Narcotic Withdrawals and a Man in Tighty Whities

I have been involved in an opioid withdrawal study.  This time around, I am the one in charge of everything.  This has led to working 60+ hour work week, which I am not at all used to.  Especially when all of those hours are standing  walking  running around.  I had 10 patients/subjects that were my responsibility, but the problem is, you have to do hundreds of assessments for each subject, and you have to do each assessment on the exact minute that it is due or you get a deviation. (Kind of like getting a ticket in research)  Couple that with 8 out of 10 going through opioid withdrawal, and you’ve got some stress on your hands.

It’s been interesting though.  The point of this medication (like other opioid withdrawal studies) is to see if you put an ‘anti-opioid’ or Narcan inside of a pain medication.  If taken properly, the Narcan isn’t released into the body and the pain medication works as it should.  Taken improperly, i.e. crush it, inject it, snort it, the Narcan will overcome the pain medication and there will be no effect.  However, if someone does this who is already physically dependent on the pain medication, the Narcan will kick off all opioids already on your receptors, and cause a withdrawal.  In the study, our pharmacist crushes the drug (as an addict would) and puts it in a syringe, and I inject it into these people. (Sounds barbaric, but it has to be done and these people do understand why we are studying this and what they are getting into) Withdrawals include high heart rate, sweating, extreme anxiety and restlessness, body tremors, shaking, nausea, vomiting, goosebumps, yawning frequently, and increased pain.  Essentially, your sympathetic nervous system (fight or flight response) in overdrive.  This may not seem that extreme, but when you have a guy whose heart rate is at 180, legs flailing everywhere (and foot clonks me in my jaw while I'm trying to hold him down), streams of sweat, and body shaking violently, it can get scary.  In most cases, when they start to feel these symptoms, we reverse the withdrawal in the first 1-5 minutes of symptoms with other medications and they are just fine for the rest of the day.  But for a few people in the study, it went on for hours and had these more serious side effects.

The company who makes this medication wants people to feel some adverse effects (i.e. some anxiety, sweating, uncomfortable but not getting a ‘high’ from the med), but not throw them in such a severe withdrawal that it is considered a medical emergency.  It has been hard to watch, and the doctor who oversees everything (the Primary Investigator) tries to calm me down by saying that this is helping tens of thousands of people who could do this at home and not have anyone to help them.  I guess addiction is everywhere, but I prefer to keep my addiction to Smores ice cream instead of narcotics.

As a happier side note, during all this mayhem, I also had one of my Alzheimer’s patients in house to receive his study medication.  He is so cute and is the unofficial greeter at McDonalds with his dog that he walks 5 miles everyday.  On the morning that was especially busy, I may have neglected him some attention and pretty soon I saw him dancing down the hall in only his tighty whities and trying to dance with the other nurses.  Oh, brother.  It was a welcomed change in mood though, although I am not entirely convinced he did this as an effect from his Alzheimer’s because he is in the very mild stages right now.

Being in charge of a project like this has also led me to re-evaluate how I am as a leader.  I’ve always thought that I could be a leader, but it gets trickier when those around you have worked there longer and/or are older than you and you have to direct them to do everything.  I mean, how can you ask each person to do 10 different things without them thinking or saying behind your back that you are too demanding?  I try to say please, thank you, and tell them that I really appreciate them doing it.  But I feel bad about ordering people around who have the same title as me, especially asking them to do tasks that aren’t exactly fun. 

I’m going to have to learn what makes a good leader, because the next project I am on is even bigger.  In fact, they have hired an assistant for me (weeeee!) and if I make significant mistake, it could cost millions (waaaaaa!).  Oh boy, I guess I will sleep again when it is Christmas.