How Can You Tell if a Pt. Is Addicted???

Specialties Addictions

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Specializes in Rehab.

I have been taking care of a pt. every weekend since she has been admitted. I would like to start off by saying I am a big pain advocate, however I believe that her pain needs to be reassessed. I do find pain management very therapeutic when used appropriately, and it is easier to prevent pain that relieve it. However, I believe my pt. is developing an addiction to her pain medication or we may be feeding a long-standing addiction. I noticed a certain "uncomfortable" feeling when speaking initially with her and her husband about pain management. Her husband became very quiet, did not keep eye contact w/ me and she was looking at him at times with a look like you better not say anything. I did not think too much of it at the time but did notice she wanted her pain meds around the clock, right on time, every time. I thought ok, no big deal, she has just had back surgery and she has a long list of past surgeries and DJD so she must be in pain. However something else peaked my suspicion which was that while getting report, the dayshift nurse told me she was speaking about pain medication w/ the pt. in-front of the pt's sister and that the sister had the most disgusted look on her face. So, with the husband's reaction plus the sister's reaction, there must be some history there we do not know about. Also, the pt. is constantly scratching herself. She states it's because she gets an allergic reaction to the pain medication and that Benadryl helps it, but I also know that scratching is a symptom to narcotic addiction. She also always seems to rate her pain at a constant 7 or 8 but objectively, she does not look to be in distress. I do not say anything because as nurses we are taught that a patient's pain is whatever they say it is, so I give her the medication but just feel like I am feeding into something but maybe that is what she needs to function. She gets Oxycontin 20mg qAM and 10mg qHS plus Soma q6 plus 2 tabs Norco 10 q4. And believe me...she watches the clock. So how can you tell?? Do you think any of the things I mentioned is enough to bring up to the Dr. and ask them to reassess her pain and perhaps prescribe her a lower dosage or possibly even dc one of her meds??? Thanks for your input...

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Specializes in Cardiac Telemetry, ED.

Itching is a common side effect of narcotics, not an allergy or a sign of addiction. Clock watching is commonly observed with patients who suffer from chronic pain, and is not, in and of itself, a sign that the person is addicted. The subjective interpretations of the husband's and sister's behavior are just that; subjective. It does sound like there may be some conflict within the family around the management of the patient's chronic pain, but that could stem from many factors, and is not objective evidence of addiction.

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Specializes in psych. rehab nursing, float pool.

There are good articles available on chronic pain syndrome. This very well might be what you are observing.

To me addiction, equates to the patient who's speech is so thick ,their eyes can barely stay open yet they continue to demand more pain medication. Those are the ones I then begin to suspect.

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Even if she has a problem with her pain medication, trying to get her meds decreased or d/c will help absolutely nothing in the short time she is under your care. Just medicate as ordered and let it go. More than likely her surgeon is already aware of any issues as far as this is concerned anyway-they did have to write for all she is taking.

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As an EMT, we end up being the ones who bring you your addicts lol, sorrrrry. But in all seriousness; the best way for US to tell if the pt is an addict, is to do SAMPLE(Signs-symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, and Events that lead to the event). We ask these in a certain way and order and they end up contradicting what their actual problem is. Usually the "seeker" will exagerate his/her symptoms, and if we don't show them enough attention(on purpose) they will get desperate and make up more symptoms, or continue to exagerate what is going wrong. Sometimes they will go as far as asking what the nurses at the hospital will do for their problem, including any medications you(ER staff) will give them, how long they'll be in there. And usually they're our frequent flyers and end up being your frequent flyers, and sooner or later you'll know if they are or not.

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I have been taking care of a pt. every weekend since she has been admitted. I would like to start off by saying I am a big pain advocate, however I believe that her pain needs to be reassessed. I do find pain management very therapeutic when used appropriately, and it is easier to prevent pain that relieve it. However, I believe my pt. is developing an addiction to her pain medication or we may be feeding a long-standing addiction. I noticed a certain "uncomfortable" feeling when speaking initially with her and her husband about pain management. Her husband became very quiet, did not keep eye contact w/ me and she was looking at him at times with a look like you better not say anything. I did not think too much of it at the time but did notice she wanted her pain meds around the clock, right on time, every time. I thought ok, no big deal, she has just had back surgery and she has a long list of past surgeries and DJD so she must be in pain. However something else peaked my suspicion which was that while getting report, the dayshift nurse told me she was speaking about pain medication w/ the pt. in-front of the pt's sister and that the sister had the most disgusted look on her face. So, with the husband's reaction plus the sister's reaction, there must be some history there we do not know about. Also, the pt. is constantly scratching herself. She states it's because she gets an allergic reaction to the pain medication and that Benadryl helps it, but I also know that scratching is a symptom to narcotic addiction. She also always seems to rate her pain at a constant 7 or 8 but objectively, she does not look to be in distress. I do not say anything because as nurses we are taught that a patient's pain is whatever they say it is, so I give her the medication but just feel like I am feeding into something but maybe that is what she needs to function. She gets Oxycontin 20mg qAM and 10mg qHS plus Soma q6 plus 2 tabs Norco 10 q4. And believe me...she watches the clock. So how can you tell?? Do you think any of the things I mentioned is enough to bring up to the Dr. and ask them to reassess her pain and perhaps prescribe her a lower dosage or possibly even dc one of her meds??? Thanks for your input...

she is not on a lot of med, per se......and the oxy should be q8' not bid.....if she needs the BT meds on the dot, her baseline slow acting meds should be upped....not lowered......the family reaction you are seeing, may the preception that they have, (subjective) that any use of narcs is addiction......and now that the surgery has been done, the patient should be "all fixed, no more pain" and the family is viewing this as confirmation of their opinion........good luck

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Specializes in Cardiac, ER.

You know, I've decided that it really doesn't matter to me most of the time if my pt is addicted. It isn't with in my scope of practice to diagnose drug addiction, and while the pt is in the hospital for an acute, painful disease/injury isn't the time to withdraw an addict.

Just because the pt is an addict doesn't mean they aren't hurting after a lap chole. If anything it means they may require larger doses for affect.

I used to let this really make me frustrated, and now that I'm in ER it does still frustrate me at times. I get angry at the people who come in every other month with a long story about how their meds were stolen from their car in Walmart parking lot, the roommate stole them, they dropped them in the sink etc. I'm angry because they are taking my time away from pts who are honestly hurting/injured.

I do probably let that influence the haste at which I give them their meds, but if the doc orders the med I give it. I don't waste even more of my time away from my other pts by arguing with the pt or the doc. Most addicts know they are addicts, they know what they are doing, know what to say and what not to say. They know when and where to get what they want. I honestly don't believe that a lecture from me, at 3am when they are needing their fix,is going to change a thing.

I started in this career thinking I wanted to make a difference. Leave a permanent imprint on peoples lives. I have since learned that I can only help those that want help. I save my time, energy and tears for those injured in trauma, Mom's with sick children, the 45yr old Dad with an acute MI, and the sweet Grandmothers who pat my hand and tell me I am their angel. I get my satisfaction by getting that MI to the cath lab in less than ten minutes, watching the CVA sx resolve in the pt I started TPA on, and getting the sloppy kiss from a 3yr old we just put 8 stitches in.

I hope that doesn't make me sound cold and jaded, because I really do love my job and would be happy to do my part to help any addict who wants my help. I think I've just learned over the years that I am a better nurse and a happier human being by focusing my energies where I know they will be most productive.

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Specializes in Cath Lab, OR, CPHN/SN, ER.

When she goes into DT's ;)

Addictions are not broken in the hospital- make sure discharge planning has her hooked in with a pain mgt. clinic once she is discharged.

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Specializes in Emergency/Trauma.

You job as her RN is to relieve her sx and help her heal from the surgery. There are RNs trained in what s/s to look for in addiction and that's why they specialize in that. And the itching is a very common side effect of narcotic pain meds, not a sx of addiction.

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I agree with the previous posts- it is not your duty to diagnose addiction. Rather than wasting time investigating her "addiction" your time would be better spent assessing her healing after a very painful surgery.

You also should never objectively put your own rating on someone else's pain. If she says it is a 7 or 8- it is. Not everyone rolls around crying when they are hurting. You didn't say anything about her apearing dysfunctional, so I don't know why a few supposed looks between family members bothers you so much.

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Please take the advice of those on here who say it's not our job to try to figure that out. My Mom was in chronic pain and who knows how many people in chronic pain ARE addicted or not, but chronic pain needs to be treated.

Itching is very common with pain meds, first dose, hundreth dose, addicted or not addicted.

Please don't start a habit of trying to determine addiction. You will end up doing that with people who are really in pain and need your help.

If she were stealing, lying, getting in legal trouble, then there might be a problem. And even at that, addicts still feel pain and deserve treatment. Everyone deserves to be taken at their word in regards to how they feel.

Please, please, please don't allow yourself to become the narc police. As a child of someone who was in chronic pain for years, I can tell you, my Mom was embarrased that she took pain meds, and that in itself made her act "funny" about it.

Watching the clock, it may have become a comfort measure, because the DREAD of the pain is scary and clock watching can help assuage the dread.

I can't say it enough, please please don't become the police to the patient.

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Specializes in Lie detection.

just because the pt is an addict doesn't mean they aren't hurting after a lap chole. if anything it means they may require larger doses for affect.

i'm angry because they are taking my time away from pts who are honestly hurting/injured.

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rn cardiac, good post. you are 100% right when stating that addicts actually need larger doses, many people want to take them off meds but that should only be done in a supervised treatment center.

as far as the highlited blue words? i know addicts can be trying, but remember they are sick and hurting too. yes they can be annoying with their lies and deceipt but most times an addict is drug seeking is because they are withdrawing. i can tell you from personal experience, it is very painful. i wish more addicts could say "i'm in waithdrawal and need help" then maybe er's and such could handle it better. however, at 3 am, not much will be accomplished, i know. there has got to be a better way.

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