How do you handle the drug seekers? - page 4

by itsnowornever 14,640 Views | 38 Comments

Ok, disclaimer---37 days left of school for me, but have some nagging questions. During my ED round we had a female patient who was a drug seeker. Complaining of abdominal pain when no cause was found. Dr did every work up... Read More


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    I understand the "I do have pain" or "this is my history" as I have been there done that. I have trigeminal neuralgia myself...and the first time is showed up I was crying in the ED and REFUSED narcotics because I didn't want them to label me. I asked for some strong tylenol or something because regular tylenol wasn't helping...and the doctor even said she wanted to give me demoral and I said NO WAY! I dont want you to think I'm looking for drugs. Turns out I should have gotten it...an agonizing weekend until I could see my doctor and was diagnosed was horrible. So I get what you guys are saying.

    To answer a few questions---mom drove herself (I also questioned how on earth she was going to get home if we gave her anything stronger than motrin) and her behaviors were suspicious. While I was crying in the ED with my headache, I wasn't moaning and yelling loudly every time someone walked by. I also understand that people handle pain differently, and I didn't mean for tempers to flair here or feelings to be hurt...I came here asking what you would do.

    THese stories aregreat and things that I will keep in mind when I start working.
    corky1272RN likes this.
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    I treat all my patients the same no matter what. But I will say that our doc's tend to check and see what type and how many narcotic prescriptions people have gotten, if they appear to be "drug seeking". In a few cases I have seen patients who have gotten a ton of prescriptions for various drugs come in and want more, but ended up leaving with a prescription for Motrin.
    CP2013 likes this.
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    Quote from mrstmarie
    We'd do a UA and he be positive for blood, xray never would show anything, and Doc would medicate appropriately. So this happened several times until one time a guard from the jail he was incarcerated in caught him sticking a toothpick in the tip of his penis causing trauma resulting in *blood in the urine* Amazing
    Good heavens. I don't even have a penis and I cringed reading this!!!

    OP, I have Trigeminal Neuraligia as well. I think what someone said about caring more about the medication than the pain relief is key here. If someone is truly in pain, they will do anything to stop it. I don't care what you give me---doesn't have to be a narcotic---as long as it helps with the pain.

    That being said, I'm glad I don't work in the ED and face these decisions.
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    Its a tough one. There's no way around it. I struggle with keeping it impersonal because really, it can feel very personal sometimes. I worked at a small community hospital, very rural, and therefore the seekers didn't have shopping options. We'd get a certain few almost EVERY day, one especially already prescribed scads of vicodin, xanax, and soma. Her son was in the paper for selling drugs. Every day it was a new story of picking up her grandkid and feeling something pop in her back, or chest pain, or fell down steps, or migraine, I am not exaggerating when I say it was EVERY DAY. Sometimes she'd get a generous doc, sometimes not. In triage I even asked her "did you try taking your vicodin?" but she'd say she threw it up and needed dilaudid IM. What can you do? You just can't take it personally. Yes the true seekers lie to your face and you'll feel like you look like a fool believing them, offering a sympathetic smile and great customer service. It gets super frustrating when, like we often did, you have 3 nurses including yourself as triage/charge, 12 full beds, 8 waiting, a STEMI, a nasty bleed you're trying like hell to get flown and its about to start snowing, and oh by the way, SHE just checked in and you have to go triage her for picking up the grandkid wrong again. I try and just do my job, advocate for the pts when I can, and go home every day thanking God I'm not in her shoes. Its tempting to want to feel like you're giving in or letting them win a point by getting them high but you just have to do your job.
    corky1272RN likes this.
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    I would medicate her with whatever Dr. ordered. Not my job to judge, or diagnose. I am not in her shoes, nor her body, and do not know the struggles she has to deal with in life. MAYBE is drug seeking as life has gotten to hard for her to handle at moment. She is on her own conscious to deal with if she's lying.

    FOr yrs I was a "VERY" judgemental type person. Didn't help I was at the time married to alcoholic, and thoght I KNEW drug seekers when I saw them. THEN sure enough one day I thought that, and Dr's found nothing wrong, come to find out the ladie had a broken hip and her daughters (said she was a druggie) didn't know what they were talking abt. She was c/o stomach pain, and finally figured out that was because she'd taken so many otc's trying to stop hip pain. SO NEVER AGAIN. I will give whatever Dr orders and keep my opinion of myself.
    friggasdistaff and wooh like this.
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    I would like to point out that Not One Nurse said that they would withhold MD ordered medication.

    In every hospital, unit, and patient care are there are people who jump in and righteously demand satisfaction about a bad experience. So if one nurse and doctor in one emergency room are to blame for a bad experience, are all nurses and doctors in that emergency room or all emergency rooms rotten to the core?

    I get so tired of hearing "I hate XX hospital. They didn't do YY correctly so they're all to blame for me having ZZ diagnosis."
    friggasdistaff likes this.
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    Quote from NurseOnAMotorcycle
    I would like to point out that Not One Nurse said that they would withhold MD ordered medication.
    Because if your MD has any brains at all, he won't give Dilaudid to an obvious drug seeker. So hopefully you two are on the same page. If an MD orders Dilaudid on a FF who's obviously seeking, yes, withhold it. However, I think it is in very poor judgment to not provide an intervention for someone complaining of pain simply because you think they are seeking. If the MD orders Dilaudid and you think they're seeking, ask him to order something non-narcotic. Simply withholding medication and not providing a different intervention is terrible nursing and below any standard of care.
    CP2013 and mariposa311 like this.
  8. 0
    To me, these situations were never difficult. Here is what you have, broken down:

    1. You have a doctor that is responsible for prescribing...that is what they go to school for, and ultimately, it is their call. If you want to withhold because you think they are seeking, you had better be right, because if you are wrong, that is a valid reason for a facility to terminate you and can put your license MORE at risk than administering.

    2. As a nurse, your job is to assess and report your suspicions, patient's history, etc.

    3. Patient is requesting narcotics and brings her kid in.

    Here is how you handle it:

    1. Report your findings to the doctor...if he wants to prescribe her enough to put her into the twilight zone, I could care less. Drug seekers are drug seekers BY CHOICE and I have zero sympathy for them. Whether or not they receive the drug has no bearing on me whatsoever. The person who will have to answer for it is him if he's ever investigated for the opiates he writes...not you. As long as you are not giving injections that kills a patient or puts them in a coma, you are clear....but you also cannot be responsible (and neither can the doc) if they are taking other meds and won't tell you.

    2. The little girl is another problem...Mom obviously drove there, Mom needs to drive back. As a nurse, you have the right to refuse to give the mother anything that will leave her impaired to drive and if she seems "out of it" while she is in the ER and insists on leaving, I would call social services (Police first)....because she instantly put that child at risk by getting into the car.

    To me, it's a no brainer.
  9. 0
    Quote from CrunchRN
    What can you do but ... duct tape the kid onto a chair?

    If only they let us bring duct tape in to the department for those days. Pretty sure it'd work better than a posey, 'cause you know duct tape fixes everything!

    (Kidding of course, but funny to consider!)


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