Diving and oxycontin

[BillP]

wazza asked...
Dr. Bill , Dr. Larry

But my question don’t u think that the medication will effect the nitrogen elimination from the tissues as well and he need more time after he finishes from his medication so his body will be 100 % clean from it, before going diving again .

Howdy wazza:

I wouldn't expect OxyContin to significantly affect nitrogen elimination from the tissues. I suppose that medications that affect circulation of blood might affect nitrogen uptake and/or elimination some, but I wouldn't expect the effect to be too terribly significant in divers. I've not heard of a drug being a disqualification for diving specifically because it affected nitrogen elimination.

Since OxyContin is a narcotic what it will do is add to the effects of nitrogen narcosis. It probably works by a different mechanism than the increased partial pressures of nitrogen has, but the effects are similar and likely additive.

As Larry already pointed out, the condition a diver is taking a medicine for is often the reason for disqualification from diving rather than the medicine itself being the problem. Sure, someone with neurological problems from a back injury could develop a decompression illness (DCI) with similar symptoms or could have symptoms from their back that might possibly confuse an examining physician about the presence/absence of DCI. Some dive authorities would say those with neurological symptoms should not dive because of this concern. Others would say some conservative diving is OK if the existing symptoms are well documented predive. My particular concern regarded someone's ability to dive if they were impaired by such severe pain that they required constant use of very strong narcotics- not just the narcotic use itself.

Regarding other medications and diving, many people take some kinds of "serious" medicine and dive successfully. It depends on the medicine and the condition they're taking it for. Scubadoc has a good article on his website listing the diving related concerns for many medications at:

http://www.scuba-doc.com/drugsdiv.htm

HTH,

Bill

The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.

 

[dmdalton]

I ran my left thumb through a table mounted router a few months back and after they stictched the parts back together (it wasn't pretty) they prescribed this. I don't recall the dose but it said take 1-2 for pain. The thumb didn't hurt but I had a heck of a headache so I took 2. I was in such a fog I couldn't function for 8 hours. No way I would have gone diving. I threw the meds away, healed and went diving 2 weeks later!

BTW, the PA in the ER did a great job of stitching. Most wouldn't realize the thumb had ever been damaged. I thought my new name would be "Stubby".

Dave D

 

[Laurence Stein DDS]

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Larry

 

[wazza]

Thanks guys for your precious information, and for this lovely explanation and concern

 

[JT2]

I probably should not get into this here on the board, as I am sure I will be told how stupid some of you think the things I do are when it comes to medical conditions, medication and diving, but here goes anyway. First of all let me start by saying that I am a type 1 insulin dependent diabetic and have been for 14 years, and when I decided to start diving I did not hide the fact that I was a diabetic, which as you probably know made it difficult to find an instructor willing to take me on as a student, but after a long search I found one who was willing to teach me after having many face to face discussions and doctors notes to evaluate my situation with. I used my early days diving as a sort of personal research on diving with diabetes, which I might add I have since shared with the people at DAN who seemed very interested in it at the time, and have done their own research on diving diabetics. Okay, now fast forward with me a couple of years if you will to a Dr.'s appointment I went to in order to discuss some nagging pain I was getting in my neck and back that had been getting worse over the years, that I had attributed to my early days of motorcycle wrecks, football and bar room brawls, and I had been told many times in the past by dotors that it was probably just diabetic neuropathy, however after extensive X-rays and MRI's they informed me that I had a deformation in my spinal chord that could be a result of an old injury, or possibly even genetic and there was not anything that could be done as far as fixing it and that the only thing they could do was to treat the pain. I did not want to have to be hooked on pain medication for the rest of my life so I decided to just tough it out, and I managed to do so for a while until the pain just got to be to much at which point I went back to the doctor who put me on several breakthrough pain meds up to and including Dilaudid and Morphine Sulfate. While I was taking these medications I did refrain from diving and just about everything else other than showing up for work and trying to make it through the day, and believe me these medications have bad side effects when taken for any length of time, and none of them were pleasent. After th pain continued to get worse and the medication no longer worked even at levels that would kill some people, I sought help from a different doctor who put me on Oxycontin that was continuously released into my system so that I did not have to wait until the pain was unbearable andthen take huge doses of the other meds to try to control it, and become a Zombie. The Oxycontin worked okay, but eventually I was switched to a pain patch called Duragesic that is a time realease as well and it is a fentanyl compound, this medication has given me my life back. After having been on this medication for over a year I decided to try and get back to diving again, and with great caution I did just that. I do not do deep dives or working dives anymore, nor will I be doing any overhead diving. All that being said, the reason I wanted to write this lengthy post is that I believe it is possible for some people on powerful meications and with conditions that have always excluded them from diving, to not only dive, but enjoy diving and have something to look forward to. I would also like to say that I have taken all types of mental alertness tests and worked very closely with my doctors before undertaking any kind of extracurricular activity, and at all times I fully disclose my medical info to all of my dive buddies, it can be done, and done safely by some individuals that are willing to go the extra mile and take proper precautions and go forward slowly, I think it has been to easy for some doctors in the past to just say NO whenever it is something they simply don't have any information on, and I also understand their views. I didn't really have the time or space to get into all of the particualrs of my situation but I would be morethan willing to do so with any of the Docs here on Scuba Board. Thanks for listening!

 

[Laurence Stein DDS]

JT2,

You said nothing that was stupid. In fact I applaud your honesty.

We docs don't like to be the bad guys here. Unfortunately, when we give advice, it is under the "color or the profession". We cannot ethically give advice that is contrary to prevailing medical opinion without opening ourselves to liability issues. So on this issue, I believe that we must advise against the use of these medications and diving. Even a "reasonable person test" or a "prudent person test" would probably come to the same conclusions--Would a reasonable or prudent person (lay person), having been told of the serious potential problems, allow themselves or perhaps someone in their family to dive while using these medication? If your answer is NO, then you have come to the same conclusion a professional has come to.

This is not to say that a prudent person will not, at some point, decide to use the medications anyway. However, a professional simply cannot tell YOU that it is OK. Any personal decision is yours to make--and that's OK--you know the risks and, in your case have wisely decided to share this imformation with those around you during a dive. You probably would not have shared this information if you REALLY didn't see a clear need for doing so.

Medical opinion is very slow to change. Diving and diabetes and asthma are two conditions which are slowly changing. Don't expect the professionals to give a blanket OK. Also don't expect these limited changes to apply to the entire spectrum of the conditions mentioned.

Your opinion is valued here and I personally don't think you are saying something stupid. I would, however, still advise caution for what I believe even you understand to be serious consequences.

Regards,

Larry Stein

 

[JT2]

I believe that we must advise against the use of these medications and diving. Even a "reasonable person test" or a "prudent person test" would probably come to the same conclusions--Would a reasonable or prudent person (lay person), having been told of the serious potential problems, allow themselves or perhaps someone in their family to dive while using these medication? If your answer is NO, then you have come to the same conclusion a professional has come to.

I completely understand a doctors point of view, and no, I wouldn't recommend that anyone taking schedule II narcotics take up diving, nor would I recommend that most type 1 diabetics take up the sport, as most people do not have the discipline to properly control their blood sugar. I have wrestled with the thought of sharing my story on the board for a long time, however, it is something that I am very serious and passionate about and I just felt the time and thread were right for sharing, I certainly hope I didn't give anyone the wrong idea. I have seen a lot of young people give up on life because of medical problems much less severe than mine, and I just like to let people know that iit is possible to accomplish things even if someone says you can't, is it easy, hell no it isn't but in some cases it is possible. Once again I do understand the blanket policy, I just like to point out that there are almost always exceptions to the rules. I have always appreciated the answers and info I have received from the docs on the board and I have on more than one occasion PM'd some of you because I didn't think what I was doing should be brought up without a thorough explaination in a public forum, and all of the Scuba Board Docs have answered my questions without judgement as well as offered words of caution when they felt it was appropriate. Great work guys! Thanks

 

[MichgnTechDiver]

Thanks for all the replies, this board is awesome. I have done a lot of research on this drug and advised him not to dive until rehab is complete, even though he says he is tolerant to the narcotic effects, he may be impaired and not know it.

His health and safety is more important than diving, and will have to wait, at least to dive with me.

 

[Dr Deco]

Dear Readers:

Nitrogen Elimination

There are not any drug therapies that can appreciably change nitrogen elimination. The primary controlling factor in the body is the local accumulation of carbon dioxide from activity and the associated “muscle pump” that assists in the movement of blood through the capillaries. This over rides any pharmacological intervention.

As the others have commented, these medication will certainly cloud your mind, interfere with decision making, and mask DCS symptoms. Other than that…..

Dr Deco :doctor: