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Thread: Backcountry Pain Pills

  1. #1
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    Backcountry Pain Pills

    What do you carry in your first aid kit to address pain from severe trauma/accident?

    In the past my doctor wrote me a prescription for APAP/Codeine (APAP = paracetamol = acetaminophen) with a dosage of 300/30mg. This would be for use on multiday/multiweek/expeditionary trips where evacuation to medical care could take days. No doctor or EMT among the team members.

    In recent years my doctor refused to provide the prescription because of the rise of narcotic/opioid abuse. I still have pills from my last prescription in 2014. My doc said to discard them after one year. Another physician said I could continue to carry them for emergency use.

    The APAP/Codeine remains in my first aid kit. Not knowning how effective they still are, I also carry ibuprofen or acetaminophen.

    In reviewing a previous VFTT thread on the topic of pain pills, user "SAR-EMT40" commented how strong pain pills administered by untrained persons could cause serious, even lethal side effects. So maybe I should toss the old pills.

    For those who may be interested here is a link to that thread.

    https://www.vftt.org/forums/showthre...ght=pain+pills
    散步 Sanbu

  2. #2
    Senior Member hikerbrian's Avatar
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    Hard for me to add any more to SAR-EMT's 4:44 post from 2005. I lean strongly towards what s/he says in that post. Don't administer such meds to anyone other than yourself.

    All drugs have an expiration date, and the date has data behind it. In some cases the products are known to decompose after a certain amount of time. In other cases it is not known what happens after that date. Maybe nothing, maybe decomposition. As a person who has spent close to 20 years in pharmaceutical R&D, I can tell you I've never come across a drug-like compound that does not decompose at least a little bit at room temperature over a period of years. So choose your own adventure. I personally would toss them. Immediately. Six years at room temp is a long time.

    To answer your first question, I carry ibuprofen for myself. The stuff is pretty effective for mild trauma. I wouldn't offer it to anyone who did not ask specifically for it. I think that's a reasonable safety/liability precaution. That said, in each of the two or three times I've taken wilderness first aid, leaders have stressed the importance of being careful when you give anything to anyone. A person is shivering and asks you for some food and water. Did you ask them if they have a peanut allergy before you gave them that Snickers? Etc. One suggestion is to use contents from the victim's pack as much as possible. I personally balance potential liability against a personal conviction to help someone who asks for it. One can take these 'What-if' scenarios too far.

    Managing a severe trauma event in the backcountry is exceptionally challenging; I've never had to do it. Again, from my WFA classes, you do your best to stabilize the patient (airways, breathing, circulation), address bleeding and other immediate threats to life if you can, and then try to help the patient hold out until 'real' help arrives. That may mean splinting a broken leg (even if there's no chance the victim will walk out, splinting can relieve pain, but that too is not without risk) and/or providing insulation to mitigate hypothermia. There's not much you're likely to do beyond that, and it's good to recognize and make peace with one's limitations in medical expertise.
    Sure. Why not.

  3. #3
    Moderator David Metsky's Avatar
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    Ibuprofen and Tylenol. I wouldn't take anything else in the backcountry, and I certainly wouldn't give anything more to someone else.

    If someone is carrying their own medication I would assist them, but it's not my untrained place to administer any of my own prescription meds. Especially not expired meds. If I wanted to be able to give those out I'd get significant medical training.
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    Senior Member iAmKrzys's Avatar
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    Quote Originally Posted by hikerbrian View Post
    All drugs have an expiration date, and the date has data behind it.
    The question of drug effectiveness beyond expiration date has been studied by FDA at the request of the military. Here is a link to high-level summary at NIH web site: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040264/

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    Senior Member hikerbrian's Avatar
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    Quote Originally Posted by iAmKrzys View Post
    The question of drug effectiveness beyond expiration date has been studied by FDA at the request of the military. Here is a link to high-level summary at NIH web site: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040264/
    Thanks for the link - that high level summary in the journal African Health Sciences doesn't have any data, though there is a paper in Archives of Internal Medicine (might be paywalled?) from 2012 that suggests codeine (and a couple of other drugs) may maintain reasonable potency for some time past its expiration date. A more complete list of medicines tested as part of SLEP (the military testing program) along with data is in Mayo Clinic Proceedings from a few years back, but codeine isn't in there. My opinion is you really just don't know - it's always going to depend also on storage conditions. That said, I did read in one of these papers that there are very few known cases in which an expired drug caused an adverse reaction owing to decomposition, so that risk is probably low. So maybe that is useful. Still, for all the reasons stated above, I'd keep the medicine to yourself.
    Sure. Why not.

  6. #6
    Senior Member ChrisB's Avatar
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    Quote Originally Posted by hikerbrian View Post
    Thanks for the link - that high level summary in the journal African Health Sciences doesn't have any data, though there is a paper in Archives of Internal Medicine (might be paywalled?) from 2012 that suggests codeine (and a couple of other drugs) may maintain reasonable potency for some time past its expiration date. A more complete list of medicines tested as part of SLEP (the military testing program) along with data is in Mayo Clinic Proceedings from a few years back, but codeine isn't in there. My opinion is you really just don't know - it's always going to depend also on storage conditions. That said, I did read in one of these papers that there are very few known cases in which an expired drug caused an adverse reaction owing to decomposition, so that risk is probably low. So maybe that is useful. Still, for all the reasons stated above, I'd keep the medicine to yourself.
    In the Whites I would never give a debilitating drug to anyone in the back country. The last thing you want to do is render someone senseless and unable to help themselves or to communicate with an EMT or paramed. The front country is never more than a few hours away in the Whites. Do no harm.
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    To answer your first question: ibuprofen and cannabis.

  8. #8
    Senior Member TCD's Avatar
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    For me for personal use, it's Ib and Captain Morgan. Used that combo once when my knee hurt after a hard hike; got out in comfort.

    As a guide, I carry Ib, Acetaminophen, and Aspirin. Different applications for each. One client had a tight muscle problem in his back that would act up after a long hike. He also had an unusual kidney condition that was treated with some oddball medication that would be deactivated by any prostaglandin inhibitor (Aspirin or Ib). So I produced the tylenol (acetaminophen) which he opted to take. 15 minutes later we were back on the move for the last few miles of our long hike. (I felt like a hero because I had all three popular OTC pain relievers in my kit.)

  9. #9
    Senior Member iAmKrzys's Avatar
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    I carry ibuprofen and acetaminophen in my first aid kit. Ibuprofen seems to work better for me, so that's what I prefer to take, although I very rarely use any pain medications.

  10. #10
    Senior Member Nessmuk's Avatar
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    Quote Originally Posted by David Metsky View Post
    Ibuprofen and Tylenol. I wouldn't take anything else in the backcountry, and I certainly wouldn't give anything more to someone else.

    If someone is carrying their own medication I would assist them, but it's not my untrained place to administer any of my own prescription meds. Especially not expired meds. If I wanted to be able to give those out I'd get significant medical training.
    Exactly. Any level of basic or wilderness first aid instructor should caution you that administering drugs is not within your level of training. If you did so and the person had some kind of allergic reaction, you could be held legally liable for any lasting negative effects. You are allowed to assist them with their own medication, as long as they are able to administer it to themselves.

    Personally, I prefer Ibuprofen for myself. Canoe racers often refer to it as "vitamin I". Before my Yukon canoe races, I have my doctor prescribe a fresh batch of 800mg vitamin I for me. During the 1000 mile races, I tend to hold off until day-3 before I relent and finally decide to take one.
    "She's all my fancy painted her, she's lovely, she is light. She waltzes on the waves by day and rests with me at night." - Nessmuk, Forest and Stream, July 21, 1880 [of the Wood Drake Canoe built for him by Rushton]

  11. #11
    Senior Member nartreb's Avatar
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    I generally don't carry any pain medication at all. There are none that I've found effective for sprained-ankle or higher levels of pain, without either requiring very unsafe doses, or rendering me dangerously slow-witted, or both. (And for any lower level of pain, medication is not needed.) The best use case would be for extended trips where proper medical aid might not be available for several days. In that scenario, taking something like a codeine/acetominophen combo in the evening, to allow the patient to sleep, makes sense, as grogginess isn't a dealbreaker. But as others have said, get it prescribed and don't give it to anybody else. TCD gives a good example where an ordinary medication used for an apparently ideal purpose would have been a major problem.

    If codeine is not available, I believe high-dose ibuprofen is now considered less risky to your liver than a corresponding dose of acetominophen, but either should be OK for a night or two. It will probably be less effective than the codeine, but when you're trying to sleep, a little relief is better than none.
    Last edited by nartreb; 01-06-2021 at 08:14 PM.

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    I had to have a root canal pre-covid and walked out with scrip for a short run of Percocet (Oxycodon Acetaminophen). About six months later when Opioid addictions got a lot higher visibility, I had to have another one from the same specialist. Same exact procedure. I asked for a script and he said no need just take Advil up to 1600 mgs a day for two days and avoid alcohol. I didnt use the percocet on the first round and took a couple of Advil on the second round.

    Vitamin I is a pretty standard AT thru hiker daily drug.

  13. #13
    Senior Member ChrisB's Avatar
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    How About CBD?

    Quote Originally Posted by Nessmuk View Post
    ...Personally, I prefer Ibuprofen for myself. Canoe racers often refer to it as "vitamin I". Before my Yukon canoe races, I have my doctor prescribe a fresh batch of 800mg vitamin I for me. During the 1000 mile races, I tend to hold off until day-3 before I relent and finally decide to take one.
    This thread got me thinking: High doses of Ibuprofen are pretty toxic to your kidneys over the long haul.

    Has anyone tried locally applied CBD for muscle and joint aches and pains? Friends that tell me it works very well
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  14. #14
    Senior Member Nessmuk's Avatar
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    Quote Originally Posted by ChrisB View Post
    Has anyone tried locally applied CBD for muscle and joint aches and pains? Friends that tell me it works very well
    No way on this earth, regardless of my condition, would I support in any way any part of that industry. My feeling on that is a large part of my upbinging, my career requirements, and my firmly held beliefs. Even when I have ibuprofen with me, I hesitate strongly to give in to its use. I was surrounded by that crap in my college days and thank the lord that it could be and was willfully and proudly 100% avoided. I was given percocet after surgery more than once during hospital recovery. It made me vomit each time.
    Last edited by Nessmuk; 01-07-2021 at 09:08 AM.
    "She's all my fancy painted her, she's lovely, she is light. She waltzes on the waves by day and rests with me at night." - Nessmuk, Forest and Stream, July 21, 1880 [of the Wood Drake Canoe built for him by Rushton]

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    Quote Originally Posted by ChrisB View Post
    This thread got me thinking: High doses of Ibuprofen are pretty toxic to your kidneys over the long haul.

    Has anyone tried locally applied CBD for muscle and joint aches and pains? Friends that tell me it works very well
    I use a 1:1 CBD:THC salve and a straight CBD salve on areas of past injury (soreness around broken bones, torn tendons and ligaments, etc) with some success. I find ingesting is more effective overall but they do complement each other. My liver levels are such that I need to avoid excess medications like ibuprofen for chronic pain. An experienced user could also utilize it to help reduce anxiety while dealing with an injury. I avoid opiates the way Nessmuk avoids cannabis.

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