Drug Seeker Antics and Dramas

Specialties Emergency

Published

They are an everyday event in almost every ER around the country. What is the drug of choice in your area? I've noticed around here it is Vicodin.

Our latest little treasure was an ex RN who was a daily event in our ER. She would come in complaining of backpaid and demand a shot of demerol and a script for Vicodin. Her MD's (She had many over the years) refused to see her. We kept a lot of documentation on her antics in order to confront her with her possible little problem. Well the big day came, she didn't take it real well. She stormed out of the ER, went around the building, came in thru the main lobby and straight to a pay phone. She called in a bomb threat to the ER. The police tracked her down, they could hear the hospital pages in the background. She is now in a facility.

The ones that really drive me nuts are the ones that come in with Burger King in hand and 5 people in tow, laughing joking all out having a great time and tell me they have a migraine that is so terrible that they just can't take it anymore. And, it's not always migraines. I have had a seeker who was working off of back pain too.

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{{{{{ang75}}}}

...Like I said before...I even have a letter from my PCP that states I sometimes need to come into ER for pain control...but....they probably don't beleive me. WHY????? :stone

Why, because we have seem MANY people forge, alter, and make up those notes (yes, even on "official" letterhead)...

And part of the problem is many PCPs will write anything to get rid of a seeker, then not return a page to verify, or just say "I have 10,000 patients, I don't know so and so"

sean

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Okay, I hope I don't offend anyone here:

To the person who has a note from her doctor telling the ER that the patient has "real" migraines and apparently will require narcotics: A note like that is often looked at with skepticism in the ER. I once had a patient bring a note from her doctor instructing the ER doctor how much po dilaudid to prescribe for her. Turns out her doctor didn't exist. I do like the idea of a care plan and calling the primary care doctor to ensure appropriate, consistent care.

To the person asking about a CT in the ER: Please find a different doctor and get a consult for a neurologist. This is the most appropriate way to find out what's going on and to get the best treatment (and it's actually much less expensive than the ER).

Here's my experience with migraines in the ER: Nothing will work but Demerol for patients who want Demerol. I've seen Benadryl and IV fluids work great, I've seen Benadryl and Reglan IV work great, I've seen Compazine IV work great (when you could get Compazine), I've seen Imitrex work great, I've seen Toradol work great. But I have never seen any of those work at all when a patient says that "only Demerol works". And as far as I can tell in the recent literature narcotics are contraindicated in migraine treatment these days except in very rare cases.

In the old days we used to keep a file card on migraine patients with orders for pain medications. When the patient came in to the ER, we gave them whatever the card instructed, no need to see a doc. Some patients came in daily, some weekly, some monthly... This practice stopped after someone's pain was not a migraine, but a subarachnoid hemorrhage.

I do doubt that someone had a "real" migraine when the nanosecond I remove the needle from their behind they ask me if 1.)they can go outside and smoke 2.)they can go home without waiting the customary 15 minutes because they've never been allergic to Demerol or 3.)if they can use the portable phone to call their boyfriend to chat.

Anyway, I could go on and on, but I'm tired. I don't want to have anyone suffer pain, but I also don't want to facilitate anyone's addiction. I agree with Tom who says the pain docs need to be available outside of usual business hours.

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Sorry there are some who are obviously so blatant, that it is being perfectly human To Roll Your Eyes At Them

While they have all these problems, RSD, FMS, Migraines, All these other chronic pain syndromes Where as some like Pain Management specialists love to make up and foster these labels because its good for there business. Yet their patients always seem to end up in the ER wanting MORE

While Physicians like ER Docs do tend to take them with a grain of salt, becaause the ER does get abused by these patients all wanting more.

Might be better if these so called Pain Management specialists would work more than routine office hours.

:angryfire :angryfire

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Okay, I hope I don't offend anyone here:

To the person who has a note from her doctor telling the ER that the patient has "real" migraines and apparently will require narcotics: A note like that is often looked at with skepticism in the ER. I once had a patient bring a note from her doctor instructing the ER doctor how much po dilaudid to prescribe for her. Turns out her doctor didn't exist. I do like the idea of a care plan and calling the primary care doctor to ensure appropriate, consistent care.

To the person asking about a CT in the ER: Please find a different doctor and get a consult for a neurologist. This is the most appropriate way to find out what's going on and to get the best treatment (and it's actually much less expensive than the ER).

Here's my experience with migraines in the ER: Nothing will work but Demerol for patients who want Demerol. I've seen Benadryl and IV fluids work great, I've seen Benadryl and Reglan IV work great, I've seen Compazine IV work great (when you could get Compazine), I've seen Imitrex work great, I've seen Toradol work great. But I have never seen any of those work at all when a patient says that "only Demerol works". And as far as I can tell in the recent literature narcotics are contraindicated in migraine treatment these days except in very rare cases.

In the old days we used to keep a file card on migraine patients with orders for pain medications. When the patient came in to the ER, we gave them whatever the card instructed, no need to see a doc. Some patients came in daily, some weekly, some monthly... This practice stopped after someone's pain was not a migraine, but a subarachnoid hemorrhage.

I do doubt that someone had a "real" migraine when the nanosecond I remove the needle from their behind they ask me if 1.)they can go outside and smoke 2.)they can go home without waiting the customary 15 minutes because they've never been allergic to Demerol or 3.)if they can use the portable phone to call their boyfriend to chat.

Anyway, I could go on and on, but I'm tired. I don't want to have anyone suffer pain, but I also don't want to facilitate anyone's addiction. I agree with Tom who says the pain docs need to be available outside of usual business hours.

Demerol does NOT get rid of a migraine for the love of god! AFTER 72 hours... its the drug with the best results........its called pain control.........WITH a letter from my PCP that states they are professors, (sp)with the university..... and they're insructors with valid pts...like me.....THUS could be valid instructions!!!! And its very easy to verify if he exists or not. If Demerol works...who freaking cares!!!!!! If Morphine works...who cares!!!!!!!!.........You would have to be a complete moron to NOT know what works AFTER a few visits at the ER.

If you follow after care...great...if you are on prophylactics ...should be awesome....don't lump everybody together. Is ther nothing that tells you its legit? My Bp is 180/90...in pain......I'm 27. Normal weight.

Yes I agree the pain docs should be available outside of ER...organize a golf game tee it up tom! :p

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Specializes in ER, ICU, L&D, OR.
I believe in adequate pain control. When I send people home with fractures and an appointment to follow up with an orthopedic surgeon (which they will have to drive for a good way to get to), I am not hesitant to write for the Lortab 10. I will light up your world with MS if you come in with ischemic chest pain or fentanyl if you are a major trauma patient.

However, I can't envision a situation in which I would administer dilaudid, morphine, or any other Schedule II narcotic to a patient with a migraine headache. If it ever comes to that, you better believe that I am going to be on the phone with a neurologist asking if he will accept transfer of the patient.

In our ER we do all the time

controlling pain real or imagined or even faked has to be done.

rarely do our docs really ever call someone on it, and never without a lot of evidence to back it up. Thats the hitch takes a lot of time and effort to get all that info, very difficult sometimes

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Specializes in ER, ICU, L&D, OR.
Why, because we have seem MANY people forge, alter, and make up those notes (yes, even on "official" letterhead)...

And part of the problem is many PCPs will write anything to get rid of a seeker, then not return a page to verify, or just say "I have 10,000 patients, I don't know so and so"

sean

happens all the time

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Specializes in ER, ICU, L&D, OR.
Demerol does NOT get rid of a migraine for the love of god! AFTER 72 hours... its the drug with the best results........its called pain control.........WITH a letter from my PCP that states they are professors, (sp)with the university..... and they're insructors with valid pts...like me.....THUS could be valid instructions!!!! And its very easy to verify if he exists or not. If Demerol works...who freaking cares!!!!!! If Morphine works...who cares!!!!!!!!.........You would have to be a complete moron to NOT know what works AFTER a few visits at the ER.

If you follow after care...great...if you are on prophylactics ...should be awesome....don't lump everybody together. Is ther nothing that tells you its legit? My Bp is 180/90...in pain......I'm 27. Normal weight.

Yes I agree the pain docs should be available outside of ER...organize a golf game tee it up tom! :p

I dont care what works

its whatever the MD orders

their choice, their call

Some Ive even given 8 and 10 mgs of dilaudid too

then laugh as they ask for a cup of coffee and go outside to smoke

and then want more before they leave

I will organize a game anytime

I always gamey

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I dont care what works

its whatever the MD orders

their choice, their call

Some Ive even given 8 and 10 mgs of dilaudid too

then laugh as they ask for a cup of coffee and go outside to smoke

and then want more before they leave

I will organize a game anytime

I always gamey

:angryfire Those people make me mad. You couldn't peel me off the gurney for nothing. Gamey? Cute. :chuckle

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In general with as busy as most ER's are the Dr will usually just medicate the pt with what ever they want and get them out the door as quickly as protocol allows. It only encourages those who have addictions to come back for more, its so easy.

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And its not just Migraines.

Back Pain, vague abdominal pain, menstrual pain, stress (anxiety attacks) and the ever popular tooth pain.

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Specializes in ER, ICU, L&D, OR.
:angryfire Those people make me mad. You couldn't peel me off the gurney for nothing. Gamey? Cute. :chuckle

Im too old to get mad

besides getting mad creates stress

stress accumulates in your shoulders and neck

thus causing tension in your golf swing

therefore dont get mad get even

keep the stress out of your shoulders

gives you a smoother, more fluid swing with incresed power and distance

So if getting mad interferes with your golf, dont do it

stroke that shaft, swing that club, square tracking makes a beautifull shot.

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