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.
Feb 25, '12
by Anna Flaxis
I view addiction as a health issue and not a moral one. I think it's important to base the treatment plan on the clinical picture, not a moral judgment based on the patient's socioeconomic status. Also, while it may seem to us that drug seeking in the ED is out of control, especially at peak census times when we're also caring for real emergencies, keep in mind that ED physicians prescribe only a small percentage of all the opioids prescribed nationwide, less than 5%.*
In addition, I think it's important to remember that even drug seekers can have medical emergencies, and to discount a person's complaint because of their history could have disastrous consequences.
In my ED, doctors have frank discussions with patients they suspect of drug seeking behavior, and will refuse to prescribe opioids if they feel that opioids are not clinically indicated.
Do some seekers get their payoff? Definitely. But I'm not there to play pain police, and when in doubt, I'd rather err on the side of providing compassionate care than to mistreat someone who is legitimately suffering just because I feel morally superior.
Yes, these people can be incredibly annoying; self centered, overly dramatic, demanding, and will attempt to monopolize your time with their problem. But I have found those qualities to NOT be unique to drug seekers. Even patients with real medical emergencies can act like that, unless they're tubed and sedated; but then you can count on family members to take up the slack.
*Medical Newsrug-Seeking Patients No Strangers to ED Docs - in Pain Management, Pain Management from MedPage Today
Last edit by Anna Flaxis on Feb 25, '12
I am not passing judgment. I have been around plenty of addiction: father was a heroin addict, step father a crack head, worked for 2 years in a rehab facility for addiction and psychological problems, college roommate and lifelong friend became addicted to prescription pills and threw away a full ride to medical school. I guess you could even say I am addicted to coffee and endorphin rushes from exercising. I have been around it all; as I am sure many others on this site have as well. It is becoming all too common and unfortunately we as medical professionals have to deal with it many days of the week, if not every day at work.
I agree it is a complex problem. The doctors for over prescribing and not paying attention because they are overworked; the pharmacies for not double checking the frequency and number of refills for one patient and not raising an eyebrow; the patient for not recognizing a growing problem or just not caring enough about their own life to change; the pharmaceutical companies for developing a highly addictive substance; the FDA for approving a man-made chemical substance nearly identical to heroin; the federal government for not cracking down harder on the more dangerous drugs; society in general. We could point fingers and play the blame game all day. I am trying to do something about it. So are our ED doctors.
In my area of Florida, I live 50 miles away from the meth production capital of the US. I live on one of the major highways in and out of Miami. There is a grow house busted within a 100 mile radius every week and splayed across the front page. My county has one of the highest rates of prescription pill abuse and methamphetamine use in Florida. And my city is either 1st or 2nd in the nation on average elderly age- it truly is a retirement city of 65+ retirees. So not only do I see your grandchild for overdosing on grandma or grandpa's pills at a 'Skittles party' but I also have to deal with the elderly that are addicted to oxycodone due to their chronic back pain.
In a 12 hour work day, I do not get paid for the first 3 hours; it goes to taxes alone. I am taxed at a little over 26%, and out of my hard earned money, some of it goes to pay for 1) the 'care' of the abuser/seeker coming in to the ED to get their high squared away 2) filling said prescription 3) paying for the doctor's time 4) supplies used, etc etc. Now with universal healthcare looming on the horizon (which I am an advocate for, coming from Canada), the problem is not set up to get any better.
I am not here to police patients. That is what the police are for. If a patient threatens me with a gun, I call the cops. I report the crime. If a patient is raped by their stepfather/ neighbour/ stranger, I call the cops to report the crime. Why shouldn't I report the crime of obtaining controlled substances under false pretenses? Doctor shopping? Possible theft of prescription pad and forging prescriptions? I am very proactive, and I would love to live in a safer world. You cannot change the world, but you can make a dent.
We warned them. We educated them. We pointed them towards pain management. We looked up their prescription activity on the Florida database and some of these people we amazing. They will go to some length to get their fix. One of our long time seekers actually fractures toes and finger and gets lacerations or sprained ankles to get her prescription filled. It is well documented, but no one is addressing the problem. My problem is that we are healers not drug dealers. So we fix them up, save their life, push that Narcan, and then it is déjà vu all over again because of their addiction. Just like brainkandy said, the soup du jour in this decade is prescription pills. I never got into this line of work to be a drug dealer. I never meant to push dilaudid on a patient and actually watch as they relax and enjoy their high. Not what I pictured.
I love every aspect of my job. It is very rewarding. Adding to the problem, being part of the problem, that is not what I had in mind. I started this post to see what, if anything, you guys were doing to help remedy the situation at hand. I did not want to start a moral argument, and no matter what the root cause, I think we are part of the problem and we can be part of the solution.
Last edit by thelema13 on Feb 26, '12
: Reason: spelling