Written by Dr. John Crosby – November 28, 2017 for canadianhealthcarenetwork.ca
I recently had lunch with Dr. Andrew Worster, an old friend from my emergency days 25 years ago. He works at an opioid addiction clinic in Cambridge, Ont., and still does ER shifts at Hamilton General Hospital. He works in the ER one or two eight-10-hour shifts per week but doesn’t do night shifts any more so he enjoys the two jobs. He has been practising for 26 years and also runs a non-profit corporation called BEEM — Best Evidence in Emergency Medicine — which conducts evidence-based emergency medicine courses for emergency doctors worldwide.
Andrew works in the addiction clinic on Monday morning and all day Wednesday. It is a private business and they help patients get healthcare cards He says that 70% of the patients are functioning, with jobs and families.
Many patients start with chronic pain and about 50% work at physically demanding jobs, hence, they use opioids to get through the day’s work as their bodies are wearing out on the job. They start small and gradually require higher and higher doses for relief.
Andrew said he feels opioids are sometimes appropriate for short-term severe pain but not for non-cancer chronic pain.
Andrew noted that doctors and the patients have to accept that in life there will be pain. In the ER, he often gets patients who tell him that their GP has done nothing for their back pain. For ER patients with severe, debilitating pain, he sometimes uses ketamine (15mg I.V. over 15 minutes) to break the cycle of pain and spasm but does not prescribe opioids upon discharge… Click here to read the entire article.