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Questions for surly docs regarding painkillers


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As is his wont, my teenage son managed to break his collarbone in two places yesterday on his first snowboarding run of the first day on a trip to Colorado.  (We're not with him.)  The docs prescribed hydrocodone for pain.  They suggested only using it for severe pain and when he's travelling back to Texas midweek.

He has apparently inherited my abject fear of opioids.  Is there any issue with taking the hydrocodone intermittently?  Does such a drug need to be tapered?  He's only taken one, and the break occurred 24 hours ago, so it seems he's handling things pretty well with ibuprofen.

Also, is there any problem traveling by air with a legal hydro Rx in one's carryon baggage?  I would hope not, but 'murica.

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Not a doc, but possibly better in an addict who has broken a collarbone.  Mine was a simple, but displaced fracture.  I was in a sling for three weeks.  The only time it hurt was moving my arm to involve my shoulder, which means not very much except when showering or changing shirts, and that was only a risk of pain and fear/anticipation of it in the event of a "wrong move."  His may be more complex, but mine was entirely manageable with OTC non-opiate/oid painkillers.

As a recovering addict, I share the abject fear of narcotic medications.  I have a personal theory that as long as they are actually used to treat pain, real pain, there's little fear of addiction/dependence/withdrawal.  It's when the use gets long-term, with little or no regard for relieving actual pain, that the worry starts.

As long as he's not taking them continuously, for a period of longer than a few days, I think there's minimal risk of tolerance and withdrawal.  Addiction begins with tolerance (more for same effect) and that is a leading indicator that there will be withdrawal that requires tapering.

Not sure about the travel question, but I think prescribed meds are always cool.

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7 minutes ago, Celery Man said:

Stating the obvious out loud that I am certain jimmy&co are cognizant of but don’t let the teenager have access to the bottle. Hot commodity.

It's a little difficult right now, since he's almost 1000 miles away, but he's with his friend and his friend's dad, both of whom I trust.

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I don't have an addictive personality about meds and have been prescribed hydrocodone a few times over my life for various injuries.  I mean yea I can acknowledge that the "feel" is pretty good.  I remember after I tore up my legs with screws falling off a wooden ladder that took huge gouges out of them (long story) that they gave me some pretty strong ones and it felt a bit like I was melding into the bed....which certainly didn't suck.  That said to the point above I was using them for actual pain and the script was pretty limited to get me through the first few days.   I generally don't think there is any harm in taking them for pain if they are prescribed in a limited amount to get your son through the worst first few days of recovery.  Now if they gave him like 30 days worth or something stupid like that matters could be different.  

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58 minutes ago, jimmyjazz said:

Is there any issue with taking the hydrocodone intermittently?  Does such a drug need to be tapered? 

No and no. He would need to take them consistently for a couple of weeks (at least) to run into withdrawal symptoms. 

58 minutes ago, jimmyjazz said:

Also, is there any problem traveling by air with a legal hydro Rx in one's carryon baggage?

No.

It's good he has a fear of opioids - that's healthy - but a few vicodin isn't going to turn him into a 60s blues guitarist. First, not everyone even likes opioids. 

There are a couple of meds in-between OTC pks and hydros - like T3 and Tramadol (that you could maybe get prescribed instead). Recreationally, I kind of like T3, I don't like Tramadol, and I love vicodin. Granted I've never had an issue with opiates or -oids.

Y (his?) MMV.

I might also chime in that you are asking doctors for advice but a doctor is the one that gave him hydrocodone. 

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10 minutes ago, jimmyjazz said:

Yeah, I just want to make sure I understand all the parameters involved, as he might not have listened to or heard the doctor in the moment.

And I'm not trying to be cynical just to be cynical. I think most doctors have really tightened up the prescriptions and view it differently today. Vicodin seems reasonable for a shattered collarbone. 

Just saying, MDs helped get us into the whole Sackler/opioid epidemic mess. 

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1 hour ago, FirstTimeCaller said:

I think I am more scared of skiing than I am of hydrocodone, and I don't want anything to do with that stuff. Seems like skiing is just a matter of time before you rip up a knee at best and ski headfirst into a tree at worst.

Maybe.  I'm an amateur on skis, I can handle a smooth but steep black diamond at the most, but I have never hurt myself.  Not that I've spent a ton of time on the slopes, but I went on plenty of ski trips in my 20s-30s.

Snowboarding seems to be a different animal.  The line between "upright" and "face down" is very precise.

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Maybe.  I'm an amateur on skis, I can handle a smooth but steep black diamond at the most, but I have never hurt myself.  Not that I've spent a ton of time on the slopes, but I went on plenty of ski trips in my 20s-30s.
Snowboarding seems to be a different animal.  The line between "upright" and "face down" is very precise.

If he has any left when he gets back put them on sale here lol
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11 hours ago, jimmyjazz said:

Thanks.  He says he might take another one in a few hours, so the pain is clearly significant. 

I saw the x-ray -- yikes.  The entire middle third of the bone is floating at a different angle than either end.

The x-ray of mine made me want to barf, but it was just a single fracture.  But it illustrated how the bone ends could rub together if I made a wrong move, and that really made me want to barf.

The finger with the bone chip with the tendon attached that was fixed with a k-wire and screw wasn't nearly as barfalicious.  I also took a couple of Tylenol 3 in the day after the surgery, probably more out of fear of pain than actual pain, but it was throbbing like a mofo.

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5 minutes ago, jimmyjazz said:

image.png.242bd0b250cbb46b46c7a49a9c41f8ca.png

Barf.

Mine looked like the outboard one, except displace the ends completely.

What's wild is when it starts to heal, you see a "cloud," faint at first, but gets more opaque as the bones start to knit.  It just appears in the void.

Edited by TwiceHorn
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Had a similar injury about seven years ago (softball, not skiing) and think I might have taken a couple of Toradol since the pain was significant.  But after the first couple of days, ibuprofen seemed to do the trick.  I did consult with an orthopedic surgeon about potential surgery.  Asked him what happens if I don't get it plated.  He said I'd just have a sexy bump near my left shoulder.  I'm not into elective surgery, so I opted out and it healed fine, although with the aforementioned bump.  

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21 hours ago, jimmyjazz said:

<if such a thread already exists, please delete this and ban user>

 

As is his wont, my teenage son managed to break his collarbone in two places yesterday on his first snowboarding run of the first day on a trip to Colorado.  (We're not with him.)  The docs prescribed hydrocodone for pain.  They suggested only using it for severe pain and when he's travelling back to Texas midweek.

He has apparently inherited my abject fear of opioids.  Is there any issue with taking the hydrocodone intermittently?  Does such a drug need to be tapered?  He's only taken one, and the break occurred 24 hours ago, so it seems he's handling things pretty well with ibuprofen.

Also, is there any problem traveling by air with a legal hydro Rx in one's carryon baggage?  I would hope not, but 'murica.

Tylenol 3,  Hydrocodone 5/325, 7.5/325, 10/325 - the first two generally don't do so much for pain as they make you not care about the pain. So, take them if you can't get to sleep at night otherwise go to 600mg or 800mg ibuprofen or even better an acetaminophen/ibuprofen mix like the new Motrin tablets. There is some concern that NSAIDs like ibuprofen slow bone growth so listen to the doc whether they want him to just take Tylenol/acetaminophen. Short-term opioids shouldn't be a problem with addiction but I would avoid them if they aren't absolutely necessary and definitely don't take them before driving or before work.

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1 hour ago, Native Horn said:

Had a similar injury about seven years ago (softball, not skiing) and think I might have taken a couple of Toradol since the pain was significant.  But after the first couple of days, ibuprofen seemed to do the trick.  I did consult with an orthopedic surgeon about potential surgery.  Asked him what happens if I don't get it plated.  He said I'd just have a sexy bump near my left shoulder.  I'm not into elective surgery, so I opted out and it healed fine, although with the aforementioned bump.  

Gonna need this story.. slide gone wrong? 

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2 hours ago, Native Horn said:

Had a similar injury about seven years ago (softball, not skiing) and think I might have taken a couple of Toradol since the pain was significant.  But after the first couple of days, ibuprofen seemed to do the trick.  I did consult with an orthopedic surgeon about potential surgery.  Asked him what happens if I don't get it plated.  He said I'd just have a sexy bump near my left shoulder.  I'm not into elective surgery, so I opted out and it healed fine, although with the aforementioned bump  

Yeah, I have a bump as well.  The only lingering effect is that I can feel the tissue over the bump kind of "hanging" on it as it adjusts to the new shape of things there.  And, apparently I am about 1/4" narrower in the shoulders than I used to be.  Doc said I might have to get suit jackets tailored, but I haven't really noticed.

Edited by TwiceHorn
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I got fentanyl last spring leading into a gall bladder removal.  My God does that stuff work good.  It doesn’t make the pain go away.  Doesn’t make you forget the pain.  It makes you not CARE about the pain.

Then when I got home and had no pain, I spent a day wondering what fentanyl fees like when you aren’t in pain.  That scared me a lot.

It’s good that your kid is afraid of opiods.  Keep him away from them unless the pain itself is killing him.

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23 hours ago, ztejas said:

I don't like Tramadol

Man, I got prescribed some of that for a root canal and never took it because root canals are painless but did need to take some about a year later for a toothache over the weekend before going in to see the dentist and that stuff is great for a toothache.

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11 hours ago, Parliament said:

I got fentanyl last spring leading into a gall bladder removal.  My God does that stuff work good.  It doesn’t make the pain go away.  Doesn’t make you forget the pain.  It makes you not CARE about the pain.

Then when I got home and had no pain, I spent a day wondering what fentanyl fees like when you aren’t in pain.  That scared me a lot.

It’s good that your kid is afraid of opiods.  Keep him away from them unless the pain itself is killing him.

Apparently, biliary colic is one of the worst pains you can endure and traditional opiates aren't usually real good for it.  Keterolac, which is non-narcotic hyper NSAID, is really effective for it, but causes bleeding, so it has to be stopped before surgery.

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I’ve had hydrocodone prescribed many times, and I’ve never understood how people get addicted to it. It makes me a little sleepy and seems to fuck with my stomach, but that’s about it. We’ve got bottles of it in the bathroom closet going back 15+ years from prescriptions I’ve only used a few pills out of. I’ve also got anyone covered who needs antibiotics in the zombies apocalypse.  We may be hoarders now that I think about it. 

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1 hour ago, UT_OB1 said:

I’ve had hydrocodone prescribed many times, and I’ve never understood how people get addicted to it. It makes me a little sleepy and seems to fuck with my stomach, but that’s about it. We’ve got bottles of it in the bathroom closet going back 15+ years from prescriptions I’ve only used a few pills out of. I’ve also got anyone covered who needs antibiotics in the zombies apocalypse.  We may be hoarders now that I think about it. 

You do know that drugs do go bad right? I would toss them if they are more than 5 years old. 

On 2/12/2024 at 9:56 AM, Parliament said:

I got fentanyl last spring leading into a gall bladder removal.  My God does that stuff work good.  It doesn’t make the pain go away.  Doesn’t make you forget the pain.  It makes you not CARE about the pain.

Then when I got home and had no pain, I spent a day wondering what fentanyl fees like when you aren’t in pain.  That scared me a lot.

It’s good that your kid is afraid of opiods.  Keep him away from them unless the pain itself is killing him.

My wife got a fentanyl drip during her labor with our first child. After the nurse left she immediately turned to me and asked “is this why people are homeless?” 

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On 2/12/2024 at 10:08 AM, SimonBolivar said:

Man, I got prescribed some of that for a root canal and never took it because root canals are painless but did need to take some about a year later for a toothache over the weekend before going in to see the dentist and that stuff is great for a toothache.

Oh I've never taken it for actual pain. Yeah it probably works well for that. 

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I've had many a sports injury - 2 ACLs, 2 broken ribs, dislocated foot/ankle, broken wrist, dislocated shoulder twice, herniated disc in my back a couple of times.  I think it's perfectly ok to get doped up for a few days when recovering.  It's 2024.  I want to think most doctors will understand the length of time a painkiller is needed, then cut it off after that point.  I state this because in Knoxville, I had a doc that would - quite literally - just fill prescrips left and right as needed.  I seem to recall his degree was from Guadalajara or somesuch.  Luckily for me, I don't have an addictive personality or genetic disposition for such, so I could easily walk away.  I can see how those with that kind of disposition can get easily addicted.  Anything over 2 weeks, IMO, needs remediation.

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4 hours ago, UT_OB1 said:

I’ve had hydrocodone prescribed many times, and I’ve never understood how people get addicted to it. It makes me a little sleepy and seems to fuck with my stomach, but that’s about it. We’ve got bottles of it in the bathroom closet going back 15+ years from prescriptions I’ve only used a few pills out of. I’ve also got anyone covered who needs antibiotics in the zombies apocalypse.  We may be hoarders now that I think about it. 

I can't prove it, but some docs back this up: if you are in actual pain the euphoric effect is somewhat attenuated and less likely to be addictive. 

And, best evidence seems to be that tendency to addiction is genetic, so either you will or won't find drugs entertaining in a pathological way. 

Finally, I think the opioid epidemic is not classical addiction, but rather people experiencing chronic pain and dopesickness that don't power through it before they OD or get pretty strung out. In other words, a primarily physical addiction, not the combination of physiological and psychological involvement that characterizes classic addiction. 

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8 minutes ago, TwiceHorn said:

I can't prove it, but some docs back this up: if you are in actual pain the euphoric effect is somewhat attenuated and less likely to be addictive. 

I mean you're either an addict or you aren't. Granted, non-addicts/alcoholics die all the time from ODs or drug-related violence/accidents.

i.e. - you can not be an alcoholic and still die from alcohol. 

Edited by ztejas
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23 minutes ago, TwiceHorn said:

Finally, I think the opioid epidemic is not classical addiction, but rather people experiencing chronic pain and dopesickness that don't power through it before they OD or get pretty strung out. In other words, a primarily physical addiction, not the combination of physiological and psychological involvement that characterizes classic addiction. 

This part I do get. I get prescribed prednisone packs frequently when my lower back problems flare up. Going from the pain I’m in to the relief I feel after those first ~4 pills, i understand how someone could get addicted to that. 

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3 minutes ago, UT_OB1 said:

This part I do get. I get prescribed prednisone packs frequently when my lower back problems flare up. Going from the pain I’m in to the relief I feel after those first ~4 pills, i understand how someone could get addicted to that. 

Yeah it's that and the dopesickness that accompanies physical dependence and withdrawal. 

I think people become so accustomed to "relief" that they lose their ordinary capacity to deal with untreated pain and the additional pain of withdrawal, and so keep using despite the consequences. 

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14 minutes ago, TwiceHorn said:

I think people become so accustomed to "relief" that they lose their ordinary capacity to deal with untreated pain and the additional pain of withdrawal, and so keep using despite the consequences. 

I think this is basically correct. 

As someone that is going through what I would call a "bad" period of my alcoholism - I might offer this alteration:

- pain is generally greater for those afflicted

- they also tend to like the substances better 

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6 minutes ago, ztejas said:

I think this is basically correct. 

As someone that is going through what I would call a "bad" period of my alcoholism - I might offer this alteration:

- pain is generally greater for those afflicted

- they also tend to like the substances better 

Yeah it resembles classic alcoholism/addiction in a lot of ways, but I'd be willing to bet that if you tracked the five year relapse rate, among most opioid "addicts" of the prescribed>street pills>heroin>fentanyl variety, you'd find a lot fewer relapses than among conventional addicts.

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1 minute ago, TwiceHorn said:

Yeah it resembles classic alcoholism/addiction in a lot of ways, but I'd be willing to bet that if you tracked the five year relapse rate, among most opioid "addicts" of the prescribed>street pills>heroin>fentanyl variety, you'd find a lot fewer relapses than among conventional addicts.

That's an extremely interesting theory that I've never thought about - but an idea that I've suspected for awhile. 

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44 minutes ago, ztejas said:

That's an extremely interesting theory that I've never thought about - but an idea that I've suspected for awhile. 

You probably get this, but it seems the one outward symptom that characterizes us is the tendency to craving and relapse even after detox and months or years of sobriety, hence my thought on the five year relapse rate.  I suspect that the major barrier to the sobriety of the oxy-era opiate/oid addict is detox and once that is done, they're probably sober for good.  The wild cards there being do they return to an environment of heavy usage, like meth addicts seem to, and do they continue to have pain management problems that get them back on the pill track,

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Docs are generally more restrictive with pain medications now than in the past. If he was prescribed them, he should take them as needed. When he has surgery to fix his collarbone, they will likely prescribe him more.

 

If you're both really that concerned about hydrocodone, then you could ask for tramadol at your ortho appointment. Not as strong, not as much addictive potential.

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23 hours ago, david chaum said:

Docs are generally more restrictive with pain medications now than in the past. If he was prescribed them, he should take them as needed. When he has surgery to fix his collarbone, they will likely prescribe him more.

 

If you're both really that concerned about hydrocodone, then you could ask for tramadol at your ortho appointment. Not as strong, not as much addictive potential.

Hey! 

That's what I said.

😉

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My wife was prescribed hydrocodone after her mastectomy.  Her assessment was that it didn't do much for pain and was far better at causing constipation.  She ditched it pretty quickly.  

 

I was prescribed 10 when I had surgery to reattach a torn biceps tendon and  based on her assessment, I just stuck to alternating advil and tylenol.  

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i had a back fusion surgery three weeks ago on a thursday.  hydrocodone through the weekend and last one on monday.  none from tuesday forward.  didn't take a shit until wednesday and it took two hours.  the fusion was at the l5-s1 level so it required an anterior approach to start resutling in a scar in my abdomen that was still in surgical recovery.  i told my wife that i just delivered a baby naturally with a c-section at the same time.

anyway, if they don't have a predilection towards addiction, etc..., i wouldn't worry about it but if he is on it for more than a week or so, he does need to taper off or it won't be a fun couple of days.

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On 2/11/2024 at 1:08 PM, jimmyjazz said:

Appreciate all the input, surlies.

When I got the diagnosis 11 years ago that I had inherited gout, my childhood doctor prescribed me hydrocodone. He gave me a 30 pill bottle with a refill. Best two months of sleep I had in my life up to that point. Never took them again after that. Had a friend try to buy them from me, but I quickly said no.
 

I hope for a speedy recovery for your son and that he makes it home safe and sound. 

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