Tips on how NOT to appear like a Drug seeker - page 2

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... Read More

  1. Visit  Cyndee, MSN, NP} profile page
    0
    Quote from traumaRUs
    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.

    Good luck.
    I work in pain management and it's pretty easy to figure out who's faking pain and who's diverting their meds. The other day, I had a pt ask me if I could give him 8 Oxycontin 10 mg instead of the 80 mg caps...he said he was allergic to the dye in the 80 mg - I called the pharmacist and the same ingredients were in the 80 mg caps. Another red flag is when the patient starts crying at every single visit or they are wanting to switch meds all the time. It's always a huge red flag when the patient knows how to convert from one opiate to the other, or knows more about the drugs than the practitioner! Also, people who take methadone AND a benzo will get a buzz, although with methadone alone they won't. Hydrocodone and Soma together really gets them off, so I never prescribe the two together. I'm amazed at how many new pts tell me that Lortab and Soma are the only 2 medications that work for their pain! When a breakthrough med (opiate) is given to patients on methadone, they won't get the "high" that they would when taking the breakthrough med alone. Therefore, a lot of people have OD's while they're on methadone, because they keep taking more and more of the opiate trying to achieve that "high."
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  3. Visit  Cyndee, MSN, NP} profile page
    1
    Quote from Jennifer, RN
    Don't come in with BP of 110/60, heart rate 60, chewing gum, talking on your cell phone, c/o'ing of pain 10/10. Pt's who are in severe pain usually present with elevated bp and pulse (unless they are on betablocker), diaphoresis, and agitation. They also usually don't care if you stick a 22 or 16g needle in them, since that is not the worst pain they have ever had (compared to the pain they came in with). The pts who present in pain I will seek out pain meds. The others have to wait to see a doc.
    Totally right on! If they aren't willing to get an intervention , even though they claim they're in severe pain, then that's a red flag.
    TraumaNurseRN likes this.
  4. Visit  rehab nurse} profile page
    0
    Quote from Jennifer, RN
    Don't come in with BP of 110/60, heart rate 60, chewing gum, talking on your cell phone, c/o'ing of pain 10/10. Pt's who are in severe pain usually present with elevated bp and pulse (unless they are on betablocker), diaphoresis, and agitation. They also usually don't care if you stick a 22 or 16g needle in them, since that is not the worst pain they have ever had (compared to the pain they came in with). The pts who present in pain I will seek out pain meds. The others have to wait to see a doc.
    excellent advice. the only other thing i can offer is to always be upfront about any past drug abuse issues. but, you are already doing that, so, you shouldn't have any issues.
    if you go to the er with a kidney stone, don't worry. everyone will know it! hope you don't worry too much about this.
  5. Visit  ERNP} profile page
    5
    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.
  6. Visit  gauge14iv} profile page
    6
    Someone who wasn't a drug seeker wouldn't even be concerned about this.
    JKL33, TraumaNurseRN, Woodenpug, and 3 others like this.
  7. Visit  P_RN} profile page
    0
    gauge14 I have to disagree slightly with this. When my first HNP happened they gave me demerol.....it helped a lot, but I hallucinated seriously.

    So I asked for darvocet.....the doctor laughed and said to give me fentanyl. I can tell you I WAS seeking because I was in real pain. There's a difference in intolerance and allergy.

    I know darvocet works to take the edge off. When you are in pain it's best to let the doc/NP make the first decision, but hopefully they will be aware enough to listen to their patient.
  8. Visit  WillowBrook} profile page
    2
    Quote from gauge14iv
    Someone who wasn't a drug seeker wouldn't even be concerned about this.
    Oh really? Reading through some of the threads on here about the assumptions that are sometimes made regarding who is and who isn't a Drug seeker, as well as hearing testimony from others who have mistakenly labelled as "drug seeking" and mistreated because of that fact, along with the fact that I have personally experienced being mislabelled as a "just a junkie looking for a fix" by ER staff, I seriously beg to differ with you on this point.

    In 1997 I presented in severe pain to a local Emergeny Dept. I was sent there directly from an after hours medical service and was suspected of having a Pneumothorax. I had been experiencing severe headaches and earaches all that day, by night time I was vomiting and being wracked by extremely painful spasms all through my neck, back and stomach. I have never experienced anything more painful in my life so far, and that includes crush injuries and fractures to my foot and post Laparoscopy/Hysteroscopy pain, I was literally screaming with pain and I could not help myself. When I got to the ED right from the start I was treated badly. The admissions Nurse berated me for not being able to say more than 2 words at once through the pain to give my details properly, the Nurse who was assigned to look after me once I was admitted was very short and abrupt with me, at one point she lowered the back of the bed down and it set off a series of extremely painful spasms, so she quite roughly shoved the bed back up to a more upright postion and walked off with a huffy "there hope your happy" comment thrown back at me. At all times, whilst I screamed and cried and begged for pain relief, I was made to feel as if I was just a huge inconvenience and annoyance to them. When the X-ray came back clear for Pneumothorax, do you know what they did?? The Nurses and The Doctor who were supposed to be looking after me went and stood in full view of me drinking coffee, laughing, pointing, rolling their eyes in my direction and making comments about "junkies looking for a fix". I was discharged with a valium and one Panadeine Forte tablet. I half squat walked, half crawled out of that ED, still in excruitiating pain and still vomiting. 2 weeks later it was finally realised that I had Bornholms Disease.

    So after an experience like this please do not try and tell me that only a Drug Seeker should be worried about being seen as such.
    SmilingBluEyes and MoshRN like this.
  9. Visit  AggieQT} profile page
    0
    You know... i was just in the ER this past Friday with kidney stones.... I tried to deal with the pain on my own (this is my 9th time to have them) because I know how overcrowded the ER can get and didnt want to wait to be told I was passing a stone when I already knew that.... ya BAD idea.... I think I made it like 3 hours and then wanted to die... I also have a bad complex... the first time I went into the ER with that HORRIBLE pain they did every test on me... KUB, CT, ultrasound... i had to drink that nasty stuff too... and then the dr came in and told me it was all in my head and that he wasnt going to give me any drugs!!! YES HE ACTUALLY SAID THAT!!! The RN behind him even laughed and so since then, I always try to tell myself its just gas or somthing because that is the worst feeling ever... for someone to look you in the eye and imply that you are a drug seeker... I was 17 at the time and was lucky enough to have a very determined mother. So after a visit to my gyno and my now urologist they found my kidney just fulll of stones!!!

    A long story short, I feel your pain about the worry of going to an Er for them to look at you like you are a drug seeker. Luckily after my first episode it was quickly believed that my problem was infact the passing of a stone and I had no further "Doubts" as to my condition.
  10. Visit  vamedic4} profile page
    0
    Quote from EDValerieRN
    If you have a chronic condition, the pain is best managed outside of the ER.
    Even so Val, the ER is the place people end up because frequently even chronic pain involves breakthru, and that is an acute condition best managed in the emergency setting.

    My advice to the OP, talk with your doctor about the best course of treatment SHOULD YOU HAVE TO go to the ER. Carry a letter with you from him/her that says "This pt. is under my care , please give med X, Y, and Z and call me if you have any questions or concerns." You will find that many doctors appreciate this (both ER and private practice). This will expedite your care and allow your ER doc to know that YES, your PCP is aware and that he/she can be contacted at any time. This can go a long way in avoiding the perception that you are a "drug seeker".

    vamedic4
    Good luck!!!!
  11. Visit  EDValerieRN} profile page
    2
    Quote from vamedic4
    Even so Val, the ER is the place people end up because frequently even chronic pain involves breakthru, and that is an acute condition best managed in the emergency setting.

    My advice to the OP, talk with your doctor about the best course of treatment SHOULD YOU HAVE TO go to the ER. Carry a letter with you from him/her that says "This pt. is under my care , please give med X, Y, and Z and call me if you have any questions or concerns." You will find that many doctors appreciate this (both ER and private practice). This will expedite your care and allow your ER doc to know that YES, your PCP is aware and that he/she can be contacted at any time. This can go a long way in avoiding the perception that you are a "drug seeker".

    vamedic4
    Good luck!!!!
    Word.
    MoshRN and gauge14iv like this.
  12. Visit  WillowBrook} profile page
    0
    Quote from vamedic4

    My advice to the OP, talk with your doctor about the best course of treatment SHOULD YOU HAVE TO go to the ER. Carry a letter with you from him/her that says "This pt. is under my care , please give med X, Y, and Z and call me if you have any questions or concerns." You will find that many doctors appreciate this (both ER and private practice). This will expedite your care and allow your ER doc to know that YES, your PCP is aware and that he/she can be contacted at any time. This can go a long way in avoiding the perception that you are a "drug seeker".

    vamedic4
    Good luck!!!!
    Thanks for the helpful advice. I am seeing my primary care Doctor on Monday and I will certainly get him to write a letter stating what medication I am on and what the possible effects of that medication are and what drugs he thinks are appropriate for pain relief in my situation. Excellent idea, thank you very much
  13. Visit  Miss Mab} profile page
    0
    I think just by being honest helps tremendously. If Dilaudid truly is what works for you--then say that. The doc will either agree or we will explore further with you. What we hate is the whole, "um, I can't remember the name of it. It's du, di, you know which one."

    Sigh.....
  14. Visit  TrudyRN} profile page
    6
    Quote from WillowBrook
    Oh really? Reading through some of the threads on here about the assumptions that are sometimes made regarding who is and who isn't a Drug seeker, as well as hearing testimony from others who have mistakenly labelled as "drug seeking" and mistreated because of that fact, along with the fact that I have personally experienced being mislabelled as a "just a junkie looking for a fix" by ER staff, I seriously beg to differ with you on this point.

    In 1997 I presented in severe pain to a local Emergeny Dept. I was sent there directly from an after hours medical service and was suspected of having a Pneumothorax. I had been experiencing severe headaches and earaches all that day, by night time I was vomiting and being wracked by extremely painful spasms all through my neck, back and stomach. I have never experienced anything more painful in my life so far, and that includes crush injuries and fractures to my foot and post Laparoscopy/Hysteroscopy pain, I was literally screaming with pain and I could not help myself. When I got to the ED right from the start I was treated badly. The admissions Nurse berated me for not being able to say more than 2 words at once through the pain to give my details properly, the Nurse who was assigned to look after me once I was admitted was very short and abrupt with me, at one point she lowered the back of the bed down and it set off a series of extremely painful spasms, so she quite roughly shoved the bed back up to a more upright postion and walked off with a huffy "there hope your happy" comment thrown back at me. At all times, whilst I screamed and cried and begged for pain relief, I was made to feel as if I was just a huge inconvenience and annoyance to them. When the X-ray came back clear for Pneumothorax, do you know what they did?? The Nurses and The Doctor who were supposed to be looking after me went and stood in full view of me drinking coffee, laughing, pointing, rolling their eyes in my direction and making comments about "junkies looking for a fix". I was discharged with a valium and one Panadeine Forte tablet. I half squat walked, half crawled out of that ED, still in excruitiating pain and still vomiting. 2 weeks later it was finally realised that I had Bornholms Disease.

    So after an experience like this please do not try and tell me that only a Drug Seeker should be worried about being seen as such.
    ITA. Just because one is a doctor or nurse doesn't mean one's head isn't screwed on backwards on certain issues. I always pray that those who are so ignorant, so cruel, so inexperienced or arrogant can have the pleasure of 20/10 pain (yes, you read it right) ASAP. And see how it feels to be the brunt of cruelty, ignorance, and prejudice.
    anangelsmommy, MoshRN, AnGG, and 3 others like this.


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