Heavy duty drugs

[abdon gonzalez]

The situation: you are doing some serious backcountry when you go from that exhilarating feeling of flying through a winter wonderland, to the painful realization that you just broke a bone on a tree or rock. Suddenly the winter wonderland became a frozen h3ll.

The question is; if you have to drag your broken body through a few miles of chest-deep snow, what would be the ideal painkiller that will let you work through almost unbearable pain while not diminishing your ability to function?

[Laurie Ann March]

Painkillers work differently for each person and I wouldn't recommend taking a prescription painkiller with you unless it has been okayed and prescribed by your doctor. Also stuff that has expired can have issues of being too strong or not strong enough. Some meds (Demmoral I believe is one) get more potent after expiry.

Now what works for you will also depend on your body, how meds affect you and pain tolerance. Myself, well I have an extremely high pain tolerance compared to others. I also am very sensitive to drugs. For me some Advil migrane strength would work in cases where most people would need Percoset or Tylenol 3. If I took a Ty 3 I'd be zooed… lol.

In my emerg kit you will find regular ASA, Ibuprofen, and Tylenol as I find some things work better for some injuries than others. I also take enough tape and such that I could make a splint. If I am in a treeless area I carry a Samsplint.

I've been taught that if you break a leg you should stay put because you could cause damage to your femoral artery and then you are in deep trouble. If you rupture or cut the femoral artery you have about 10 minutes to say your goodbyes.

[Vick Hines]

abdon,
The only legal way to get a heavy duty and appropriate pain killer is from your famiy doc, your primary care physician. I explained the situation to my doc: I needed something that would let me function with a serious injury such as a broken femur or a fractured pelvis, and I had to function well enough to take care of myself and avoid shock under inclement conditions, i.e. shelter, feed and water myself. It had to be stable, durable and transportable. We decided on something that I am not allergic to, handles major pain, and does not incapacitate. I will not say what he prescribed because that is something you and your doc need to work out without starting with preconceived ideas.

Laurie's advice about staying put is correct. If you are badly injured, your best bet is to stay where you are. But you have to be functional in order to keep yourself safe, and extreme pain can lead to shock. So I consider heavy duty pain killers to be a backcountry essential.

[Sarah Kirkconnell]

One, do as some of us do: Go to your Dr and get a one time prescription for a good narcotic painkiller. Vitamin V is a good start. It doesn't take much to make you feel happy, either. Most Dr's will understand why you are asking for the prescription.
I carry Vicodine in my first aid kit always.

[abdon gonzalez]

Don't get me wrong, I'm not advocating the use of drugs without prescription. In the past I have been impressed with the level of expertise that can be found on the forums. I'm just getting some opinions before I talk to my doctor. Somebody here may just know something specific to painkillers and cold weather.

On the past my doctor has been immensely helpful. For my trip to Tibet, she ensured that my med kit was properly stocked, including syringes in case I was forced to go to a local clinic.

[John S.]

Vicodin may be most requested for a fak. Your doc would have to agree.

[Sarah Kirkconnell]

This is my opinion, and this is what works for me, but I will say that "V" knocks out any pain in the cold for me. I threw my back out a couple years ago, and cold backpacking can bring on the pain.
I had extensive oral surgery done this year, and one "V" tablet, and I had no pain for a good 4-6 hours. Even when backpacking (mind you, I didn't take it till I got to camp though! I didn't want to risk falling in alpine.)

[Mike Barney]

Vicodin didn't do anything for me when I tore a leg muscle, but 1/2 a Percocet w/Acetaminophen worked very well. Remembering that, I later went to my MD and discussed something similar to what you're asking, and got a prescription for Percocet.

I would not want to experience Percocets' side effects for the first time in the scenario you describe. Not suggesting you go popping pills, or break your leg just to try it out :-(

Not a doc or medical advice, just my observations,

MikeB

[Dane Burke]

Have any younger (around 21 years old) outdoors person had success in getting a one-time prescription for some emergency painkillers?

I'm guessing that based on age stereotypes I'll get kicked out of the office for malingering :P

[Bob Bankhead]

1. Small quantities of antibiotics and similar Rx items are usually very easy to get, even from a new doctor, because they are for very small quantities and intended only to last long enough for you to get to medical help.

2. Your doctor is much more likely to give you that small quantity Rx for controlled substances if he or she is an outdoors type themself. They'll understand. If they're not, be sure you mention your hiking hobby at every visit. My doc always wants to know where I'm going or have recently been; even beats me to the topic most of the time.

3. It is easier to get the Rx the longer the doctor has known you.

4. OK, so now you've gotten the Rx you wanted for your hike. STOP! Before you fill it, make several photocopies – especially if it's a controlled substance – so you always have one to carry with you on your trek since it's unlikely you'll be carrying it in the original, labelled Rx container that you got from the druggist. Trying to convincing law enforcement types that yes, you really do have a prescription for that controlled substance they found in your possession but no, you don't have it with you can seriously delay or outright ruin your hike. And yes, they're trained to recognize the common pills on sight. Their dogs do an even better job and can make you miss your airplane, train, or bus while you try to explain.

4. While it may vary by state, it's always been my understanding that if the prescribing physician is not licensed to practice medicine in whatever state you're currently in, no pharmacy in that state can legally fill or re-fill that prescription for you. Therefore, either carry enough to see you through your entire trip (highly advisable if the lack of said drug could have serious health or survival risks for you) or get enough to split so you can put refills into your bounce box or however many of your resupply boxes you desire. CAVEAT: said boxes have been known to encounter wild extremes of temperature and humidity, to arrive late, to break open and spill contents enroute, and/or to mysteriously and completely evaporate into the ether once shipped, etc.

5. Let's assume I'm dead wrong on #4 and somehow it is possible to refill an out-of-state prescription. How many trail towns are you going through/near that have a pharmacy that stocks your particular prescription? Aren't they going to need the original container which has the original Rx number and druggist's name and phone number on it? Better safe than sorry, especially if your well-being depends on it (or at least, mine).

Wandering Bob

[abdon gonzalez]

The last time I needed to prepare from a trip my doctor checked what medicines I had and what I needed. She then gave me a signed sheet of paper listing all the prescription drugs I had on my kit, which simplified the process of proving that I indeed had a prescription for all of them.

If you are in the habit of removing the medicines from their original containers (imagine that, an UL getting rid of bulky cans) this is extremely handy as you can still prove that they were indeed prescribed to you. Next time you go to the doctor, bring your med kit with you.

[John S.]

Heard that..I attended the funeral of a guy I went to school with who became an OB/GYN doc and he died after taking tylenol 3 (contains codeine).

[Laurie Ann March]

It is very difficult to get a script up here for anything that contains a narcotic. That said my husband has had the same doctor since childhood and because her son backpacks as well he was able to get a script for something that would help him in such a case. He keeps it in his survival kit. At expiry he returns it to the pharmacy to be destroyed and the doctor will prescribe it again.

I have such a bad reaction to drugs with narcotics such as codeine that it is actually safer for me to stay away from them.

One thing we both carry – antibiotics and also a child's dosage and children's Advil. Travelling with a 5 year old in tow brings the need for extra first aid gear (especially bandages).

Reminds me… I need to go get everything refilled this winter.

[Thomas Knighton]

Back in the 1990's, I was a Navy Corpsman with a speciality as a pharmacy tech. In my "C" school, one of my instructors told me a little trick that might come in handy. Tylenol (Acetaminophen) and Aspirin (ASA), when taken together, have a pain killing effect pretty close to that of codeine, but without any of the side effects of a narcotic.

Personally, I've never tried it myself, but it might be worth a shot to carry a little of both. However, keep in mind that aspirin thins the blood, who is bleeding from more than a mere scratch, or has a potential for internal injuries (blunt force to the torso for example), should NOT attempt this at all!

[Mark Verber]

I find this question that started this thread troubling because it make it sound like a quest for the miracle drug that will help you push through. I would encourage anyone interested in this question to first take a look at books that analyze factors that lead to people making it through tough situations such as Deep Survival by Laurence Gonzales, or some of the more harrowing stories such as Touch the Void, before spending too much time investigating meds. I think you will find attitude and perspective are central, not access to good pain killers.

As to what drug, people process drugs differently so there is no universal answer. Also, different drugs are more or less effective on different sorts of pain. If there was a drug that turned off pain but left the mind clear and worked for everyone, then there wouldn't be tens (or is that hundreds) of painkillers in common use. If your doctor perceives you as responsible, it is pretty easy to get a prescription for a limited number of heavy duty drugs for a go bag as well as a good discussion as to when and when not to use the drugs.
I have yet to encounter a orally taken narcotic which left my mind clear and left me with the ability to focus and think so I won't use them. I have found that Naproxen is pretty effective for me for minor pains or inflammation through root canal level pain. Naproxen is used in over the counter aleve, and also found is heavier duty prescription drugs (just more mgs of the stuff in one tablet, sometimes with extra buffering for the tummy). The over-the-counter instructions of 1 tablet every 12 hours will not be medically effective. To be effective it needs a loading dose with requires at minimally two tablets. After the loading dose, the over the counter instructions (1 tablet per 12 hours) can be effective for many people.

[Kevin Sawchuk]

In reply to Bob Bankhead's item #4–a physician's DEA lisence is a federal licence and gives us prescribing powers in any state. However he's right–it is difficult fill prescriptions "on the go".

I agree that for longer/more remote trips it's good to have a stronger pain killer and an antibiotic along–if you have one it's also best to have it be one you've tried in the past (without allergic reaction or serious sedation). I usually also carry Diamox (which is a "sulfa" medication and may cross-react with other sulfa allergies) and Decadron for serious altitude illness.

Make sure you know how to use anything you carry (you may want to carry instructions with you) If you re-package your medications you should draw a picture of the pill with what it is along with the instructions. You don't want any mistakes!! I put pills into the small ziplock bags (1×2") along with a piece of paper with a drawing of the pill and basic dosing instructions.

[Shawn Basil]

I approach the concept with a different viewpoint having dealt with tremendous pain from injuries while in the Marine Corps, and substantial pain at times as a civilian long-distance hiker.

When injured, I would first seek medical intervention from technique, not drugs. Having held an EMT certification and later a Wilderness First responder certification, combined with experience in field evacuations while teaching for the National Outdoor Leadership School, my first thought would be to immobilize the injury. Padding and splinting might do more for pain reduction than a high-end painkiller. Combined with continued hydration, and a mixture of rest, icing (if possible), compression (if not contraindicated for circulatory reasons) and elevation during rest stops, a bit of ibuprofen may reduce pain while leaving the mental faculties less impaired than with narcotic drugs.

To me, medical training and good judgement seem a better idea than carrying a heavier drug.

[sam s]

I would agree with Shawn, but believe the judgement to avoid various situations, or taking risks in such situations, is probably a better choice.

Kids swinging logs, throwing rocks at animals be it bees or bears, climbing without appropriate gear, not taking basic safety precautions probably deserve what they get, metaphorically speaking.

On the other hand Morphine really does make all your problems go away, that is until it starts wearing off.

Sam ^2

[b d]

Shawn,

You wrote:

"When injured, I would first seek medical intervention from technique, not drugs."

Couldn't agree more.

I would add, taking pain pills can lead to really bad judgment because pain is telling us something is wrong, painkillers are overriding that message.

If we can't fix it with Advil, Tylenol or Bayer's enough to get back to base .. then we are in real trouble and pain isn't the issue.

Methodical medical treatment, within our ability, prior to a doctor's or other intervention is our job … not killing the pain. (Old Indian Trick.)

I broke my wrist once and kept working. After about 1/2 hour I had taken aspirin or something. Complicated the treatment because I didn't stop and take care of it when it first happened.

Although morphine/codeine type painkiller was great by the time I went to the M.D. with a wrist as big as a softball. Admire your past; you put it 100% well. Anyway, the answer to the issue is … IMO … if you are worried about pain then take morphine or codeine with you, but watch out for the side effects and the reliance on the meds can severly dim judgment.

PS: Thomas K, I have tried that and there is a stronger effect from a combination of common, low level pain killers, but as another poster said blood thinning is an issue. I would chose 2 extra strength Tylenol and 1 stronger Advil. If that didn't do it, I'd be wondering about the benefits of the EPIRB devices.

I don't know about the blood thinning characteristics of either, but they must be better than aspirin, because it is contraindicated for severe wounds and internal bleeding, especially. Although it is good to thin the blood, prevent clots and heart attacks.

(In my training the main issue with morphine is that, for example in a desert environment, it dehydrates and has a curve which means things can get worse without more. Therefore, it is only a drug of choice if your mind cannot take the pain or your situation requires you to do things that would not normally apply in a backpacking incident where you can calm your mind and self-treat your body.)

b d

[Randy Brissey]

Hello,

I have had two incidents where vicodin comes in very handy without interfering with one's faculties. Mind you if the vicodin is taken in the amount that a doctor prescribes it will leave most people functional.

Having a nerve in a tooth die (and you need a root canal NOW) and the second;

Kidney stones……for any of you that have had them you will attest to the pain. If you know what they are (a history of them) you know that you need to cut the edge off to evacuate.

For everyone pain is a relative proposition……..for me the root canal to be was much worse than breaking multiple ribs. Naprosyn works great (as long as you also eat something) for sprains and muscle soreness.

I have asked my physician in the past for "V" and he knows what I bring it for and he has never questioned me about illicit useage.

Randy

PS I am very lucky now in that my wife is a doctor and she prepares a med kit with everything needed for the runs to pain. I trust her, she has been helping others for 10 years.

[b d]

Randy,

What does your wife prescribe and consider good in a medical kit?

[Randy Brissey]

Hello,

I will have to quiz her. What usually happens is she hands me everything prepacked in a ziplock bag with notes on each blisterpack or vial as to what for, how many and how often along with a more detailed description as to what to eat/or drink with each one in a small notebook that I carry.

Randy

PS I also keep some extras in a "bounce box" when I through-hike.

[Thomas Knighton]

"PS: Thomas K, I have tried that and there is a stronger effect from a combination of common, low level pain killers, but as another poster said blood thinning is an issue. I would chose 2 extra strength Tylenol and 1 stronger Advil."

I agree totally about the blood thinning issue, and I thought I had said something about that as well. It shouldn't even be attempted if there is even a slight chance of internal bleeding (to say nothing of external bleeding!).

I also agree that it should only be done after proper technical treatments, such as splinting a break, are done. I simply assumed everyone understood to do that first!

Tom

[Jay McCombs]

1) All NSAID (aspirin, ibuprofen, naproxen being the most common) will have antiplatelet effects by virtue of their mechanism of action. The difference is aspirin is a permanent long lasting effect (EDIT: lasting for the life of the platelet) while ibuprofen and naproxen have a reversible effect that goes away (EDIT: before the platelet dies and a new one is made). The benefit of combining acetomenophin with an NSAID is you get essentially two different types of analgesia while also getting the benefits of reducing inflamation. Its for this reason I am a bigger fan of a drug like vicoprofen than vicodin.

2) If you do have a doctor thats kind enough to give you a script make sure you go in to see him the minute you are back after sustaining the injury you felt warranted use of the meds. He can document it to keep himself out of trouble and it will make him feel more comfortable if you happen to need a refil. If your script expires and you need a refil take it to him and show him the unused pills in their original bottle.

[David Wills]

To go along with Mark Verber, my buddy andrew carries a tube a vagisil with him to remind him to 'man up' when things get rough. not to be sexist, but attitude can be a serious determinant for success in dire situations. I never carry pain killers (unless liquor counts) on trips because they seem like cheating (and they weigh close to a gram, which is unnacceptable).

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