Discussions that mention morphine

Pain Management board

Hey Murph, I've heard the same thing about the diamond clinic as far as their use of opiates, but that was 3 years ago. Everytime a new medical director comes on board often policies change. I've seen it happen at local PM clincs that have gone from not using opiates to using them selectively to using them on many patients. It just depends on the new medical directors position on opiates. However when a major policy change occurs because of differenrt beliefs from the new medical director, other docs and staff that won't get on board with wide spread use of opiates have large turnovers. Just because the medical director is comfortable using LA mopiates doesn't mean that every doc and NP or PA is going to stay on and instantly change their beliefs about the use of opiates. I they have run the place with a fairly high success rate for the last 10 years without making every patient dependnet on opiates, the docs that have been there that long aren't going to instantly change their POV on the use of opiates.

So what they offered 3 years ago, may be very different from what they offer now. If the new staff hapens to be apposed to the use of opiates, there first goal is to get you off them. It's kind of tough to learn new techniques and try new methods that don't offfer the imediate and level of relief that opiates do why your going through withdrawal.

MY only concern is that if you go to the clinic and they don't use opiates, It would be much eaasier to taper down the Vicodin fairly quickly rather than trying to taper off Long acting morphine. If it were me, and there was some way to continue your old med regemin untill you go to the clinic I would shoot for that. Now isn't the greatest time to switch your protocol knowing it's likely goingto be switched again in 3 weeks. Those 3 weeks may give you enough time to significanlt reduce your Vicodin use where 3 weeks is enough time to start to develop dependence on round the clock morphine.
Take care, Dave
Hi Dave,

You make some excellent points (as usual).

I've talked to a few h/a patients that have gone to the Diamond Clinic and the latest one (about 11 months ago) was put in hospital and detoxed off of the morphine and fent. (Kadian and Actiq) she was taking and I don't remember if they switched her from Ativan to something else and started a taper or just tapered from Ativan.

Since it is run by Dr. Diamond and he is quite firm in his beliefs, I wonder if they will ever come around to being more open minded when it comes to opioids. I'm very much a believer in what you have written about using them AFTER exhausting every other option, but feel that there comes a time when they can improve a persons life big-time.

I've never considered going to Diamond, but have asked for information at other clinics and some state right on the first application sheet that they don't accept patients that are taking even tylenol #3's, so if it were me, I'd call them and run that question by them. You are right, you can't expect to get a whole lot out of going there if you are trying to detox off of morphine (or Vicodan) while trying to learn new techniques.

The problem I think we are seeing more, now that there is such an increase in PM Dr.'s, is that patients are being given stronger pain medications earlier in their treatment and that is doing them no favor at all.

If someone goes from taking tylenol *1 2 or 3* to MSIR, it works (for most) SO much better than anything they have tried and once that happens the motivation for trying the myriad of meds. and other techniques is diluted or gone. It's so easy just to pop a couple MSIR and carry-on.

The best h/a Dr. I've seen who Rx the major pain meds. but calls them an 'end of the line' treatment is Dr. Robbins in Chicago (Northbrook Ill.). The information that he freely gives out is second to none!

Nice reading your response!