re: Doctor murdered after refusing to prescribe opioids

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Bc tramadol (ultram) in high doses causes seizures and people will eat more of them chasing a high and more people will die or show up in the ER after seizures from tramadol.

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People get high off tramadol?

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Tramadol blocks pain very effectively, without the high.

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Oh I guess not. So why worry about patients seeking tramadol if it's not recreational?

And tramadol works about the same as Motrin. I don't fill tramadol scripts either.

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People get high off tramadol? 

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Some try. It's used recreationally because of its similarity to opiates structurally, but even from a pure nuts and bolts standpoint, the "good" feelings it would produce would be a little different from you hydrocodone/oxycodone/etc.
But I mean, you would be surprised what people try to get high on. Wellbutrin. Seroquel. Gabapentin. Even high doses of Immodium.

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So why worry about patients seeking tramadol if it's not recreational? 

And tramadol works about the same as Motrin. I don't fill tramadol scripts either.

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It still acts on opioid receptors, so tolerance is a big issue. With "pure" opiates, the real big concern you get is respiratory depression. The main reason this is a problem is that people take high doses, get off it for short amounts of time, get back on it and it is too much for where their tolerance has dropped. Also, every time you go up on the dose, there's some confusion/stupor concerns that make a fair number of daily activities (IE driving) unsafe. Oddly enough, the one thing that you never really build tolerance to is the constipation. Everything else with slowly steadily increased doses is typically adjusted for by your body.

Tramadol is a bit of a different story. It only partially agonizes (not capable of full effect) the opioid receptors. But it doesn't stop there. It works on a few other receptors, including norepinephrine reuptake. It's incredibly effective against pain, but again, the opioid receptor effect is lessened over time, so you go up on the dose (or, in reality, the patient typically starts taking more due to ineffectiveness. Unfortunately, your body can only take so much of those secondary effects (of note: the SNRI class of drugs, of which ultram is loosely associated, are also great for chronic pain), and the main effect of over using that pathway is seizures.


The short of it: all opiates (speaking of chronic use) typically cause the user to develop tolerance and require more of the drug for the same effect (physical dependence, not the same as addiction, a common argument I see on this board), the main problem with regular opiates is running out/missing days and going back to the old dose or upping the dose too quickly leading to respiratory depression and death not infrequently. And with meds like ultram which do also cause some of the same effect but to a lesser extent, going up leads to seizures, among other things.

I don't think it's ever been a problem if taken as prescribed.

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I'd love to hear stories from ER docs about people that come in looking for opiates. I bet they see some shite. Please share some of your stories

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"My pain is 10/10, and I'm allergic to everything but Oxy and Demerol. All other pain meds give me a severe rash, and I can't breathe."

You think I'm joking...

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"My pain is 10/10, and I'm allergic to everything but Oxy and Demerol. All other pain meds give me a severe rash, and I can't breathe."

You think I'm joking...

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No, I completely believe that. I guess I just gave people too much credit and figure they would come up with more creative stuff. Like hurting the dog and going to the vet for pain meds. That's horribly cruel, but pretty fricking creative. I don't think I would have thought of that. It wouldn't surprise me if people hurt themselves often to go get pain meds.

My Grand Champion drug seeker was detailed. He was a twin and had taken the twins legitimate medical history for cardiac issues. He was in the ER for chest pain. I knew what he was immediately. Not the details of course but I know turds. And he was a turd, but a crafty turd. One mental ninja technique some seekers use is killing with kindness and then turning it around in you. "Are you ok? You look like you are having a bad day?" He hit me with that line and I thought "frick you". That's upper level techniques. Put the HC staff on defensive and have them questioning themselves and whether they are being jaded.

He later gave up too much of the brothers chart (that he carried with him) and I don't recall what he said he had. Maybe Dextrocardia or something else that's out there? Well by then he had had X-rays and CT scans and the docs knew by images that something was fishy. But this was after a day or two worth of doses of Dilaudid. I believe admins came in and told him to go. He was fired as a patient and told if he returned they'd press charges for false ID etc.

I've got another, but as it happens I have a MD appointment. Drug seeking appointment for my Crestor.