prescription pain med abusers

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    I get really tired of feeling sorry for a new time server, who claims to have degenerative disc disease, and a torn ligament or whatever, send me on a wild goose chase for records to clarify DX. I had this guy come in with a bottle of Methadone, original fill date 2-25, fill date 2-25, 180 pills dispensed, it's 10 days later, he knows he's gonna serve 85 days and the bottle is empty. He tells the booking officer " my doctor said dump it out at home and the jail will fill it". I said like **** we will! I open the bottle and sniff, and it smells like weed, in fact, there's even some green flakes in the bottom of the bottle. He says "gee, how could that happen?". I asked him if he thought I was retarded or something. I called the jail doctor and were not giving anything for pain until we see some records, by the way the prescribing doctor for the Methadone is not responding, just says " yea yea I will I will". This is one time when they will not get the med they say their supposed to be on. I know there are Doctors out there that will prescribe just to get the low life out of their office, but please, have some back bone. SHEESE!
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  4. 0
    NurseT...
    On the issue regarding abuse of prescription pain meds. I wholeheartedly agree. These doctors not only need to have a backbone, but the state licensing board needs to start looking into some of these cases and these drs. need to lose their licenses. This is nothing more than legalized drug dealing! I have inmates coming in stating they are on oxycontin for "back pain". And of course I ask them who prescribed it, as if I can't guess...it is always the same two drs. They are nothing more than legalized glorified drug dealers! Of course, we rarely prescribe narcotics at the jail I work at. If our doc prescribes them it is usually for someone who is in REAL pain. And even then it is usually short term and NEVER oxycontin. We use Darvocet and occasionally Tylenol #3.
    And I have a question...do you think that a person can have withdrawal from a prescription pain med (narcotic) that they say they are taking AS PRESCRIBED? I have had this discussion with several colleagues. I say NO.
    Just wondering...
    CRJnursewarrior
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    Dear crjnursewarrior,

    The inmate in question with the empty bottle of methadone tried to tell me he would have withdrawals if I didn't get it for him. Initially, I told him we would wait to see if withdrawals occured and then we would deal with that. I have Librium on hand for such events.He never did have any problems as I could have guessed. I have had lots of inmates who come in swearing they are addicted to their prescription pain med. Not one ever had withdrawals. I think it is possible to become addicted to pain medication taken long term. The patients I have had this experience with were elderly. Usually it's Darvocet or vicodin, or some anxiolytic. Most of the inmates I have contact with are too young to have had a chronic pain condition. But they do know how to play it. What they don't realize is that in jail, I don't have to be nice. In jail, malingering is against the law, and I have charged inmates with it in the past.
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    It is a frustrating problem to have drug seeking inmates. I did a three year stint at a county nursing home in NH. In NH the County facilities usually include the county correction facility and a farm for the inmates to work on. As nurses on the alzheimer's unit we had to do jail med pass as well. I actually usually enjoyed that part of my job. I received a letter of commendation from the supervising officer for bravery and excellent nursing care. I had responded to a call for emergency medication. When I got buzzed in I headed to the med room when a new CO came running down the hall saying he needed me in intake there was blood everywhere. As we ran I pulled my gloves out of my pocket and pulled them on. There was a terrified 19 or so year old federal prisoner curled up in a corner with blood pouring from his forearms. Attempted suicide. He spoke only Romanian as far as the guard knew. I went right to him and spoke softly, getting his eye. I took his arms and held pressure. He allowed me to help him stand and sit on the cot in his cell. Other officers and my nurse manager were close behind. I kept him focused on me as his wounds were cleaned and stitched.
    He haltingly said thank you in pretty fair French.
    Well we were off talking in French.
    His story was that he had come to the US through Canada to try to make a new life here and send for his wife and new son. When he got stopped at the border and brought to our County jail, he thought he would be beaten and tortured and maybe even never come out again as that was what would have happened to him at home.
    He spent a few weeks with us and then was deported. I often wondered what had happened to him.
    Sorry I got off topic a bit but it brings me back to the drug abusers.
    This inmate I had helped was in line to receive his antibiotic when the inmate before him asked for his narcotic medication. I checked the MAR, still not ordered. Now he had been with us two days and he was not looking so good. He was sweating profusely, had serious tremors and his heart rate was 130. His BP was up too, can't remember exactly how high. Well, the guard was saying to me that he had been "pulling" this all day. I asked why I hadn't been called. He said because the nurse before me had told him this inmate could not be in withdrawal because he had been on prescription oxycontin.
    I tended to agree with her and was about to be dismissive when I heard in soft spoken French, "He really is drug sick. He had convulsion last night but no one believed me."
    This inmate that I had helped help me avoid making a BIG mistake. I called the jail doc and we got him on Librium. He did OK but he was really sick for a few days.
    Sorry for the long windedness.
    EEYORE nurse.
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    Yes, you can have withdrawal from a medication taken as prescribed. It doesn't even need to be pain meds. Remember that withdrawal is a pysiological response. It is very common with beta-blockers, clonidine, Prozac, anti-eptileptics, and a wide range of other medications.

    [/QUOTE]
    And I have a question...do you think that a person can have withdrawal from a prescription pain med (narcotic) that they say they are taking AS PRESCRIBED? I have had this discussion with several colleagues. I say NO.
    Just wondering...
    CRJnursewarrior [/QUOTE]
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    Perhaps the real question should be whether you can have life-threatening withdrawal versus simply uncomfortable withdrawal. Heroin, vis-a-vis methadone, withdrawal is disgusting and unpleasant, but not dangerous. Alcohol withdrawal, which is the most common form in corrections, is fatal very quickly and is often not looked for because alcohol is socially acceptable.

    Quote from nurseT
    Dear crjnursewarrior,

    The inmate in question with the empty bottle of methadone tried to tell me he would have withdrawals if I didn't get it for him. Initially, I told him we would wait to see if withdrawals occured and then we would deal with that. I have Librium on hand for such events.He never did have any problems as I could have guessed. I have had lots of inmates who come in swearing they are addicted to their prescription pain med. Not one ever had withdrawals. I think it is possible to become addicted to pain medication taken long term. The patients I have had this experience with were elderly. Usually it's Darvocet or vicodin, or some anxiolytic. Most of the inmates I have contact with are too young to have had a chronic pain condition. But they do know how to play it. What they don't realize is that in jail, I don't have to be nice. In jail, malingering is against the law, and I have charged inmates with it in the past.
  9. 0
    Thank you for all the answers to my question regarding the withdrawal from prescribed pain medication. You all made interesting points, some I had never considered. NurseT, you had said something about elderly people going through a withdrawal and I think that is something I have heard colleagues say, I was thinking about it after that and this is probably the case with a lot of elderly patients since they would tend to metabolize and secrete the medication differently, more slowly, than the younger patient. BSNTX-Thanks for the info on withdrawal from the other meds, this is something I never really knew. I know that you can't just STOP certain psych meds, especially benzodiazepines, but some of the hypertension meds you mentioned I was unaware of. What I tend to have a problem with is when an inmate tells me on intake that he or she only takes their medication (pain meds) as Rx'd then they end up having this terrible withdrawal episode because, in truth, they eat the things like candy...such is the "nature of the beast", I guess. One of you had said that it depends on the type and severity of withdrawal...this has been my experience, as well, as our one psychiatrist used to say, "You can't die from narcotics withdrawal...you'll feel like crap for awhile, but not life-threatening." Of course, my experience bares that, the worst withdrawal symptoms I have seen have been alcoholics. They, of course, need a longer monitoring period as they can sometimes not have withdrawal until later when all the ETOH finally starts to get cleared from body. I am always watchful of the alcoholic that admits to drinking a case or two of beer a day, since alcoholics always tend to minimize their habit...if he admits to 2 it's more like 4 or 5. Has that been you experience? How about the narcotics withdrawal? Anyone ever experienced an inmate with life-threatening problems r/t narc. withdrawal? And I have a hard time feeling sorry for these inmates who lie on intake and say they don't use then later they are in the unit c/o withdrawal...only then do they admit to use...have you had this experience? Thanks for your input!
    crjnursewarrior
    Last edit by crjnursewarrior on Apr 11, '05
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    DT's is a killer, monitor closley, medicate per dr. order. I go ahead and start them on librium detox and I throw in a prenatal vitamine too. The doctor laughed and said " good idea" when I asked if I could add the vitamin. Prenatals are full of goodies. I had an inmate come in with Heroin WD. He admitted to a 2 Gm per day habit. The veins in his hands and arms were so full of track marks and scarred that they just looked really dirty. Like the veins were blackened. That WD was terrible but not life threatening. Our concerne was trying to keep him hydrated due to the severe vomiting. I worked on him every 30 minutes all morning, giving 30 cc water in a little med cup and disolving his meds in this little bit of water. I ended up going to phenergan suppositories. Someone paid his bail a half hour after I administered the suppository. You may or may not think this is very funny, but,That became the biggest joke around the jail for awhile. All the officers were suddenly nauseated, and promised to at least stay the night. :chuckle
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    There is a (doctor) and I use that term lightly, here in n.c. that has multiple convictions for using and selling cocaine and he still has a license. His license was suspended for a short time and now the only restriction that he has is that he can't write for schedule 2narcs. If the same thing happened to a r.n. we would never have a license again. What do you think?

    Quote from crjnursewarrior
    NurseT...
    On the issue regarding abuse of prescription pain meds. I wholeheartedly agree. These doctors not only need to have a backbone, but the state licensing board needs to start looking into some of these cases and these drs. need to lose their licenses. This is nothing more than legalized drug dealing! I have inmates coming in stating they are on oxycontin for "back pain". And of course I ask them who prescribed it, as if I can't guess...it is always the same two drs. They are nothing more than legalized glorified drug dealers! Of course, we rarely prescribe narcotics at the jail I work at. If our doc prescribes them it is usually for someone who is in REAL pain. And even then it is usually short term and NEVER oxycontin. We use Darvocet and occasionally Tylenol #3.
    And I have a question...do you think that a person can have withdrawal from a prescription pain med (narcotic) that they say they are taking AS PRESCRIBED? I have had this discussion with several colleagues. I say NO.
    Just wondering...
    CRJnursewarrior
  12. 0
    RE: NC doctor with drug convictions still has license. Well this sounds par for the course. Nurses are held to a higher standard, often an impossible one, but doctors are there to protect one another. No surprise here. I just hope daughter who lives down there never ends up seeing this doctor. :angryfire


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