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 understand and agree with this belief.
However, there are also many, many patients who (although not always a planned thing on their part) have become addicted to prescription pain medications.
I know clinically how we handle this (pain agreements, referrals to alternative pain control specialties such as massage therapy, psych counseling, etc), but my question to you all is: How do you personally deal with this on the patient level. We are trained as nurses not to "judge", yet I find myself growing increasingly angry at these patients who knowingly abuse there medications and then come in early for more. I feel I am being "played" when they hand me a line about losing there medications or tell me "they were stolen" or any other lame excuse.
Another question I have is: If the MD does not prescribe the medication that day and the patient goes into withdrawls, is he not liable? If he does prescribe it early to keep this from happening, are there not legal ramifications for this as well? Sounds like either way we loose and in the long run the patient does too.
Good question Stormy ..? about the liability issue.. did you find an answer?
Drug seekers can be a problem in any practice.. Have you noticed a friday afternoon rush in an attempt to get controlled substances?
My Doctor (IM) is usually adamant that he will not become a pain managemant specailist. We do refer to pain management cliinics. And we usually try to weed out the drug seekers early in their attempts to establish in the clinic
What kind of practice do you work in?
Yes, we should not judge but neither should we allow patients to manipulate us with thier hard luck stories. I could write a book on the many excuses for early Vicodin refills.
If meds are "stolen" we ask for the police report....stops them in their tracks.
Do your pharmacies track drug controlled substance abuse? I find they can be helpful
Yes... Pain control is important and we should help patients in every way possible. Many patients have Pain that is very real.
I am inclined to use the medical model.. find out if there is a physiological cause for the pain, evaluate the problem, correct if possible.
The ultimate concern is for the patient and we try to get them all the help they need rather it be pain managament, psych, nerve blocks etc.
I will write more later. Gotta run!!
This is a good topic.much more to say. Thanks for posting it!
Last edit by darla80 on May 1, '02
Nov 5, '03
by Nurse Ratched
Yes, there is a difference between addiction and tolerance. We have been down this road before.
There are real addicts just as there are real people suffering from pain. No one is arguing that.
I appreciate frustration, however, remarks such as "Bite me" are not terribly constructive ways to win one to your way of thinking.
Last edit by Nurse Ratched on Nov 5, '03