Tips on how NOT to appear like a Drug seeker - page 8

by WillowBrook 72,126 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


  1. 0
    Quote from traumaRUs
    I truly am very sorry for patients that have not received adequate pain meds.
    Amen. I'd rather a drug seeker get meds than a pt who is in real pain not get meds. Get my point? Which is worse? Please say the latter...

    This whole issue really is a sad commentary on our (USA, in my case) "War On Drugs" society. Who's right is it to deny a truly in need pt pain meds because there are those who should not receive them?

    One of my clinical rotations in the ER a pt was returning for a check of his sutured finger. Nothing major, right? It was a follow up in a small rural hospital. As I did his assessment I asked "On a scale of 1 to..." I didn't even finish and pt said "10!". I finished "...to 10 how would you rate your pain?" He again said "10!" BP, temp, pulse, etc all a-okay. There's no way this guy was telling the truth--period. I documented his reply "10/10" as well as mentioned this to the RN supervisor. pt left with Rx for 10 of something (I forget what it was)...

    Point is, I'd rather see this guy get his meds than someone leave in pain any day, any time. If someone wants to fight the war on drugs, please don't deny pts pain meds. Sign up for the DEA.

    Regards,

    Ken

    P.S. I landed a preceptorship in an ED so I'm sure I'll get to see much more of the "is he or she faking or not" question.
  2. 1
    Quote from West_Coast_Ken
    One of my clinical rotations in the ER a pt was returning for a check of his sutured finger. Nothing major, right? It was a follow up in a small rural hospital. As I did his assessment I asked "On a scale of 1 to..." I didn't even finish and pt said "10!". I finished "...to 10 how would you rate your pain?" He again said "10!" BP, temp, pulse, etc all a-okay. There's no way this guy was telling the truth--period. I documented his reply "10/10" as well as mentioned this to the RN supervisor. pt left with Rx for 10 of something (I forget what it was)...
    And that is a good way to handle it.....give the pt a script for enough to get by but not enough to do anything else with.

    And congrats on your preceptorship!!
    mrsmamabear2002 likes this.
  3. 0
    I'm just a measly student, so please don't take this post the wrong way - I have already seen that what they teach us is not always how it works in the real world!

    That said, isn't pain control a right, and mandated by JCAHO? We were taught that even the people who ARE drug addicts have a right to pain relief, and that nurses are obligated to take the patient's word for it. "Pain is whatever the pt. says it is" was preached to us ad nauseum!

    Just curious how this plays out in real life. If a patient is believed to be a drug seeker, and is denied pain control by physician/nurse/staff. could the facility be subject to problems with JCAHO if the patient is wise enough to complain?
  4. 0
    Yes - but by the same token - the staff could be prosecuted for contributing to a drug problem too...

    right from the state of Texas drug diversion programs website (other states and the DEA have similar guidelines)

    http://www.txdps.state.tx.us/crimina.../diversion.htm
  5. 0
    Wow - that really puts us in a bad position! One of the "Don'ts" for HC providers on that site is ""Take their word for it" when you are suspicious of their medical condition or behavior." That directly contradicts what our profs say and (from my understanding) what JCAHO says! Thanks for the info Gauge!
  6. 0
    I agree that only someone who is seeking would worry about how not to look like she is seeking. If you are truly in pain, you are not going to care what others think of you or how you apepar.
  7. 0
    Quote from WillowBrook

    Question for people out of interest....would you have slightly more respect for a drug seeker if they just came out and honestly said that they were in withdrawal and needed something to help them out?
    Respect might not be the word I would be looking for, but it certainly does take the mystery out of the equation to have an actual admission of addiction or physical dependence. I appreciate the honesty.

    Sometimes withdrawal will produce life threatening symptoms. I have an interest in preventing the life threatening symptoms. I have given a one time dose to people that finally fessed up to being in withdrawal. Sometimes even when you know they are in withdrawal, they won't admit it. Leaving me to do a million dollar workup when all they really needed ot stop their symptoms was a dose of narcotics.

    At the same time I give the one time dose I confront them. I tell them what I think their symptoms are from and most will then admit it. I am probably quite stern, but I might be the wake up call that keeps them from dying on their next OD. I offer to have drug rehab come and talk to them. Most of the time they aren't interested. But every once in a while someone will come back later and ask to speak to someone at a drug rehab. But like WillowBrook said, getting clean is the easy part. Some make it to stay clean and some don't.
  8. 0
    Quote from leelinn
    Why are people so worried about giving someone pain medication? I thought that was what it was made for. They need to get over the idea that everyone is looking for a high and do their job and help people. Get off of their soap boxes and stop judging everyone. Even drug abusers have pain and sometimes severe pain and they need to be medicated like any other human being. Let god be the judge. I am sorry that you had to suffer like that. They need their licence taken. What horrible medical people.
    Indiscriminate prescribing of narcotics is what got a lot of people in the predicament that leads them to inappropriately utilize the ER to obtain drugs.

    If I am inappropriately prescribing narcotics then I have to worry about the state board, the DEA, the state drug agency, as well as the other providers in my community. Providers in my area have lost the privilege to prescribe narcotics due to inappropriate prescribing behaviors.

    No one is advocating letting people in severe pain suffer. Not even if they have been in 100 times in the last year and perceived to be a drug seeker. What is being advocated here is the appropriate use of the appropriate medication for the injury or illness in question. Sometimes there is a need for strong medications and sometimes not.
  9. 0
    [quote=fleur-de-lis]

    That said, isn't pain control a right, and mandated by JCAHO? We were taught that even the people who ARE drug addicts have a right to pain relief, and that nurses are obligated to take the patient's word for it. "Pain is whatever the pt. says it is" was preached to us ad nauseum!

    quote]

    A right?? Healthcare in itself isn't even a right!! It isn't in the bill of rights or the constitution. Is providing care morally and ethically responsible for a civilized society, yes. But not a one of those "inalienable rights" with which man was "endowed by his creator".

    Imagine this.... We hold these truths to be self evident, that all men are created equal... endowed by their creator with certain inalienable rights to include life, liberty, the pursuit of happiness, a prescription for Percocet, and a shot of dilaudid".

    I have often thought of JCAHO's role in the demise of healthcare in general. They have created more havoc and more paperwork than any one organization has a right to create. But they still can't dictate provider practice. Maybe that is in the works for next year.
  10. 1
    I 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
    tsalagicara likes this.


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