We have a major issue in this country with abuse of prescription pain medications. In our local hospital, it is rare that we have a month go by without a newborn child being born addicted to narcotics because of maternal prescription pain medication abuse or heroin addiction issues. This is a sad and preventable problem, yet we struggle to control it.
That being said, we need to stop the prescriptions from going out in the first place. This may prevent the first taste of the high that gets many people hooked on narcotics. We rarely prescribe such drugs because of this fear with addiction. Unfortunately, we see lots of such prescriptions coming out of the emergency room and urgent care centers around the country. This is a major concern, period!
Here is some good data showing the comparison of morphine versus non steroidal anti inflammatory drugs like ibuprofen for the treatment of extremity fracture pain. In a study from Canada by Poonai et.al., 134 children aged 5 to 17 years old were evaluated for extremity fractures at the emergency department. The study looked at the analgesic success of standard dose oral morphine versus ibuprofen as well as the side effect profile comparison.
The outcome is welcome news: 1) No difference in pain management, 2) the ibuprofen group had significantly less side effect concerns. The authors did not evaluate abuse potential which is my major concern. I think that the answer here is obvious. Morphine, codeine and narcotics are unnecessary for most pain issues. Fractures hurt a lot and if ibuprofen works there it should work in most places.
As a parent, I recommend that you reject narcotics if they are offered at the point of visit. If they are obtained and not used, they become a part of the problem of attainable narcotics for abuse. If you are concerned that you may need them, then have the Rx called in and only fill a small amount for safety.
I cannot stress how big of an issue this is. I will admit that I am biased as I watch newborns wean off of morphine over the first 30 days of their life. It is a hard reality.
Dr. M
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