17 y/o Daughter was given fentaNYL at accident scene (She is just really sore and mostly fine)) - what say the FBG? (1 Viewer)

[STEADYMOBBIN 22]

Full disclosure - I may be overly concerned due to losses in my life due to opioids but it’s bothering me…..


Daughter was a passenger in an accident. She is mostly OK but was in a lot of discomfort and pain after the accident.

At some point prior to our arrival they gave her “FentaNYL”. She told us that they did but we figured it was something else but sure enough they did.


Anyway- I’m not looking to sue or be outraged but just some information that I have not be able to find online.

I assume emergency rooms and EMTs can just do whatever they deem acceptable since it’s an “emergency”.

@flapgreen @Terminalxylem

Any thoughts or should I be worried about her being given this? Is this just SOP these days?

 

[fruity pebbles]

Paramedics give fentanyl all the time.

 

[rockaction]

I'd look into it, but I'd dial down the worry if it was given to her by a medical professional. Weird they'd use fenty of all things. Perhaps they picked it up on the corner over.

I kid. You're serious. I don't blame you. Look into it if it bothers you.

 

[Caveman33]

It doesn't seem like a problem to me. They are professionals administering a controlled medication and know how to appropriately dose.

Another way of looking at this story is why did they administer pain meds at all? I was once sedated by paramedics and taken to a hospital where a bunch of expensive exams were conducted while I was unconscious. But I was not coherent after a head injury so I couldn't advocate for myself. In all normal situations, paramedics have asked if pain meds are needed. They also ask about allergies.

 

[STEADYMOBBIN 22]

I'd look into it, but I'd dial down the worry if it was given to her by a medical professional. Weird they'd use fenty of all things. Perhaps they picked it up on the corner over.

I kid. You're serious. I don't blame you. Look into it if it bothers you.

That’s what I’m doing, friend! I’ve obviously googled but didn’t find any good results (which is becoming increasingly difficult).

 

[the moops]

Yea, fentanyl itself is not really the issue. It's that people think they are taking one thing, with a much higher dose, but instead are taking fentanyl

 

[STEADYMOBBIN 22]

Paramedics give fentanyl all the time.

This is my daughter. I’m not comfortable with it. Doesn’t mean it’s wrong or I’m not overacting- I’m just not thrilled that my 17 y/o got a taste of pain meds without talking to the parents.

I guess they can’t just wait for permission but this didn’t seem like an appropriate use. Seems excessive, unnecessary and maybe I’m being hyperbolic about this- but given my family’s history, I am more than paranoid that she enjoyed it immensely.

Justified or not, I am sick to my stomach over this.

 

[Dezbelief]

Fentanyl while just hitting the headlines the last few years has been used medically for decades.

 

[Psychopav]

Paramedics give fentanyl all the time.

This is my daughter. I’m not comfortable with it. Doesn’t mean it’s wrong or I’m not overacting- I’m just not thrilled that my 17 y/o got a taste of pain meds without talking to the parents.

I guess they can’t just wait for permission but this didn’t seem like an appropriate use. Seems excessive, unnecessary and maybe I’m being hyperbolic about this- but given my family’s history, I am more than paranoid that she enjoyed it immensely.

Justified or not, I am sick to my stomach over this.

You can probably find out what their protocol is so you can at least understand the rationale. Especially with all the headlines in the last few years, I'm hoping they have good clinical rationale for using it, and that it is SOP for a reason.

I would be careful not to make a huge deal about it around her, for fear you generate more curiosity than would otherwise be called for. With everything going on in a traumatic accident, adrenaline flowing and shock were likely also in play. It's not crazy to think she might not give it a second thought. Has she said anything indicating that she was deriving pleasure from it? That would be surprising to me, but even if so, if she's not been given a prescription for ongoing pain management via opioids, hopefully there's nothing to worry about .

 

[STEADYMOBBIN 22]

Paramedics give fentanyl all the time.

This is my daughter. I’m not comfortable with it. Doesn’t mean it’s wrong or I’m not overacting- I’m just not thrilled that my 17 y/o got a taste of pain meds without talking to the parents.

I guess they can’t just wait for permission but this didn’t seem like an appropriate use. Seems excessive, unnecessary and maybe I’m being hyperbolic about this- but given my family’s history, I am more than paranoid that she enjoyed it immensely.

Justified or not, I am sick to my stomach over this.

You can probably find out what their protocol is so you can at least understand the rationale. Especially with all the headlines in the last few years, I'm hoping they have good clinical rationale for using it, and that it is SOP for a reason.

I would be careful not to make a huge deal about it around her, for fear you generate more curiosity than would otherwise be called for. With everything going on in a traumatic accident, adrenaline flowing and shock were likely also in play. It's not crazy to think she might not give it a second thought. Has she said anything indicating that she was deriving pleasure from it? That would be surprising to me, but even if so, if she's not been given a prescription for ongoing pain management via opioids, hopefully there's nothing to worry about .

Agree on all counts.

She mentioned she wanted more later
She told everyone who would listen that she was given fentanyl because she was just as shocked as we were.

Agree on not making a big deal of it around her - we know better. We have all but ignored it and played it off like it was not a big deal and we weren’t concerned.


Se doesn’t have any broken bones, no cuts, only soreness and bruising. They could have given her something that doesn’t have addictive qualities?

Again, just a concerned parent.

 

[STEADYMOBBIN 22]

So because morphine was (allegedly) hard to keep in stock- they chose fentanyl…

Another GREAT idea I suspect was driven by greed under the guise of heath.

https://www.miemss.org/home/Portals/0/Docs/Guidelines_Protocols/Emergent_Addition_of_Fentanyl.pdf?ver=2012-06-12-135436-560

 

[gianmarco]

So because morphine was (allegedly) hard to keep in stock- they chose fentanyl…

Another GREAT idea I suspect was driven by greed under the guise of heath.

https://www.miemss.org/home/Portals/0/Docs/Guidelines_Protocols/Emergent_Addition_of_Fentanyl.pdf?ver=2012-06-12-135436-560

That's from 2012.

When it comes to pain medicine, after Tylenol and ibuprofen, there's not many options that aren't narcotics. Those are given by mouth and take longer to work as a result and just aren't very strong, obviously. Morphine is pretty standard to be given by EMS. Fentanyl as well although morphine is likely more commonly used.

If she was in a good bit of pain, then that's what EMS is going to do. They don't leave patients with untreated pain nor should they. A single dose of a narcotic after an accident like this is not going to lead to addiction. Once she's evaluated in the ER and you guys get involved, you can certainly let your wishes be known that you'd like to avoid narcotics and other alternatives can be looked at. But there's nothing about what you wrote that is out of the ordinary.

 

[the moops]

If she was in a good bit of pain, then that's what EMS is going to do. They don't leave patients with untreated pain nor should they. A single dose of a narcotic after an accident like this is not going to lead to addiction.

 

[DA RAIDERS]

They gave it to my daughter when she broke her arm. when they reset it. GNARLY! It was in the hospital and I was present. it‘s SOP.

 

[DA RAIDERS]

They also gave her a script of liquid norco as we were traveling across the country for her grandpas funeral on the day she broke her arm. We were judicious with that.

 

[zoobird]

Agree on all counts.

She mentioned she wanted more later
She told everyone who would listen that she was given fentanyl because she was just as shocked as we were.

Agree on not making a big deal of it around her - we know better. We have all but ignored it and played it off like it was not a big deal and we weren’t concerned.


Se doesn’t have any broken bones, no cuts, only soreness and bruising. They could have given her something that doesn’t have addictive qualities?

Again, just a concerned parent.

Seems like others in this thread are more knowledgeable than I am and think it's fine. That said, I don't know anything about it but do have daughters about the same age, and I'd be having exactly the same reaction that you are. So it sounds like it's actually not a problem, but definitely don't feel bad about being worried.

 

[the moops]

We were judicious with that.

We?

 

[Terminalxylem]

Agree with most of what’s been said, especially @gianmarco s post.

Key points, IMO:

1. Opioids are standard of care for the management of acute, severe pain, including that due to traumatic injuries. One doesn’t need a broken bone to experience terrible pain after an auto accident. Although healthcare professionals should try to use more benign oral agents, when appropriate, often the need for rapid relief of intense pain mandates intravenous opioid analgesics. And emergent use precludes the need for parental consent.

2. There are recurrent nationwide shortages of many commonly used medications, including opioids like morphine. Healthcare providers are forced to choose from what is available, lest they delay or undertreat their patient’s condition.

3. Fentanyl is more potent than other opioids. But doses are adjusted, such that overdose in a medical setting is highly unlikely. Fentanyl is dosed in units reflecting one millionth of a gram (microgram), compared to other opioids, where thousandth of a gram (milligram) is standard.

4. While the lore of addiction resulting from a single exposure to a drug exists, short-term, appropriate use of opioids seldom leads to abuse. At the minimum, your body processes the medications differently while in pain. I experienced this first-hand after breaking my leg, when I was given doses of morphine and fentanyl that would likely kill me under normal circumstances.

In summary, I wouldn’t be worried about what happened, as it sounds like fairly routine management following a motor vehicle accident. Was your daughter prescribed anything at discharge?

 

[Tecumseh]

Paramedics give fentanyl all the time.

This is my daughter. I’m not comfortable with it. Doesn’t mean it’s wrong or I’m not overacting- I’m just not thrilled that my 17 y/o got a taste of pain meds without talking to the parents.

I guess they can’t just wait for permission but this didn’t seem like an appropriate use. Seems excessive, unnecessary and maybe I’m being hyperbolic about this- but given my family’s history, I am more than paranoid that she enjoyed it immensely.

Justified or not, I am sick to my stomach over this.

Would you feel the same if it was morphine? I’m trying to understand whether your issue is administration of ANY opioid, or fentanyl in particular.

The reason I ask is because, depending on the severity of her injury, non-opioids may not be able to even touch her pain.

It’s very common for my patients to receive opioids for chronic pain, including fentanyl patches. Obviously this is different than an emergent situation, but opioids are used very judiciously, and med professionals will typically err on the side of under-prescribing, rather than jumping straight to the big guns. But there are situations where non-opioids are just not going to get the job done.

 

[Sand]

Paramedics give fentanyl all the time.

This is my daughter. I’m not comfortable with it. Doesn’t mean it’s wrong or I’m not overacting- I’m just not thrilled that my 17 y/o got a taste of pain meds without talking to the parents.

It's not as if she's going to turn into a raging fentanyl zombie after one controlled dose.

 

[turnjose7]

Just to add on to what has already been said by people @gianmarco and @Terminalxylem, fentanyl is by far the most commonly used opiate in trauma situations. It is a much better choice than morphine, which is a terrible drug in trauma (and pretty much in general, at least as an IV drug).

 

[ProstheticRGK]

@STEADYMOBBIN 22 You’ve already gotten lots of good info from very qualified people.

I’ll just reiterate how unlikely a single dose of fentanyl, administered for acute pain is to cause addiction issues.

There have been multiple studies done that show opioids given clinically for acute pain has a very, very low incidence of developing dependence. I wouldn’t worry about your daughter getting a single dose of fentanyl.

It struck me as odd that she was mentioning it to everyone after. Have you had talks with her before about your family history? Educated her about your concerns?

It’s probably just the nature of 17-year-olds to overdramatize things, but that was the only thing that stood out to me as potentially troubling.

Take the opportunity to talk about the importance of not taking street drugs, because the trend that is causing all the ODs lately is mixing cheap fentanyl with other drugs: meth, horse tranqs, etc. where dosages are unknown and likely to lead to overdose deaths.

 

[Ilov80s]

I feel like it would bother me as well but given what people are saying, it seems like it the right thing to do. I agree a good conversation with her about it makes sense. She is probably like me, pretty unaware of the history and facts behind fentanyl.

 

[Chaos34]

It struck me as odd that she was mentioning it to everyone after. Have you had talks with her before about your family history? Educated her about your concerns?

It’s probably just the nature of 17-year-olds to overdramatize things, but that was the only thing that stood out to me as potentially troubling.

I agree with those saying this is standard procedure and there's little to worry about. I was going to make light with a joke but the above did strike me as a red flag. I've seen the worst opiates can do. The line between not making a fuss and having a serious discussion is a toughy. Given that she may be 'enjoying the fact' that she got to partake in this evil drug that is ravaging society, I think I would make a bigger deal out of it than most. If it were my kid, I'd make sure she understands that it's no joke she enjoyed it. I might be a little pest for awhile too, at least until I was confident she was fully educated on the topic and not pleased she got high because of a broken arm.

 

[Mrs. Rannous]

Justified or not, I am sick to my stomach over this.

I've noticed that sometimes you react to some things like your hair is on fire. This might be more about you than anything else. If you have a family history in this area, perhaps talking to an addiction therapist might help. You could even take your daughter with you. (I have no idea if such a person exists.)

I'm not sure just what I'm trying to say here.

 

[msudaisy26]

You are being that parent. You think you always know what is best and you don't. Now one can be that knowledgeable in every part of life. There are people that know more than you.

 

[STEADYMOBBIN 22]

Justified or not, I am sick to my stomach over this.

I've noticed that sometimes you react to some things like your hair is on fire. This might be more about you than anything else.

That is a fair assessment, even if I don't like it. Im cool as a cucumber when there is chaos but admittedly get infuriated by little things. A little push back though, Ive maintained throughout the thread and reiterated several times that Im not outraged, only concerned.

If you have a family history in this area, perhaps talking to an addiction therapist might help. You could even take your daughter with you. (I have no idea if such a person exists.)

Ive lost a lot of people to opioids over the years. A LOT. One being my little brother. Not going to turn this into a big thing for her.

I'm not sure just what I'm trying to say here.

I know what ya mean. I always appreciate your posts.

 

[growlers]

Just to add on to what has already been said by people @gianmarco and @Terminalxylem, fentanyl is by far the most commonly used opiate in trauma situations. It is a much better choice than morphine, which is a terrible drug in trauma (and pretty much in general, at least as an IV drug).

Why is morphine terrible?
Used it almost exclusively in the ER unless there was a shortage

And to OP: I would consider it poor medical practice to withhold pain meds from a 17 year old who "was in a lot of discomfort and pain after the accident", waiting on parental permission. Definitely not the standard of care.

 

[Mrs. Rannous]

Ive lost a lot of people to opioids over the years. A LOT. One being my little brother.

I'm so sorry. That had to exceedingly hard.

 

[turnjose7]

Just to add on to what has already been said by people @gianmarco and @Terminalxylem, fentanyl is by far the most commonly used opiate in trauma situations. It is a much better choice than morphine, which is a terrible drug in trauma (and pretty much in general, at least as an IV drug).

Why is morphine terrible?
Used it almost exclusively in the ER unless there was a shortage

And to OP: I would consider it poor medical practice to withhold pain meds from a 17 year old who "was in a lot of discomfort and pain after the accident", waiting on parental permission. Definitely not the standard of care.

Sorry, terrible might have been a bit extreme. I should have simply said that there are almost always better options. Synthetic opiates are just more stable and predictable medications. Obviously fentanyl is different than others because of its rapid onset and short duration (which is why it is a great initial choice in trauma). The more direct comparison is between morphine and hydromorphone. The increased histamine release with morphine and the presence of an active renally secreted metabolite just make hydromorphone a much cleaner medication. Most systematic reviews I have seen would suggest that while the differences are small, hydromorphone has less side effects and a more consistent duration of action. The other good thing about hydromorphone is that its pharmicokinetics match almost perfectly with fentanyl so that in the right patient that really has severe traumatic injuries that will require both short and long acting parenteral managegment, the combination of the two works very well.

 

[turnjose7]

And to @STEADYMOBBIN 22, I'm sorry to hear about the people you have lost and definitely understand why you would be concerned. But it sounds like the paramedics followed standard procedure here and your daughter really shouldn't be in any danger from this. Glad she is ok.

 

[Doug B]

At the minimum, your body processes the medications differently while in pain. I experienced this first-hand after breaking my leg, when I was given doses of morphine and fentanyl that would likely kill me under normal circumstances.

This is interesting. The implication is that when in pain, the body is producing 'something' that 'expends' or 'changes' the available opiate. Had never seen it couched that way.

 

[Psychopav]

At the minimum, your body processes the medications differently while in pain. I experienced this first-hand after breaking my leg, when I was given doses of morphine and fentanyl that would likely kill me under normal circumstances.

This is interesting. The implication is that when in pain, the body is producing 'something' that 'expends' or 'changes' the available opiate. Had never seen it couched that way.

Don't they use adrenaline for heroin overdoses? They must - I saw it in Pulp Fiction.

Same thing, right?

 

[Dezbelief]

@STEADYMOBBIN 22 one important thing to discuss with your daughter if she indeed seeks to try fentanyl again is to not buy it off the streets. Fentanyl naturally attracts to itself, that's why the bathtub chemists have a hard time with creating a consistent dose. It clumps on a scale invisible to the human eye.

 

[Chaos34]

Just want to say threads like this are why I hope @Joe Bryant never shuts us down. Big props to the healthcare pros for being so informative. Appreciative props to everyone else who's contributed. When I said if it were my kid I might be a little pest for awhile just making sure she gets it - this thread would be something she would read.

 

[Terminalxylem]

At the minimum, your body processes the medications differently while in pain. I experienced this first-hand after breaking my leg, when I was given doses of morphine and fentanyl that would likely kill me under normal circumstances.

This is interesting. The implication is that when in pain, the body is producing 'something' that 'expends' or 'changes' the available opiate. Had never seen it couched that way.

Don't they use adrenaline for heroin overdoses? They must - I saw it in Pulp Fiction.

Same thing, right?

Narcan for heroin OD.

The “adrenaline” (epinephrine) might be used for a cardiac arrest following overdose though.

 

[Terminalxylem]

At the minimum, your body processes the medications differently while in pain. I experienced this first-hand after breaking my leg, when I was given doses of morphine and fentanyl that would likely kill me under normal circumstances.

This is interesting. The implication is that when in pain, the body is producing 'something' that 'expends' or 'changes' the available opiate. Had never seen it couched that way.

It’s crazy how big a difference it makes.

Prior to breaking my leg, I’d only experienced opioid medications once in my life: Tylenol with codeine, following a root canal. Codeine is one of the weakest opioids, but taking one tablet zonked me out nearly an entire day.

A decade later, I break my leg skiing at Alta. I was delirious in agony, as ski patrol took me on the bumpy toboggan ride to the resort base. Sans medication, I was shivering from the pain’s severity, not the cold.

By the time I arrived in their emergency clinic, they’d drawn up 4 mg of morphine. That‘s a pretty generous initial dose, roughly 3X the potency of the codeine pill, with nearly immediate action. Even though my pain was several fold worse than the root canal, I asked to half the dose. The medic smiled, knowing I was a healthcare provider obliged, “whatever you want”.

By the time my pain was controlled, I'd received 10mg of IV morphine, 50mcg of IV fentanyl, and 4 mg of Versed, the benzodiazepine they use for conscious sedation in colonoscopies. Yet I was wide awake.

Now pain-free, I was able to talk to the orthopedist, anesthesiologist and my wife prior to surgery. Under normal circumstances, any one of those medications would’ve knocked me out, possible causing respiratory arrest, let alone all three. Ignoring the sedative effects, the analgesic potency was ~10 times greater than the Tylenol#3 which threw me for a loop years prior. And I didn’t feel high at all.