A personal on #opioids, #nursinged & #meded, & #chronicillness:

the coverage of many topics in my first semester of nursing school worried me - and the rhetoric around the #opioidepidemic was one of them. Vilifying both opioids and addicts in clinical training is dangerous.

Discussing the overprescription of opioids, without STRONGLY emphasizing their imperative use in managing moderate to severe acute/chronic pain, breakthrough pain, and as parts of #palliative or #hospice care sets a harmful precedent in the classroom and delegitimizes these uses.

I'd like to share a difficult experience that reflects how this directly impacts patient care.

Before my first orthopedic surgery in 2018, I was told to expect to take opioids for upto 3 weeks post op, due to the severe pain that accompanied this major reconstructive surgery.

After my surgery, I was (separately) prescribed Fentanyl, Vicodin, Percocet, and Dilaudid during my hospitalization. I wouldn't tolerate one, was switched onto another, have more side effects, and repeat. Ultimately, I was discharged on Dilaudid, despite continued side effects.

Upon discharge, I continued to vomit at home, have horrendously low BP, and other unpleasant side effects, but I still needed the Dilaudid for pain management. On post op day 10 at around 3 am, my parents called 911 because of how sick I was.

One of the EMTs who responded felt inexplicably racist. Nothing was explicitly said, but it just didn't feel right. He asked why we called for help and once my mom told him opioids were involved, his behavior shifted even more. He asked me "what else did you think would happen?"

He seemed to take his sweet time transporting me, despite respiratory depression, severe hypotension, vomiting, 10/10 pain, and a possible bowel obstruction, as well as my parents asking him repeatedly to take this seriously. At the ED, the dignity stripping behavior continued.

I was left in the ambulance bay and when my mom begged for me to be taken to a room because I was so sick, he replied with "well that's what happens when you take opioids."

When I was finally seen in the ED, I was instructed to stop Dilaudid cold turkey due to its side effects.

There wasn't any priority given to managing my still severe post operative care when I was discharged, and I was all out of opioid options.

At home, my body began to shake, I started to shiver, and my body started to throb. My first thought was: oh shit. An infection.

I didn't have a fever though. I didn't understand what was happening, until I started to want more Dilaudid and realized I was withdrawing. For the following 3 days, I was miserable with muscle aches, sweating, hot flashes, chills.

I asked my parents to take the pills away.

I can't imagine what would have happened if I had access to Dilaudid. At that point, my body was withdrawing from being chemically dependent on the drug, without a detox protocol or any provider recommendations on how to get through this withdrawal period safely or comfortably.

The lines between drug dependence, substance use disorder, and addiction can be blurred.

Every part of my experience had a validated cause. I was appropriately prescribed opioids for a legitimate reason. Despite this "defense," I was still treated terribly, blamed, and shamed.

It's hard to not think about substance use disorder patients who don't have these ''medical validations" as some degree of justification for their use of drugs. I can't imagine how poorly they are treated by biased HCPs.

Despite not having #SUD, I was still harmed by the prejudices held towards this patient population.

As a student, I've noticed how addiction is overtly and covertly demonized in nursing school. Patients are generalized as being manipulative. It's hinted as being a choice.

Then there's stigma around #chronicpain and opioids. We learn a short list of "justifiable" conditions that warrant opioids, which is not inclusive of many diagnoses that result in chronic pain.

When these chronic pain patients seek care, they are stereotyped as drug seeking.

As someone who lives with both chronic pain and chronic illnesses, listening to this BS being taught early on in the classroom is exhausting.

"Patient-centered care" and "being your patient's strongest advocate" seem like empty words when this subliminal messaging exists.

I'm not an addiction specialist. I'm just someone who has lived through a traumatic but short lived experience of dependency and withdrawal, which will forever be burned into my brain when treating patients. I was privileged enough to have had my family to get me through it.

Not everyone does. I could have easily become another statistic in the "opioid epidemic" if I was alone.

Nursing education needs to do better. #traumainformedcare, #antiracist progressive curricula are not buzzwords in healthcare. They have real life implications on patients.