Drug Seeking Patients - page 3

How are each of you dealing with patients who are abusing prescription medications? There has been so much emphasis put on the patients right to pain control (over the past ten years or so). I... Read More

  1. Visit  chloe profile page
    0
    I agree with Nurse Ratchet. "Bite Me?????" What kind of response is that? I truly believe that chronic pain exists and I sympathize with those with it. It's just so frustrating when you can't "fix it" for the patient. How about some suggestions from those who suffer? What can we do for you?
    Thanks
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  3. Visit  maineiac profile page
    0
    In a timley event I now find myself in a "drug" seeking behavior.lol
    Since I last posted I had a bizarre accident at Walmart while buying dog food, they rolled a low dolly behind me and I turned around and fell over it sustaining a 3rd degree ankle sprain and 2 fractures. Now I'm taking Vicodin and it's not much fun since pain is so subjective I wonder how we can judge from this side how much pain someone is having. I also note I am not sleeping well at all ? from the vic's or the discomfort. I find myself getting so cranky from being in pain and immobile I wonder how my dog stands me.

    My point is I can now more easily understand how someone might become tolerant/dependent because this stuff really screws up you mental process, and your lifestyle.

    I am almost thinking that some kind of counseling/depression screening would be very appropriate for anyone on meds longer than 1 week.

    Is anyone familiar with the biological neurotransmitter changes that result from meds?
  4. Visit  jadednurse profile page
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    Originally posted by maineiac
    In a timley event I now find myself in a "drug" seeking behavior.lol
    Since I last posted I had a bizarre accident at Walmart while buying dog food, they rolled a low dolly behind me and I turned around and fell over it sustaining a 3rd degree ankle sprain and 2 fractures. Now I'm taking Vicodin and it's not much fun since pain is so subjective I wonder how we can judge from this side how much pain someone is having. I also note I am not sleeping well at all ? from the vic's or the discomfort. I find myself getting so cranky from being in pain and immobile I wonder how my dog stands me.

    My point is I can now more easily understand how someone might become tolerant/dependent because this stuff really screws up you mental process, and your lifestyle.

    I am almost thinking that some kind of counseling/depression screening would be very appropriate for anyone on meds longer than 1 week.

    Is anyone familiar with the biological neurotransmitter changes that result from meds?
    Just wondering what in the world a "3rd degree ankle sprain" is? Maybe I've worked in critical care too long, lol!
  5. Visit  angelbear profile page
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    Ok, I admit it "bite me" is not exactly a professional response. However I will come just short of apologizing as I was responding as a chronic pain sufferer (fibro, severe arthritis, RLS etc..) I do realize that there are true drug addicts. What I want to know is how do you know if I am a drug seeker or someone who is truely in pain when I present to the ER (which I am rarely willing to suffer through) Some have said these people hospital and dr hop. How do you know that? Unless of course they are honest like alot of us chronic pain sufferers and tell you exactly where they have gone and what they have done. Because if they did not tell you or sign a release for you to obtain that info that would be a hipaa violation. No I do not think anyone is violating hipaa what I do think is that alot of so called professionals who would never dream of saying "bite me" (sarcasim intended) are most assuredly assuming and we all know what assuming does. Someone asked what you can do to help us. Believe us and dont judge us. Thank you.
    Last edit by angelbear on Nov 6, '03
  6. Visit  maineiac profile page
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    No it's not that you've been in critical care too long.I did not know what it was either.
    3rd degree ankle is when 2 or more of the major ligaments sustain either partial or complete tears resulting in separation from the bones( it also means your entire ankle and foot balloon to 3 x it's normal size and turn interesting shades of blue and black now subsiding to green and earth tones)

    I'm highly recommending that anyone reads about it rather than learn firsthand.

    thanks for your note,it's great to stay in touch.
  7. Visit  kids profile page
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    Originally posted by glascow
    ...Just the stigma of having "chronic back pain" is awful...
    I am not in the mood (at the moment) to enter a debate about drug seeking-vs-chronic pain.

    I just wanted to mention that I carry my most recent spine MRI and x-rays to every doctors appointment no matter what it is for, I have found that it stops the eyerolling instantly.
  8. Visit  Dave ARNP profile page
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    Yesterday was Kids-r-fun day for not getting into "that" debate. Today will be mine.

    However, I must say a couple things before I go.

    1. Any MD in primary care that states he will not become a pain specialist?... Thats like saying he doesn't do psychiatry when someone presents with the first signs of depression.

    2. Part of your narc contract should also state what the PRACTICE will do in exchange for your compliance. Would you sign a 30 mortgage if the bank didn't give you an assurance of money?
    Pts need to know that their pain will be treated to the best of your ability. This includes acute post op pain.

    3. Yes, cronic pain pts often need more medication for pain post op. But worrying about 4mg of IV Dilaudid and 30 of MSO4? I'd LOVE to treat a pt with that little medication after a major surgery. Push 40 of Dilaudid and then you have somethign to worry about. You are completely right, this says TOLERANCE.

    4. Oxycontin is often the only thing that releive pain for some pts. TID dosing is used when we need to hit a total daily dose that we can't get to with BID. It is also the first thing you need to do when you have weaning of the dose effect. You may have been told that if somoene is loosing effect from a 12hr med before the window, to up the doseage. This is really incorrect with pain meds. Add more doses, then add MG.

    It just really concerns me at the lack of willingness to treat pain. You have docs who won't write the meds, and then came the nurses who wouldn't administer them. When is this going to stop?

    I'm just glad that my patients have somewhere to come, where pain will be adquately treated, and they can be managed by professionals who will adquately treat their pain without making them feel worse than they already do.

    David Adams, ARNP
    -ACNP/FNP
  9. Visit  kids profile page
    0
    Originally posted by glascow
    ...The other morning I was giving report on a pt that had been in an accident 3 yrs prior resulting in chronic pain. He was on Oxycontin qday and Xanax bid (home meds). He was also getting Demerol 100mg IV q 4 hrs for his post-op pain.

    When I told the oncoming nurse this, his response was "loser,
    nothing but a druggie."...
    I am still staying out of the debate

    I have had 5 back surgeries, I am scheduled to have the first of 2 poss 3 more back surgeries in March. It will take 1, maybe 2 to decompress my spinal cord and clean out the debris from 2 failed fusions, the last will be either another allograft fusion with pins & plates or Herrington rods, it all depends on how much or how little stability I have after the decomps. Part of the delay is waiting on the referrals and stuff to be in place for the pain management clinic affiliated with my neurosurgeons hospital to be able to take over medication management.

    The prospect of spending the next year having major surgeries does not scare me, encountering attitudes like glascow's co-worker does. I am extremely narcotic tolerant. On an equianalgesic chart Demerol 100mg IV converts to about 10% of my of my daily oral med load. This "loser" got hurt on the job 10 years ago. Due (in part) to the miracles of modern pharmacology and changng my career focus (several times) I was able to keep returning to work and was working full time until this past mid-August.
  10. Visit  Dave ARNP profile page
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    While that is alot of Demerol, I have used more.

    The other day we sent a pt. a two week supply of IV Dilaudid from home infusion.

    How much were they toating around in the car? Around 35,000 Mg.

    Home health got their only two male nurses to drive it out there.

    Best wishes with your surgery!

    Dave
  11. Visit  Big Bab's profile page
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    In the office I work in, we also have patients sign an agreement stating that they will only get rx's from our office and that they will use the same px.....If they are not compliant with this we "fire" them as a patient.....Of course by law we have to treat them for 30 days after the are notified of being fired.....supposedly to give them time to find another Dr......I too had resentment and anger for these patients UNTIL I myself became one of them, due to a chronic pain issue......although I can empathize with them, like somebody already said here, you can't let ourself me manipulated by them...(easier said than done!).....but you can give them info and help them to get the treatment they really need.......There is such a grey area around this topic and it can be extremely difficult to find out who's faking and who's not!


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