As the heroin epidemic continues to worsen, we are seeing more and more patient's being admitted to medical floors with a host of complications arising from IVDA. I work as a psychiatric consultant on a Behavioral Health Consultation Liaison service. I am often consulted to provide treatment recommendations for these patients. I work hard to be an advocate for these patients, as well as provide psychoeducation, supportive counseling and motivational interviewing during their stays. Most of these patients are not on methadone or suboxone~and therefore cannot have these types of treatments continued for them in the hospital. We are therefore left to provide symptomatic treatment only; which then leads to patient suffering.
Despite having an opiate withdrawal protocol, that provides fairly sound guidance for physicians in symptomatically treating w/d symptoms; there seems to be significant controversy among clinicians in how to best manage this population during their hospitalization. If their stay is short, and their medical issue minor, they seem to do fine with just the opiate detox protocol (catapress, or clonidine, antiemetics, valium, etc)
However, what if the medical issue is severe and they require longer stays? Some physicians are comfortable prescribing opiates for pain management; though never seem to come close to their tolerance...Others tend to withhold opiates, or go with medications like norco or toradol. Consulting a pain specialist has not been found to be particularly helpful~as they tend to be more withholding than hospitalists!
Does anyone else have this problem or a really good approach that seems to work?