroin overdose.
The ONLY reason anyone found out about her heroin usage because of the autopsy and friends inquiry by family with people in her contacts.
While I normally don’t visit anyone in the hospital given my disabilities, because I had an appointment at the hospital campus when my friend suddenly starting getting sick from her gastric bypass complications and saw her several months after I had my gastric bypass reversal.
My friend was originally a co-worker and one conversation with her probably saved my life, and that she was having her gastric bypass a month before mine was originally scheduled at Fairview University Medical Center a month before with a new surgeon who was coming to pioneer the minimally invasive surgery center.
Within a week I switched surgeon and facility to her;s and honestly for how sick I got from a perfectly performed gastric bypass, I don’t think I would’ve survived my complications otherwise and probably would’ve died within the first 3 years post rny.
I just got out of Fairview University Medical Center on Wednesday, 8-2-23 after a week’s stay due to having an urgent lap chole w/ egd and then having bile leaks that required an ERCP.
I understand that some may think I might be giving too much context but it’s important not just for my sake but any other patient who’s gone through what I went through.
I have blogged about issues that I’ve had with opiate and obesity bias at FUMC for a long time now.
The only reason why though I still go there is due to the enormous talent of the physicians and other medical as well as non clinical staff there.
And if you would’ve asked me exactly a week ago (blog being published on 8/5/2023) I would’ve said that everything that could’ve been done for me was being done even though while I know for me oral opiates won’t work with abdominal pain even IV injections of Dilaudid which had worked in 2010 for gastric bypass post op pain via pain pump even though I broke out all over in hives, bounceback migraines and severe nausea wasn’t working and while it was starting to get to me being in so much pain with an actual attempt to arrest it, I just blamed by body for malabsorbing the iv drugs too.
I had asked instead of throwing me so much drugs at a lower dose as I knew as a chronic pain patient that nothing less than 30 mme a dose would be effective, orally and given my history with dilaudid that fact I hadn’t broke out in hives again I blamed on my body malabsorping the .04 Diluadid q4.
The problem is by last Sunday I was in a lot of distress, I was in an insane amount of pain enough to start hysterically crying and scare the nurses on the floor because I was crying so hard and while I wasn’t mean or scary, I was starting to get a bit defensive because I was beside myself during the 2 hysterical periods feeling so helpless that in a major hospital I felt no one could help me and well, that was the answer I gave partially true.
What I had not said is that I was thinking of quietly going into the Mississippi River in hopes of drowning IN it.
Which wouldn’t have been too difficult of a task, given the fact it’s directly across the street from the hospital.
I don’t have ideation very often and I’m pretty good about fighting it not demonizing those who struggle with drugs and/or suicide ideation and feeling horrible for those who lost their battle.
So, yesterday on 8/4/2023 I’m researching the amount of dilaudid I was given and while I shouldn’t have been on it in the first place, I realized that it wasn’t my body having absorption issues with what I was given intravenously (but it’s a possibility to me,I’m very complicated and difficult to medicate, i.e. I had 4 epidurals with my son while in labor almost 31 years ago and still managed to have completely natural labor with super painful labor and delivery because I didn’t get any benefit of meds put in epidural) but that I was given too little medication, to my horror and devastation.
Like extremely undermedicated enough to not have a prayer of therapeutic benefit w/any dose but enough mmes to be at risk of full blown opiate withdrawal.
I have dealt with obesity and opiate bias from physicians and society my entire life but I’m on a new path now as an activist that a patient who has an established history of NOT being opioid naive that our care isn’t compromised because of the assumption we either are a drug addict or will become a drug addict and have become so riddled with pain in a hospital that they are contemplating suicide thinking that is the only way to end it, no matter how rational the patient is otherwise.
Or even without the ideation. My saving grace is that in addition to realizing quickly it’s not a legacy I wanted to leave to my kids the ideation or an attempt, that this can no longer be my normal when seeking out medical attention either preventative or acute help, not just for me, not for anyone who needs opiates as a tool and have proven they can utilize them without liability to anyone else.
I was already working on that from a chronic pain perspective knowing that there is absolutely NO data was out there to show the harm towards patients in pain who weren’t being treated at all or undertreated for pain having become collateral damage in the opiate epidemic.
But there are stories of patients dying by suicide when meds getting pulled and one bad example of a patient’s family suing post suicide of a patient who was non compliant and was on what’s considered an enormous amount of opiates like my tolerance is considered high and that’s 90-120mmes daily and was given 60mmes though w/a minimum of 30 mme dose needed to get a therapeutic benefit. (I said I wasn’t a drug addict, but my compliance being human wasn’t perfect just not habitually non compliant) , the patient was on over 500mme daily of the family who sued.
The thing is that in the chronic pain patient/activists we know in our advocacy on our own unique circumstances as well as others how to help a physician better help us.
IF we would just be listened to.
Then there’s me who goes further and directly defends that no physician should feel that their liability is at risk when they write a script or feel in mortal danger when they pull one.
This is a few things starting off with a hospital that is supposed to be one of the best in the United States (ahem talking about you, mhealth fairview university medical center) can start out with.
1. Get a patient history with opiates and reassess at the point prior in a new admit of verifying med history w/opiates and any other substances and how patient reacts and make it safe for them to tell their truth because opiate bias, like obesity we know it’s rampant and patients know they are going to be judged and labeled.
But we also as patients respect our doctors, their need to use caution but still respect our own unique circumstances.
2. Check databases for abuse (I use mn courts pa for legal history that can sometimes show a pattern and/or escalation of addiction issues, but mds also have PDMP) and/or drug test, for those who aren’t abusing like myself we understand why it might be necessary and won’t be defensive about it.
I’m not saying blindly follow patients as they lie, I know that given my advocacy in bariatrics the problem is NOT all of us are lying or drug seeking and even patients who do have OUD, still can have severe pain problems that warrant the need of acute/or chronic pain intervention WITH pain meds, just again cautiously so.
3. Check in with patient med protocol is working, change if it isn’t.
4. Post operative contact after discharging a patient with a 3 day supply of pain meds after 3 weeks of being on IV narcotics such as what factored in to my friend’s addiction and overdose could’ve been prevented of asking without stigma of any pain or any drug concerns at discharge and followup by hospital AFTER inpatient discharge to home, especially like me who can’t see primary right away of having new protocols in place to follow up with patient to see how they are doing post admission in recovery and to check for possible of withdrawal so the patient doesn’t become at risk of drug seeking or being in full blown opiate withdrawal regardless of how much they were compliant, which is in the realm of possibility.
The above is a start, hoping desperately to help others so what I went through and my friend went through doesn’t keep happening and hoping Fairview University Medical Center will work with me on this as it’s not self serving, it helps everyone to take a cautious attitude but one that isn’t punitive to those who need opiates as a last resort to manage both acute care and long term chronic pain.
Or run the risk that I will sue to ensure change because I’m so traumatized by my last experience and previous admits that while I’m careful that people including physicians will feel safe with me and people like me, but that I can NO longer be caught up as collateral damage in the opiate epidemic, don’t think anyone should and am only capable though (again I do violent crime prevention for general public, physicians and first responders) of seeking every legal remedy at my disposal in a court of law.
Respectfully, Alissa Kasen
unstapledlisa 
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