Advice for dealing with addicts? - page 2

I'm in a detox clinic & this is my first nursing job & first experience in addictions. We have standing PRN orders for 25mg Vistaril Q6H PRN, Phenergen (must see vomit),75-150mg Trazodone for sleep or 50mg Benadryl for sleep. My... Read More

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    Working with addicts can be so draining, especially when you are working with them in the community and they are actively using and all you can basically do with them is harm reduction. Addicts while in the throes of their addiction (or precontemplation as the stages of change puts it) think they are the smartest people in the world and they can get away with pretty much everything be ause they are just so slick. Our pdocs rx pad has multiple boxes on it so he can write for more t han one med on each one. He crosses out the unused boxes. We had a client get a refill script for seroquel, and in one of the crossed out boxes she tried to write a script for oxycodone for herself. The pharmacy caught it and let us know. They even gave her the chance to fess up and she bald faced lied to them. She got arrested, kicked out of our program and will probably have to do the rest of her 15 year priso. Sentence (she was on probation). It is really frustrating to deal with, or you KNOW someone is looking for a benzo and magically atarax, melatonin, trazodone and even SEROQUEL doesn't help them sleep. Uh huh. But then I remember that when.someone is in withdrawals, they are really sick, probably the sickest they have felt EVER. I know I can't expect them to be sunshine and daisies. I'm a freakin pain in the ass when I have a COLD LOL. But yeah, it can vet tiresome, and setting boundaries and repeating it over, and over, and over is the best way to go. Even more fun when you throw axis II traits into the mix.
    TriciaJ likes this.

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    As Nurses we are taught not to judge. However there is a fine line between compassion and being taken for granted. That is something we all have to deal with on a personal basis. As an educated Professional - Im sure you will make the right decision.
    tshepp11 likes this.
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    People with addictions don't think the way a "normal" person does. Sadly, until they want help they won't change. And even the sober ones struggle to stay sober. It's not cut and dry. I'm thankful I've never been addicted to anything harmful however we all have some type of addiction. It's not our place to judge how or why a patient is where they are in life. It's our job to give them the best care possible to get them through today, even if its fruitless.
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    all those meds you mentioned... vistaril, phenergen, benadryl, are at the bottom of the list of what an addict would ever abuse. especially if the addict is in rehab... i'm assusming they are there for REAL drugs of abuse, not antihistamines. why do you care if the are asking for vistaril every 6 hours? it's your freaking duty to dole it out as the doctor ordered. also, YOU have CLEARLY never suffered from withdrawal. why not make withdrawal as comfortable as possible? these patients are trying to allay their anguish, not get "high", while you sit there.... even if you gave these patients all of the mentioned drugs at once they would STILL be in pain. yet you have the attitude of "how dare they want to feel better? don't they understand they must suffer to understand what they have put themselves through? don't they get the puritan ethic of no pain no gain?" wow. simply. wow.
    Last edit by Esme12 on Sep 30, '13 : Reason: TOS
    tsalagicara, Lane007, and TXRN2 like this.
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    I guess I am not understanding why you feel the need to withhold medications that are legitimately ordered for these patients to take as needed during the period of detox.

    I understand that dealing with addicts can be frustrating, but if Vistaril is ordered Q6 hours prn, I don't understand why you are giving them a hard time for taking them as they are prescribed.
    tbirdtyler, Lane007, Orca, and 1 other like this.
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    First of all, phenergan can and is abused. I've taken it, it can and with a lot of people myself included give you a high, not to mention knock you out cold. Out of the list of meds the OP mentioned the only one I would even be concerned about evaluating real need versus med seeking with IS the phenergan. Vistaril, Benadryl, antihistamines I don't really care. If my patient wants an antihistamine ill usually give it. It's not like its Valium. I usually don't withhold phenergan unless the patient is requesting it for nausea they have rated at a 1, I will try mylanta first or ginger ale, or if they just ate 2 sandwiches. My theory is if you have been out there snacking and eating you can't be about to vomit. With the trazodone- I give it unless they are sleeping. If I have to wake you up to take meds there's no need for a sleeping pill. If you find you can't sleep later third shift can give it.
    TriciaJ, sharpeimom, Orca, and 2 others like this.
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    Quote from RxOnly
    Neurontin is one of the most abused non-controlled substances around here
    I work in a prison setting, and we have pretty much stopped prescribing Neurontin at my facility. We had such a serious trafficking problem that even crushing didn't stop it. We found out that inmates were pretending to swallow it, spitting it out in a cup of water and handing the cup to whoever they agreed to sell/trade it to (it's amazing what lengths inmates will go to, and what they will endure, to get the pills they want). We have pretty much restricted Neurontin orders to inmates who are HIV positive and cannot tolerate other seizure meds.

    We had similar issues with Seroquel, and we took it off our formulary. Our first hint of a problem was when we started getting mental health service requests from inmates stating that they needed Seroquel without even bothering to identify why they believed that they needed it.
    TriciaJ likes this.
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    I give everything and anything TOGETHER for these people who are in the throes of withdrawals. It's only for a few days, 'till their system clears. None of those meds mentioned are addictive, or they would be scheduled meds. It's amazing the stuff people can write and not be questioned. Phenergan is not addictive! Hydroxyzine isn't, either! Please look it up and recheck abuse statistics. Better yet, study and take the CARN exam! Make it your business to UNDERSTAND addiction, not treat it as a moral deficiency.

    I slam them with everything my judgement allows, because after all, they're not my own personal supply of meds (so why act like it)? Why be so stingy with them? We recently had a nurse FIRED for not doling out meds as ordered and requested. It's not my job to try to talk them out of their PRN's. Addictions nursing is a field for the very few who truly understand the disease of addiction. Others should move to straight psych wards. Many get into hot water for not giving meds as prescribed and requested (that's a dangerous game with your license being played). Our nurse who was fired did not give the meds the patients were requesting that the providers were ordering! If they say they're sick, then they're sick. The old saying that addicts are bad goes against the very fact that addiction is a diagnosis, not a moral deficiency (so don't treat them by controlling them; work with them)!

    Imagine throwing someone in jail (who has diabetes) for eating a cookie because they had a craving for one! It's just that simple and these meds are there to reduce cravings, help them sleep or feel more relaxed so they can cope. It's a horrible disease and you want to keep them there so they don't leave AMA and potentially die (relapse is a dangerous time when they may, or may not make it back). The reason they don't add other diagnoses for ANYONE in the throes of withdrawals are because withdrawals can mimic schizophrenia, panic disorders, phobias, bipolar, and explosive disorder. We, as med nurses can't expect to "fix" them by controlling what they take in the moments we interact with them. Why not give Trazodone and a little this and that? Why not give a couple, or a few meds at a time? I throw meds at these guys 'till the cows come mooing home and they appreciate my efforts to helping them feel comfortable. Upon admission, I go through their list of meds with them, discuss what effects each of them have, then we decide on what's most likely to snow them (if they're opiate addicts and it's night time). If an ETOH addict is uncomfortable, I throw benzo's at them to stay ahead of the game, so I'm not chasing withdrawals (I'm more careful with the ETOH and benzo's, though but I always stay ahead).

    The nurse who was fired was investigated by the board and found guilty of playing this dangerous medication withholding game. If it's ordered and the patient requests it and the patient says they're having symptoms (the kind we cannot see), then that's a legal basis for a complaint and a case. Anxiety isn't fun, neither is addiction or withdrawal. If I were uncomfortable, I'd play whatever games I had to, in order to gain some relief! It may turn into a game of getting through the med nurse-barrier between me and the meds my prescriber ordered. If I'm comfortable, then I'm more likely to be precontemplatiive about addiction versus sobriety. That's where I need them to be.
    silverbat, tsalagicara, tbirdtyler, and 4 others like this.
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    Disagree ... I've taken phenergan and it made me feel like I was on Vicodin for a couple hours before it knocked me out. It's not a scheduled med but its naive of you to think people don't abuse phenergan lol. I recently cared for a patient who admitted to being addicted to and abusing neurontin.
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    Seems to me the OP is trying to develop the judgement needed to support people in their efforts to get well and not support them when they manipulate to stay sick. It is a very fine tightrope and I think some facilities put way too much onus on the nurse. In a place rife with manipulative behaviours, it is really essential to have very clear MD orders and unambiguous unit policies. Most nurses don't withhold meds for the fun of withholding them; we are trying not to add to the problems people already have. Maybe addictions should be covered more thoroughly in nursing school so we have a better idea how to genuinely help people and not feel like we're sinking or swimming.
    sharpeimom and morte like this.

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