Drug Seekers

Specialties Addictions

Published

Hi all,

I am just curious how you deal with drug seeking behavior as a nurse. I have a hard time with these people, because while I know they need help (like a rehab or psych hospital), their orders for meds sometimes contradict what I assess, and I feel like the MD's are not always helpful in these situations with setting limits.

For example I had a pt last night who was on a med surg unit at my hospital and was discharged, only to be found lying next to the elevators. So, she was readmitted to our unit. I had her last night, and she was constantly on the call bell asking when shecould have pain meds, and also asked at the start of shift to have her morphine changed to Demerol, and could I page the MD and ask. Well, the first red flag was that when asked her pain scale it was always 10/10 but she could get up and walk to the cafeteria or outside to smoke, despite my asking her to stay on the unit and ask for help when ambulating, then when informed the MD would not change her pain meds asked for morphine and ativan (by name) as I was giving her scheduled methadone. She was A&O, but stoned out of her gourd already, and I told her I can't give those meds at the same tme, and would come back and reevaluate her in an hour. She started in about how noone understands her pain and that she was fine, but yet she was constantly up and restless even after meds that would have put me in a coma. I realize everyones tolerance and pain is different, but her behavior was very manipulative and led me to believe she was drug seeking. She got very upset with me and asked to talk to the Charge Nurse who backed me on this (we suspected she was using illicit drugs in the hospital but could not prove it).

How do you all deal with these patients when you also have 4-5 other SICK patients who require your care and attention? They do not listen to reason, just watch the clock to get their next dose, and God forbid you are late giving their meds!

Help!

Amy

Specializes in medical/oncology.

I work on a medical/oncology floor, so i have encountered some of what you have mentioned. Of course, pain is what the patient says it is, and I always stick with this, and do my best for every patient.

however, i have had some encounters with some pain seekers, and i really think that puts nurses in a tough position, especially when doctors only want to give a certain amount/dose/frequency of a pain med to a patient, which is understandable, and then there you are in the middle, and the patient's upset.

i did have a recent encounter with a pain seeker/drug abuser who was so manipulative, that i felt i couldnt function properly after 3 days of that..it was so bad to the point of the patient purposely occulding the IV to make it beep, to make me come faster with pain meds, even though i always came on time anyways..

Specializes in ER/ICU/Flight.

Admittedly, I'm not an addictions nurse but most of us have encountered plenty of addicts.

the thing that's always bothered me is the phrase "pain is what the patient says it is". I just don't believe that's always true. Someone had posted that people in chronic pain can adapt, which I do believe...but plenty of people are simply lying about it.

A common example: someone is demonstrating excruciating pain, cannot move on their own, can't be assisted without screaming at the top of their lungs, frightening their children who think mommy must really be hurting. then the doctor orders toradol and they have a "miraculous recovery". Within seconds they can move, get their clothes, put their shoes on...all without assistance. And as for the screaming and yelling, it's not in pain anymore. It's just cussing and threatening to sue.

Often we'd find a wristband from another local hospital ER with today's date on it. We'd call over there and the patient had conducted themselves the exact same way a few hours earlier.

I'm not saying I'm unsympathetic to the plight of addicts, but don't play me for an idiot and think I'm not hip to it.

Specializes in med/surge.

Do we work at the same facility? haha. I work in a rural hospital in the south which has 1 hospitalist to care for our patients. Let me start by saying that I know that pain is what the patient says it is......but when there is lacking clinical evidence I find it hard to be sympathetic. We have around 6-8 "frequent flyers" who are admitted to our small hospital on average once monthly. The SSD patients are admitted for SS crisis with RARE or NONE sickled cells on thier lab reports. We have Abdominal pain patients with no evidence on x-ray and better labwork than mine would probably be. This is the norm at our facility for these particular patients. The hospitalist I spoke of rants and raves if medication is withheld for low b/p or excessive sedation. He has written up a nurse that refused to let a patient go smoke that had a PCA and a Central Line that had 2 unused ports and has tested positive for every drug under the sun. We are not allowed to use our judgement with these patients. We usually see orders for these patients as follows: Demerol 100mg IV q 2 hours, Phenergan 25mg IV q 4 hours, MS Contin 60mg BID, Ativan 1-2 mg IV q 6 hours. They complain of nausea, requesting Phenergan with a pizza box on the bedside table. The pancreatitis patients are ordered a diet as tolerated, and they can certainly tolerate anything you can bring to them!! We have one that lays up in the bed with his girlfriend, and most of them request pain med and then after you give it they follow you down the hallway to go downstairs and smoke. I have only been in major pain 3 times in my life, and I am a smoker, but going to smoke never crossed my mind AT ALL those times in my life. Is this the norm in other facilities. Let me now say that my coworkers and I do give the ordered meds when asked and these patients rarely miss a dose of PRN pain med. Demerol is neurotoxic at doses of more than 600mg in a 24 hour period and these patients usually get 1200mg in a 24 hour period. Let me also say that my coworkers and I know these are not safe meds to be giving in these amounts, but we are not allowed to use our judgement. God forbid a patient tell this particular MD that you did not give the meds when requested to. Please let me know how it is done at other facilities. I have been a nurse for 5 years, and this is the only acute care facility I have worked in.

Specializes in ER/ICU/Flight.

We might we work in the same facility!!! hahaha. I am in the rural South too. I think it depends on the doctor, sometimes they cater to the patient and give in to their demands, other times they say "there's the door if you don't like it."

I'm not a rehab nurse so I usually say, "if the doctors order then I'll give it until the order runs out. if I wanted to argue with someone I would've gone to law school."

Specializes in Psychiatric, Detox/Rehab, Geriatrics.

It sounds like she was drug seeking. One thing to always remember is, that patients should know all the medication they are taking by name, it's their right. Just because someone asks for their med by name doesn't mean they are drug seeking. Never forget that.

I have a herniated disc. I have been on pain medication routinely for probably 20 years. I cannot function without it. My pain level is probably 8/10 at all times but to see me at work no one would ever know as I go about my job and act normal. You would never know I am in pain but it consumes my every moment. People are seeing me act normal when actually in my head I am thinking " when is this task going to be done, when can I sit down for a minute, I wish I was in a hot bathtub, when can I have my next pain pill".

I have no choice, I have to work and that's all there is too it. But all I think about is the throbbing pain in my back all the time. I have a high tolerance to pain meds and never have enough to actually control my pain.

But I will say this, there have been times when I have ran out of medication and have not taken it for days at a time. I am in severe pain and miserable but I do not have any withdrawl symptoms. I don't know if it's because I am taking the meds for pain and not to get high but I have never experienced withdrawl.

I hope there never comes a day when pain meds are not available because I would not be able to work or do anything else for that matter. It is still miserable even on meds.

Anyway, I am rambling but my point is, my pain level is very high but I am still able to look as if I am functioning as a normal person who is not in pain so you can't always use that to determine a person's pain level.

Specializes in NICU, ER, OR.

If its a prescribed med, you give it. the fact that they are seeking, whatever, is irrelevant. you, the nurse on duty that shift, is not going to be the one who miraculously cures that person of their drug addiction--- assuming of course that there *is* an addiction... which again, isnt your call to make.

Specializes in CHN, MH & Addictions, Acute Med, Neuro..

In response to the comments about "If its ordered I just give it" or the doctor gets ****** if we dont give the dose. I would be wary of this in the sense that as a nurse you are responsible for your decisions and if they do nod off from respiratory depression or what have you, you are accountable for that.

Drug seeker is a tough issue for me as I think addiction is a serious issue that shouldn't be dismissed on the basis that they 'dont need the drug'. It may not be for a physical pain but it is most likely for a psycho-physiologic addiction.

Specializes in ICU, MedSurg, Medical Telemetry.
Another thing is BUPRENORPHINE which is the miracle drug for opiate addiction. It brings them down while keeping them from being sick. Addicts are terrified of withdrawals and this works wonders BUT you need a doc willing to prescribe enough. You can get them clean in 3-5 days with maybe a sniffly nose but no shakes, no puking or runs.

Will they get addicted to buprenorohine? I've heard that this problem occurs withe methadone...

This might be a dumb question, but I work MedTele. After some real frustrating experiences with drug seekers, I really want to learn to deal with them better. I hate being so angry about them the whole shift.

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