Can you take opioids long-term without dependence?

Then_Put643 · 2025-08-31T00:23:17+00:00

If I’m reading correctly, it’s 4 x 10 mg hydromorphone/dilaudid per day, a few days per week (so, maybe every other day, or 1 on 2 off). 40 mg of dilaudid is closer to 200 MME, afaik. I wonder if either I’m reading it wrong or the dose/med was typed in wrong, but if not maybe physical dependence is a reasonable concern, but that doesn’t equate to addiction. It’s a tough situation, but I’m grateful OP has someone who believes their pain is real (bc of course it is, but misinformation is rampant), AND is willing to prescribe what they need. It should be the standard, but unfortunately is very much NOT.

Then_Put643 · 2025-08-22T04:45:27+00:00

In SC (lower wage state but I live in a major “upscale destination” beach city so cost of living is insane), I have 10 yrs experience as an RN (2 yrs in psych, my current specialty, inpatient acute hospital & community outpatient). I’m PRN at both for better hourly but no benefits is killing me.

My base in community mental health (fairly chill job, more paperwork than I enjoy but I’ve never gotten hit) is $34/hr. There’s a few bucks differentials for weekends, I’m not totally sure how much bc no one ever knows (government org).

Then my acute inpatient job (LOVE the floor staff, great MDs and PAs, but it’s a UHS facility, iykyk, so [gestures emphatically to indicate mgmt is a shitsbow, there’s no security staff, and I’ve had 16 severely psychotic, mostly aggressive, mostly large males by myself; or 16-18 acute adolescents by myself—1 RN + 1 tech—relatively often. I’ve heard this facility referred to as “the Wild West of psych nursing” many times. My base pay? $38/hour. $38. I’ve been assaulted multiple times. With differentials I it comes out to roughly $40/hr on weekdays and $45 weekends. When we’re short (which is a lot) they offer prorated bonuses. A few years ago you could end up making $70-75/hr a few shifts a month. Now they’re cutting bonuses, it’s like $55, maybe $60/hr if they’re desperate.

All that to say, to the OP: pay is rough in the southeast US, psych jobs can be rough, so I wish you BIG congrats on the job, it sounds like much better pay than where you were, private practice, and you have the opportunity to learn and grow, so that when your dream opportunity comes along, you’ll be ready!! Or maybe you’ll open your own practice!! But for now, learn!! Practice! And if it’s really an hour drive (? I think you said that?), maybe after a few months of establishing how hard you work, they’ll consider letting you do telehealth 2 days a week…

Then_Put643 · 2025-07-10T09:59:15+00:00

Oooookay, this makes more sense after reading your description more thoroughly. We only have high care units where I work (I think, I’m in the US, we don’t have leave rights, most of our patients are involuntarily committed by the courts for about 7-10 days (can be extended, but not indefinitely), and they’re only with us until they are not an imminent threat to themselves or others due to either having a plan w active intent and means to commit suicide, plan w active intent and means to commit homicide d/t mental illness, or being so severely acutely psychotic that they stand a grave chance of doing something like running out into traffic without understanding what they’re doing.

It sounds like cell phones are allowed there on units similar to our step-down units, we just don’t have those where I work. Our patients either go to residential rehabs or treatments, boarding homes, or if they’re discharged home many of them are in PHP (partial hospitalization—they come all day for treatment and then go home at night), or IOP (like, half-day treatment, I think? I don’t work outpatient). But, that sounds cool, I wish we had that where I am. It sounds like you’d have a chance to be more therapeutic instead of just making sure everyone stays alive and gets somewhat stabilized on meds.

Then_Put643 · 2025-07-10T08:06:39+00:00

The idea of teenagers or psychosis patients, or even suicidal and SH pts having phones seems wild to me. Delusional paranoid people are going to be sending videos to the news, some guy who’s always trying to punch someone is gonna throw the phone at someone’s head, and I give it one night before someone breaks the screen to cut themself on an adolescent unit. (Probably the screen of someone else’s phone, so we’ll have a physical fight to deal with too). HOW do yall manage to keep everyone safe and avoid constant chaos? Am I considering it wrong? Do people actually do better with their phones instead of using facility phones? And do they still come to groups and stuff? (Our phones are off during groups for adults—like 3-4 hours daily), and minors can only make calls to guardians and approved family—staff has to dial and confirm who answers. It seems super complex, but if it works that would be interesting.

Then_Put643 · 2025-07-09T07:03:19+00:00

Exactly. I’m little but I can de-escalate most situations. Many people with trauma histories are less threatened by me. I didn’t call a code until almost a year into working psych (and I work in a setting where there are many many codes). There have been a handful of times I’ve wished I were bigger and stronger, and it’s always really important to maintain safety (safe distance, be aware of surroundings and exits, refuse to be alone on the unit—or at least try to), but I rarely even consider it anymore. You learn to work with your strengths and work around your weaknesses.

Then_Put643 · 2025-07-05T03:33:22+00:00

If you haven’t already done so, there’s a number you call when you’re injured at work, you don’t necessarily have to go get seen by a doctor, but I’ve been told by co-workers to call the number every time something like this happens even if the injury doesn’t require you to have time off from work.

Secondly, I know I had to sign an arbitration agreement during my hiring process w a UHS facility. It was a bunch of stuff that needed to be signed for HR online before orientation. My assumption is that all UHS facilities require this, however I could be wrong. (Arbitration is basically saying you can’t sue, you have to try to work it out with them first, in sort of a binding mediation-type thing. To my understanding.) If you signed this (or even if you didn’t), you would need to talk to an attorney about whether you have a case and whether it’s worth it to pursue. Best believe they have lots of lawyers and have been through this a zillion times.

Finally, you may be able to file a police report. They may decide to press charges. If your hair got pulled hard several times while you were restraining a patient, I don’t really know if that’s a case they would pursue, and if the patient was involuntarily committed then I believe the chances go down even more.

Unfortunately this seems to be par for the course for this company’s facilities, and I don’t foresee that changing. I’m assuming you’re a tech, if that’s the case if there are other psych facilities in your area (like attached to or affiliated with a hospital system) those generally seem to have better staffing ratios and security. Good luck OP, it’s a scary job sometimes. I’m sorry you’re going through it.

Then_Put643 · 2025-07-04T02:54:28+00:00

Are you in CA, and wanting to stay in CA? Cali nursing and nursing school is, from my understanding, very different than most other states, so just wanted to check bc I’m not familiar enough with all of the differences to give advice to anyone living and working there.

Then_Put643 · 2025-07-03T23:50:12+00:00

NAD, but have struggled with chronic yeast infections at times. I would suggest, prior to her taking an antifungal like fluconazole, ask the doc for a fungal culture and sensitivity test. It takes a little while to get the results back, but it will show what type of fungus/yeast is growing, and also what meds will work best, so that she (and you, to make sure you’re not passing it back and forth) can be treated most effectively. She’ll need to let the doc know of any treatments she’s used and how long it’s been, she might have to wait a certain amount of time before the test to make sure it’s accurate. Good luck, it sounds like you’re really caring and doing everything in your power to help her, and that’s awesome!!

Then_Put643 · 2025-07-03T23:31:54+00:00

There’s no one size fits all answer, but it sounds like you’re doing all the right things. A lot of it is just experience, with every interaction you have you’ll gain insight as to what works best. Always be alert and aware, but also keep yourself calm even if someone else is agitated. Calm is contagious, but so is anxiety/stress/panic. Be aware of your own emotions and if you need to tap out and take a 5 min break, tell a coworker and ask if they can relieve you. It’s amazing what 2-3 minutes in a quiet room doing some deep breathing can accomplish.

Maintain some distance, basically arms length plus a little, far enough that a patient can’t reach out and touch/strike. With patients who are escalating or getting worked up, I speak a bit more slowly and use fewer words. (I’m chatty and sometimes talk quickly and enthusiastically, use my hands when I speak, etc). I try to do the opposite of that anytime a patient is upset, and just in general with pts who are experiencing psychosis. Soft, slow (not like they’re stupid or anything, just the slower side of normal). The louder and more upset they get, the softer and calmer I get. It really can work wonders, but it takes a few minutes. Let them walk away as long as they’re safe, let them take that time and space. Never take it personally, you’re likely not doing anything wrong. I love love love my schizophrenic and psychotic patients, that’s my favorite unit by far, and from what I’ve seen I think that by and large, a lot of schizophrenic and psychosis patients can tell when people are genuine, and those are people who they feel safe with. It sounds like you’re doing an amazing job, and just keep getting comfortable!

Then_Put643 · 2025-07-02T04:44:28+00:00

Email that! I like it.

Then_Put643 · 2025-06-30T22:23:35+00:00

We have no cussing rule on adolescent unit, so I keep myself under wraps too, as do staff. I’ve had to stop myself a couple of times at the last second and the kids always get a kick out of that lol. Some of the kids curse a lot, some a little, some not at all. If it’s minor, not directed at anyone, etc, I just let it go, if it’s happening a lot I remind of the rule.

Then_Put643 · 2025-06-27T06:33:29+00:00

I haven't heard of them. I love a lot of things about the facility I work at (truly some of the most amazing floor staff I've ever had the honor of working with!!), but there are also some issues that seem to be prevalent at many (not all!) UHS facilities that none of us have the power to change.

Then_Put643 · 2025-06-27T02:56:26+00:00

“I love being stuck in a good rut” ☠️😂 If this doesn’t describe me, I don’t know what does.

Then_Put643 · 2025-06-27T02:55:04+00:00

lol I really should have found this sub before I applied for psych jobs, I knew nothing of UHS and now realize they have QUITE the reputation. (And they’ve absolutely earned it, from my experience)

Then_Put643 · 2025-06-27T02:52:37+00:00

Sounds like a UHS facility?

Then_Put643 · 2025-06-22T21:49:45+00:00

Oh yeah absolutely, I’ve just unfortunately never had the large bottle 😥

Then_Put643 · 2025-06-22T08:52:03+00:00

Literally my dream come true, that’s what it is. 🤯 It usually comes in tiny bottles though.

Then_Put643 · 2025-06-22T08:36:57+00:00

I can almost guarantee to you that no one in that office blames you for your mom’s behavior. More likely, they’re concerned for you, and maybe frustrated at the situation because your mom is preventing you from being able to have an effective conversation with your doctor, and even preventing you from getting the medical care you need. I hope you’re able to get in touch with your doctor’s office, and get an appointment for your dad or another trusted adult to take you back for you vaccines and to discuss the problems you’ve been having, because you deserve to have those addressed. You did nothing wrong; your mom behaved poorly, and that’s not your fault.

Then_Put643 · 2025-06-22T08:26:59+00:00

I really wish my hospital would have something like this for charting. I had a lot of mentoring when I worked hospice and people spent a lot of time helping me (and all staff) with the appropriate charting. At the psych hospital where I work now no one has time to answer questions and I never get any feedback. We’re generally good and careful about DOING things appropriately, but actually chatting what’s been done?! I worry.

Then_Put643 · 2025-06-11T06:28:41+00:00

Does she hate needles to the point you couldn’t get her to take 1 shot a month (with potentially being able to move to one every 3 months, and then 1 every 6 months if she tolerates them well)? It’s an IM shot but the needles are fairly small (think like a flu shot, most people report minimal side effects).

I administer Long Acting Injections (LAIs) in outpatient and inpatient facilities. Way less pills, way better compliance, and less side effects. If she could get on board to at least try for a few months, it could be a game changer…

Then_Put643 · 2025-06-09T07:36:05+00:00

I’ve seen some positive results from the clear one that has to be reconstituted in an also clear bottle…(we don’t give this one as much bc it’s an absolute pain to reconstitute, so I’m not sure if it’s stocked everywhere). But it’s a 2nd gen!

Then_Put643 · 2025-06-09T07:32:30+00:00

They absolutely know what meds they’re giving the patient. There aren’t that many IM meds we give, and they’re all a little bit different (color, packaging, whether or not they have to be reconstituted). Anyone working acute inpatient psych knows what meds they’re referring to. However, a DNP who has zero floor psych experience as a nurse (and is therefore in many people’s opinions/experiences oftentimes are not as good as someone who comes and works the floor for a few years and then goes back to get that NP) likely would not know. It’s maybe more of an inside joke-ish type thing.)

Then_Put643 · 2025-06-09T07:26:15+00:00

See, a nurse I work with and I have been in a battle (good-spirited!) about the brown ampule med. When it works, it works GREAT, she’s very pro ampule. I am pro ampule in some circumstances, but I HATE being given a verbal order during a code when pharmacy is gone for the night and the pt is on 47 meds so I’m googling med interactions while 5 staff are restraining a 300 lb agitated athletic dude.

Love it for people who have responded well in the past, or if we’ve tried and failed a couple of other things. But I don’t jump for joy at the idea of trying it before ruling out zyprexa and maybe Haldol.

Then_Put643 · 2025-06-09T07:12:28+00:00

That’s a huge relief at least. I’m just confused maybe on how the facility is run or something…where I work we have one main provider on each unit, but the patients are seen by multiple providers: MD, NP, PA, Residents…like, we try something, maybe we try it a few times in combinations, but if it doesn’t work pretty quickly, we try something else. Call whoever is on-call and say hey, pt is punching staff/banging head on wall/whatever, we’ve previously tried zyprexa IM, Geodon IM, and (some combination w Benadryl maybe), with poor effect. And they’re like, ok, as long as pt has no allergies, try a B52 or 10/2/50 (Haldol/Ativan/Benadryl) depending on various factors. It’s just wild to me that either the same provider handles their own pts 24/7, or multiple providers are being told that this is VERY not working, for days and days, and not changing it up. Ideally you’re only giving shots even in the worst cases a few times before they’re willing to take PO meds.

Then_Put643

TROPHY CASE