Tips on how NOT to appear like a Drug seeker

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emeraldjay

77 Posts

I have suffered migraines for the past 10 or so years. My last experience of having to resort to going to the ER for relief felt like a disaster. I knew I needed to be up for work in a few hours and couldn't get to sleep d/t the usual visual disturbances I get.

During triage, the nurse actually said, it's 3 in the morning, what are you doing in here with just a headache. Is it really a migraine or are you just calling it a migraine. Why are you coming in now if you had it for three weeks. Only the final question is forgivable, though the tone of her voice isn't. I knew it was a migraine since it was all of the same symptoms as the last headache that got me a dx of having migraines. All I wanted at that point was to get rid of the flashing lights and get to sleep. I even told them what worked the last time, compazine timed IV push. Nurse took off in a huff. I don't remember actually seeing a doctor that night, I just remember the nurse coming back with a tramadol IM and a script for Ultram. Even after complaining that the flashing was still there.

Then the most amazing thing happened when I asked to use the phone to call for my ride. I asked them to dial an in house extension and suddenly everyone fell over themselves to be accommodating. Like oh here use this phone.

Now that I am on Depakote for the migraines, and Imitrex for the rare ones that get through, I'm treated with plenty of tender care when I say I have a migraine. I also carry a list of allergies and meds since half the time I forget to say all of them and only tell the ones that I think are relavant. I include dosages and freqency of my meds and the reactions of of my allergies. After that, the MD/NP can make the decisions.

TazziRN, RN

6,487 Posts

Why are you coming in now if you had it for three weeks.

I ask this kind of question a lot, because I often get more information this way. By asking this question I find out that there are new symptoms, or a worsening of the symptoms.

Don't run out of chronic pain meds on Friday at 5pm. Even if you "called the office and they didn't call you back". Plan ahead!! Call them before Friday when you know you are getting low. If it is time to have a refill they will usually get one called in for you. If you are too early they will assume you have either diverted your meds or not taken them as directed.

Don't call administration to complain that you didn't get your drug of choice.

Don't throw your soda on the floor and go into full "writhe mode" as soon as you see me walking into your room. I have already been past your room and had found you resting comfortably. I don't hand out awards based on performance, like the Emmys.

Don't call back 2 hours later requesting a new prescription because you lost, your dog ate, or you washed the old one.

Growing new allergies during the discharge process is a dead giveaway. "What did you give me?" "Ultram". "Im allergic to Ultram", "That wasn't listed as an allergy nor did you mention it earlier in our interview... you remember when I asked.... "Are you allergic to any medications?" Were you not allergic to it then?

I could go on and on... there is so much of this in our community.

HA HA HA HA! You are describing so many of my pain management patients. I see this crap all the time, they'll even come in with a police report stating someone robbed them and took that meds! I just write them a script for a clonidine taper and tell them this will keep them out of withdrawal until they can get another refill. I just discharged someone today because I suspected she was abusing her meds...turned out I was right on the money...she tested positive for benzo's and oxycodone, but she was only being prescribed methadone. When she told me that she was getting the other meds from another doc, I showed her the contract she signed stating that WE were the only ones allowed to prescribe a controlled substance!!! She has 45 days to find another physician. I LOVE busting the losers!

Trauma Columnist

traumaRUs, MSN, APRN

88 Articles; 21,249 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

A pain contract is very important for chronic pain sufferers. This provides a double-purpose system of checks and balances: the patient receives the needed meds and the provider stays out of trouble also.

IL is going to be going online for patients who utilize Medicaid. This will help to weed out those folks that fill meds from multiple providers.

I did have an enterprising young man who had Medicaid but who would pay cash for his narcotic scripts, thus avoiding the computer because Medicaid didn't pay for it. However, the pharmacy called me.

rjflyn, ASN, RN

1,240 Posts

Specializes in Emergency.

Something else that may help in the OP's case. The example was kidney stones. If we refer you to a Urologist see the urologist. Don't come to the ER for the 10th time with kidney stone and tell me/us that you have never seen one.

In the migraine example if we refer you to the neurologist see the neurologist, narcotics dont abort a migraine anyway they just mask the pain and alow you to sleep. By the way I have had more than one neurologist tell me that knocking one out for at least 10-12 hours of sleep and the right combo of anti-inflamatory meds will abort most migraines. This doesnt nessesarily equate to narc either.

Rj

Specializes in ICU, ER, HH, NICU, now FNP.

Trust me - I truly believe in providing as complete pain control as is medically possible. I REALLY REALLY do. But a person who has a real problem can generally be assessed as such and isn't worried about looking like a drug seeker. In my experience that is the LAST thing they are worried about. They are worried about their PAIN and the problem at hand. When a person is more focused on "appearances" than their issue, that raises red flags with me all over the place. Pure n simple. They are not calling the office at 430 pm on Friday hoping the MA will feel sorry for them when they tell her their dog ate their prescription, they are not calling the on call doc after hours and arguing with him about what he wants to prescribe - never mind that they got a prescription earlier that day called in for them. They aren't verbally abusing your office staff. And they generally are willing to come in and be seen because they really are that miserable.

I wasnt making a judegement call here - just a simple observation. Absolutely junkies have kidney stones - and to deny them adequate pain control would be criminal! Yes they know what works for them - but even a junkie - at that point in time - would be less worried about looking like a drug seeker - and more concerned about their PAIN.

THAT was what I was saying. Sorry it got so twisted.

Specializes in ICU, ER, HH, NICU, now FNP.
I know none of the comments were directed at me, but I feel as though I should defend myself here. Experienced AND CARING ER nurses and doctors can tell when someone is in genuine pain versus looking for a fix. Usually.

Exactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.

anniesong

46 Posts

Specializes in NICU.
Exactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.

I think that this may perhaps be why the OP and others with similar concerns are asking this question now, rather than waiting until they are writhing in pain. And those that have experienced inadequate pain coverage are trying to find methods of lessening the chances of it happening again.

Does this mean that drug seekers never try to learn new "tricks" for covering their butt? Nope. But does it also mean that we cannot imagine there are legitimate concerns out there? Nope to that too.

I've never given birth, nor had a kidney stone, but when I remember the most painful experiences that I have had to date, I do fear that pain and suffering. Making a plan now for how one would cope in the future can give a sense of control and perhaps calm some of their fears now about what will happen to them in the future if they are ever in such a position.

Having a plan that includes backup, such as the doctor's note suggested above (an MD/practitioner might be more willing to take another practitioner more seriously than a stressed and in pain patient), a list including health history, previous hospitalizations/ER visits and their reasons, allergies, and current meds w/side effects can offer legitimacy as well as "backup" for the ER practitioner to call and get confirmation of the patient's health status.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Exactly - so if a person truly is in pain, then they should not have to be concerned about appearing to be a drug seeker. If they are worried about that - then I have to be at least a little suspicious.

I thought the same thing, till that happened to me last year. Here i was in a fetal position crying, begging for relief from the worst migraine i'd ever had, and got treated like a FF drug seeker, when i'd never been to that ER (or facility) ever. It was frightening, wondering if i actually had a migraine, or worse, and being treated like i was asking for a narc hit.

So thanks to that, i get the joy and pleasure, if i'm ever in that kind of pain again, of wondering if i'll be taken seriously next time.

Specializes in ICU, ER, HH, NICU, now FNP.

What is a shame - truly - is that people even NEED to be worried about being taken seriously, or that providers have to worry about being used as a source. Both suck. There just aren't any easy answers for that unfortunately. As nurses we can do a good job of assessment, of being compassionate and sensitive, and also sensible - that requires that people slow down enough to get the whole picture.

Marie I hope you and your doc were able to plan ahead for future migraines - nobody needs that kind of stress when you are in that kind of pain.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

We had planned ahead, and that still happened. We can try and plan ahead for that again, but the next time could be worse.

nursetim, NP

493 Posts

Specializes in ER, HH, CTICU, corrections, cardiology, hospice.

I am not proud of this and he was not my patient. We had a man come in with a headache. He was shuffled off to a quite corner until his cat scan. Can you say subdural bleed. He was flown out within the hour. We didn't think he was seeking, just a wimp.

We also had a fella who dropped an greasy engine on his arm acouple of different times, on purpose, for the drugs. He never broke anything and it was superficial damage not requiring sutures.

Then we had a guy come in for little toe pain. Okay no problem let's try toradol or nubain, nope had to be dilaudid. No dilaudid he got loud and whiney and obnoxious refusing our treatment. He did this several times. The last time I saw him we xrayed his chest for some reason. Thw twit has a spot on his lung. We admited him started a line and gave him his favorite, within ten minutes twity gave us the positive gown sign (he amscraed with his heplock):madface:

The idea of a letter is terrific, leave it to medic to come up with the right idea.

Willowbrook, I hope things go well for you, you have delt with a lot of difficulties and you seem to be handleing your business well, I admire your resolve and courage:pumpiron: :bowingpur :yeah:

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