Tips on how NOT to appear like a Drug seeker - page 11
by WillowBrook | 74,288 Views | 150 Comments
Having read through some of the threads regarding Drug seekers in the Emergency Department I must admit I now feel quite nervous of being misperceived in this way. I take medication which causes some urinary retention and... Read More
- 0Sep 16, '06 by gwenithQuote from gauge14ivI think we might have hit a nail on the head!!!Oh but were there some sort of tracking system in the US...that sure would make save time for all the rest of us and for patients.
There is a tracking system of sorts, but not one that anyone has any access to in any timely manner.
The other day we got a few letters from insurance companies listing the Rx's that had been filled by a few of few our patients - from several doctors. Many duplicate narcotics written within a week or two of each other. That and notification from the DEA or the state is the only way you will find out. About all you can do is let the patient know they wont be getting anymore narcs, refer them for CD treatment, and set limits with them otherwise.
A national registry IS needed to help identify those who need treatment for drug addiction - our system is nowhere near perfect and is also not that easy to access but it is there.
What I am reading again and again on these threads is frustration. Nurses do not want to be the "big bad guys" witholding needed medication but neither do we want to feed addiction or worse be virtually forced into giving overdoses/toxic levels of medication because the patient is on the tenth dose of whatever having already taken 8 doses that they obtained elsewhere.
The few ARE spoiling it for the many and I think most acknowledge that. If there was a way of deterring the real drug seekers (I.e. come to ED and you WILL be caught and referred for treatment) then you are once again freed to treat all patients as if they are genuine and without facing a personal ethical dillemma.
- 0Sep 16, '06 by gauge14ivI agree - but...
People will lie about who they are, fake their identities etc etc...
It wouldnt be fool proof by any means - but anything would have to be better than nothing.
It would also be nice if all the narc scrips were linked on a computer - that would help reduce forged scrips too.
- 0Sep 16, '06 by babynurselsaSome states have enacted pharmacy databases to track narcotic prescriptions. Oklahoma just enacted theirs this summer. When a patient fills a script at a pharmacy, the pharmasist is able to see what this patient has had filled elsewhere. We recently had a patient come into our ER and left with the desired scripts only to have the pharmasist notify this patient that she was attempting to fill them. The pcp apparently had the final say and she did not get them.
I wonder about a similar database for ER visits. Working agency I see people one night that I may have seen in another ER a few nights earlier.
- 0Sep 24, '06 by rph3664Quote from traumaRUsI haven't read the whole thread, but I'm a pharmacist and when I worked at a grocery store some years back, I had three patients who the local ER refused to see because of their drug-seeking behavior. The ERs in the cities around us were on to them as well.I worked as a case manager in the level one ER for about two years and it was my job to deal with the chronic patients. Drug seekers are those who continually seek care from DIFFERENT ER's, they don't follow discharge instructions, give different names and social security numbers, shop from one ER to the next and alter prescriptions. The other ERs as well as pharmacies call around to each other.
So...given this criteria, you should have no problem. Especially if you are upfront about your problems, I don't think there would be a problem. It is not a problem for patients in pain to receive excellent care. The biggie red flags are listed above.
Eventually, we called them out, got them angry with us, and they took their business elsewhere.
- 0Sep 24, '06 by CritterLoverQuote from gwenithi think we might have hit a nail on the head!!!
a national registry is needed to help identify those who need treatment for drug addiction - our system is nowhere near perfect and is also not that easy to access but it is there.
what i am reading again and again on these threads is frustration. nurses do not want to be the "big bad guys" witholding needed medication but neither do we want to feed addiction or worse be virtually forced into giving overdoses/toxic levels of medication because the patient is on the tenth dose of whatever having already taken 8 doses that they obtained elsewhere.
the few are spoiling it for the many and i think most acknowledge that. if there was a way of deterring the real drug seekers (i.e. come to ed and you will be caught and referred for treatment) then you are once again freed to treat all patients as if they are genuine and without facing a personal ethical dillemma.
while this sounds like a great solution to the problem, i think we would have a very difficult time implementing it in the us.
i believe that you have a national health care system in place in australia, right? and i would guess that this system has facilitated the ability to track rxs, since they are filled through the same insurance.
while we might be able to develop a system for medicaid patients, i can't see all of the insurance companies getting together and cooperating on a similar tracking system for private pay patients. plus, all the patients who are self-pay.
there would also be many people who would object on the grounds that it is a privacy violation.
it would certainly help, though. not just with drug seekers, but people who are having legitimate pain that could be taking too much tylenol due to all the scripts they have filled. who hasn't heard "well, i took two percocet that dr. x gave me, but that didn't help, so i took two davocet that dr. y gave me, and that didn't help, so i took two lortab tht dr. z gave me, and that didn't help, so now i'm here...."
- 0Sep 24, '06 by kk2000Quote from gauge14ivHad to respond here-when you know you aren't believed, and are not validated just because you are not presenting with classic pain signs and vitals, one tends to be very scared of being labelled.Someone who wasn't a drug seeker wouldn't even be concerned about this.
I, for one, have had this experience, only to find out a few days later after having an MRI at my own expense, that I had 3 additional disc herniations after the ER doc told me that there was nothing wrong with me and to go home and take tylenol. Wouldn't even do an xray.
Please don't judge until you have been in the situation. Yes, there are drug seekers, but a person in pain is always suspect.
- 1Sep 24, '06 by geniannI too know what it is like to not be believed. It is beyond frustrating- and of course we must deal with the pain. kk2000, I had almost the same situation. Then I see an ortho doc and he tells me "I know nurses know what to say to get drugs and they know how to act". I was shocked and apalled- I told him "I have NO insurance- If all I want are the pills I can buy them off the street cheaper than coming to you. I spend $200-$300 dollars to see you plus the cost of the scripts. I want a professional to help me so I get the best treatment. Yes I am in pain and I do need narcotic meds but I want them to help me- NOT rule my life! Needless to say that doc later changed his tune, but the words still hurt. Another poster said "wear a suit,have insurance and be articulate"- a drug addict can be as well dressed and well spoken as anyone and still be a DRUG ADDICT- and the doctors will see past all this- They have probably seen it ALL before- and they DON'T fall for fancy clothes or good insurance.
- 0Oct 24, '06 by PatmaQuote from JessicRNI have to admit it but I feel for the people with mental illnesses coming in with pain. They automatically are deemed either neurotic or drug seeking. 10 years ago I was misdiagnosed with a mental illness and put on a whole slew of drugs. I developed severe abdominal pan while at work (I was and still am an RN) The pain was a 50/10 when I moved. As long as I stayed still I was fine with no pain. I had to be picked up from a chair and put on a stretcher taken by ambulance then placed on an ER stretcher. Needless to say I was not handled gently and I screamed in pain. A resident came in told me to stop sreaming then proceeded to ask me what illegal drugs I take and how much alcohol I drink. I told him I work in a jail get random drug tested and I do not drink. He drew blood and refused to give me anything for pain. He then sent me to xray for a sitting and standing KUB. needless to say I could not do it so the Xray tech "helped" and spun me into a dangling position (I was only 85lb) She recieved a reflexive punch in the arm. I was so embarrassed but the tech told me I had nothing to be sorry for it was her fault the resident told her to do it because he thought I was faking. I was diagnosed with pancreatitis with a lipase level off the charts. The resident came into my room and said "now tell the truth how much do you drink" I told him I do not drink he then said well you have severe pancreatitis I said nice how else do you get it he said gallstones. I was admitted to the ICU and almost died. I recovered and had 2 surgeries to remove all the stones (they filled 2 urine cups. When I recuperated I made a date with the medical director and had a meeting with the resident and presented him with the stones. He humbled and said when he saw al the meds I was on he immediately felt I was faking and a drug seeler. Sad to say but I got that whereever I went. Thankful to say I stopped the meds on my own 8 years ago and have had no problem and continue to work as an RN. No one has since ever labled me a drugseeker or neurotic. Go figure
It breaks my heart as I read your story, but it happens all the time. As far as I'm concerned, being "humbled" is not enough for what you went through. He should have been disciplined in some way, so that others will see what happens when you deny a patient relief from pain and for labeling patients as "drug seeking".
Without going into a long story, the same thing happened to me a year ago. I presented with chest pressure/pain and SOB. I'm female, 52 and a smoker. I'm also a patient in a pain management program.
The Nurse in Triage assumed I was a drug seeker and put me on the back burner, so after a few hours, I left and went home. Upon seeing my family doctor a few days later, and after performing an EKG, he immediately sent me back to the ER and they did the same thing again!! I chose not to leave this time because of my Doctor's concern.
My Doctor showed up in the ER several hours later to check on me and found me sitting in the waiting room. He somehow brought me in, ordered an EKG which didn't look so good and then ordered an emergency cath which showed I had an 80% blockage of the left main branch. I needed emergency bypass surgery which was done an hour later. I was told by the surgeon that I could have died at any time if I had not had the bypass.
So, do you think that the Nurse who saw me should get a slap on the wrist?Truth is, I don't care, they all stick together, all I wanted to do was get the hell out of there as soon as I could. As far as they are concerned, anyone who is a chronic pain patient and on narcotics, is lower than s--t, and will be treated as such.
As you can see, I have struggled with this type of discrimination before, and I'm just plain tired and fed up. What can a patient do to protect themselves? Evidently, being in the medical field, and RN for goodness sakes, doesn't stop the discrimination, so what will?
I don't mean to be hard on RN's because the ones that took care of me in CCU were wonderful as was my homecare nurse, but enough is enough. If you were in my shoes, you would be afraid of nurses as I was. I didn't want any nurse near me after what had happened in the ER. I had an angel of a nurse in CCU who set me straight that there are good caring nurses.
- 1Oct 24, '06 by gauge14ivI want to add - I believe the person - ALWAYS - who presents in pain. They get their pain meds.
The problem arises when they want their refill in 5 days instead of 30, they lose their rx or "leave it on the bus" repeatedly. Even then - they get ONE chance.
THATS where the problems show up - THATS the people who are concerened about it that should be worried about what provider thaty are going to go to next - cuz after they start pulling stunts - it wont be me!