Rx drug abuse in your ED- steps you take?

[thelema13]

I have been getting fed up with the number of people coming into my ED drug seeking. One of the PA's have access to a database of all providers, pharmacies and pt info related to schedule 2, 3 and 4 prescriptions written and filled. When we started looking up some of the frequent fliers, it was amazing. Amazing these people are still breathing, amazing the pharmacy isn't being investigated, amazing some doctors aren't being investigated.

One lady got 2 different percocet rx filled, one for 100 tabs, the other for 80 tabs, at the same pharmacy on the same day from the same doctor. Just an example, but we strated printing, and printing, and printing some more.

Now we are making up drug seeker/drug abuser/ doctor shopping packets. We have a list of names posted by the charge nurse desk. The ED docs are banding together to fight this crap, excuse the expletive.

You guys know what I am talking about. These people either 1) don't work 2) are on medicare/medicaid 3) are on welfare/food stamps 4) drag family members into their addiction or 5) all the above. I am getting sick and tired of busting my hump and having 25%+ of my check going to taxes to pay for these people abusing the system. It's not like they pay their bill, nor does medicare/medicaid most of the time because their survey score isn't high enough, because the patient didn't get high enough.

But what gets me is that administration does not care one bit. We called the SO on a patient last night because she lied straight to the doctor about seeking, after being warned at her last visit about seeking, and the SO did not care either. No arrest, just forwarding the info for 'investigation by the SIU' (special investigations unit).

So now my rant is over, what have you guys done to reduce recurrence and abusers? I am tired of seeing resources being wasted.

[Blacky4130]

thelma13, thankyou for being proactive and being a real change agent in nursing. as a formeraddict (i've been clean and sober for over 5 years now) and new rn working atan inner city hospital in philadelphia, i am very aware and conscious of thisproblem. our hospital is flooded with "patients" wanting their fix.the dispensing and over-prescribing of narcotics in and out of the hospitalsetting has turned patients into customers and dr.'s into drug dealers. i feelcaught in the crossfire. i know what we are doing is wrong and yet i amcompelled to administer pain medications and the like. shame on us! afterreading many of the posts on this issue, i believe that many of your detractorsare living in fairytaleland. "pain is what the patient says it is" isa dangerous adage, used to justify this harmful behavior and help naive nursestolerate the overuse of prescription narcotics and has contributed to ourcurrent national predicament.

do you know when an addict gets clean? when the pain gets great enough. onlywhen the consequences of using cause enough emotional pain is change possible.anyone who stands in the way of those consequences is an enabler and is doingthat individual great harm and a huge disservice. i became a nurse to relievepain and suffering not to contribute to it. by participating in a person'sactive addiction, you are robbing them of the joy of truly living. prescriptiondrug abuse has become an epidemic and is killing americans. recent statisticsshow that more people die in 1 year from prescription drugs than from motorvehicle accidents. if this was a class of let's say "statins," theiruse would be only in cases where the need was significant and the benefitsoutweighed the negatives. so why are drugs that only mask pain and not bringabout prevention or resolution to a health problem so readily available topatients?

i was becoming so disenchanted with nursing because of this reason and thanksto your post thelma13, i now see that there are initiatives i can advocate forat my institution and a means to become part of the solution; to do what i knowto be right, and break the complacency and mindless acceptance of negativeinterventions nurses have been ordered to perform to the detriment of theirpatients. as i begin my nursing career, i hope that this problem doesn'tcontinue to grow even more out of control than it already is, and thatprescription narcotics will begin to be used conservatively and cautiously incases where they are necessary not just a casual order set for any complaint ofpain.

[Jsnap1]

When you have talked yourself blue in the face about rehab, dangers of addiction, extend referrals to pain management doctors, etc and the patients do not change, nor want to change, that is when I lose compassion.

When you keep doing the same actions over and over again and expect different results each time- is that not the definition of insanity?!?!

I have dealt with addictions both in my family personally and professionally, this is not what we call "insanity" it is was we call "the DISEASE of addiction" and although it can make us on the outside feel insane trying to treat/fix/help these people, we must remember that they are suffereing from a disease, and until they are ready to get better they just won't. I agree with the fact that not all docs/nurses/health care professionals are not all on the same page, but at the same time, who are we to judge, it is our job to provide care and compassion, even when we may disagree. I think all docs should be mandated to attend and become certified through ASAM and maybe this would help some.

We are stuck between a rock and a hard place I hear ya