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First Aid/Traumatic injury, (poly)substance dependence and detox


What is the general way of dealing with a person with an (acute) injury that needs pain management and has a substance dependence?

Let's say, a person with multiple drug dependence comes in with a GSW to the abdomen (yes, I've been looking at the questions you've gotten and decided to stick to the theme, though in my case any kind of injury with similar results would do - I'm merely curious, not planning the next big novel of the decade), and is looking at a fairly lengthy recovery with some weeks in the hospital and several months of recovery afterwards with a temporary colostomy bag.

What is the general way of dealing with the dependence issues in a case such as this?

I would assume that no-one will attempt detox while the person still needs pain management, but at what point would detox even be an option? I would assume that detoxing during the acute phase of an injury would be a stressor not conductive to a speedy recovery. (Let's assume that the person is willing and motivated to stop using.) On the other hand, what kinds of drugs can be given to a dependent person to stop them getting withdrawal symptoms in such a situation, especially if that person is dependent on multiple drugs? I know there are things like methadone and buprenorphine for opiate maintenance, but what about other drugs, and especially multiple ones?

Also, would having a colostomy bag make withdrawal symptoms such as vomiting somewhat undesirable? Would one wait until the person is fully recovered and the colostomy has been reversed or could treatment for the addiction begin at some point before that moment? What kind of effect would one expect from the (possible) combination of withdrawal and post-operative issues? Would withdrawal symptoms slow the recovery from the injury and *vice versa*?

I'm looking at this more as a medical problem and how this kind of issue would affect the treatment (and *vice versa*) from the medical point of view, not as an issue primarily about the process of addiction recovery (which is itself a whole 'nother bag of fish).

Thanks for your answer in advance!

Hello Chione,

I'm sorry for taking so long to get back to you. For the most part it doesn't matter what they are addicted to. If the character has a heroin addiction or a prescription pain medication addiction having the patient on pain medication for some kind of post-surgery recovery isn't going to make much difference (the body wants the narcotic (in the case of heroin/ narcotic addiction) and as long as the body gets something it's happy. The character may need higher doses for pain relief in the hospital because he's used to the higher dose on the street, but withdraw symptoms won't show up because he still has some derivative the drug of opium whether its heroin or a synthetic narcotic used in the hospital. As the patient heals and pain medication isn't needed he can be given methadone and slowly deceased off methadone for a full recovery.

I've never had the pleasure of dealing with a colostomy bag and a patient in withdraw but I don't think it's anything that can't be managed with the colostomy bag still present. remember, some people survive for many years with a colostomy and manage through illness and injury (and addiction).

I'm not an expert on addiction and recovery so I can't say exactly how that journey would play out but your character would get treatment for his injuries, pain medication during his recovery, and when appropriate, help recovering from the addiction when he was well enough to. They don't sell heroin in the hospital so he would need something to replace it with eventually.

Good luck with your story, I'm again sorry it took so long to respond back.


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Marcus LaBarbera


I am available to answer most questions related to: first aid, pre- hospital medicine, EMT and Paramedic questions, medical transport, critical care transport, ICU/CCU care, sedation, and medicine in general.


I have worked as a NYS Paramedic since 1993 for both community based ambulance companies and large commercial agencies. I Have experience as bike team commander, and shift supervisor for a commercial ambulance. As a member of the Disaster team I was deployed to Louisiana for 20 days following hurricane Katrina. I worked along side the county Haz-Mat team as a "Tox-Medic" with advanced training in treating injuries from chemical agents. Besides my experience on the on the ambulance I have worked in a number of hospital based offices including dialysis and a sleep lab.

I started my EMS career as a NYS CFR (Certified First Responder)in 1989, an EMT in 1991, a Paramedic since 1993, and a CCU transport paramedic since 2005. I currently hold certification as a: NYS Paramedic, Critical Care Transport Paramedic, ACLS/CPR/PALS certified. Advanced Haz-Mat Life Support certified (AHLS). In the past I have taught CPR and ACLS to my coworkers and the local community.

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