Tips on how NOT to appear like a Drug seeker

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NHNurseMan

36 Posts

Specializes in Medical, Surgical, Cardiac.
I work in an emergency room and disagree with the idea that someone asking a question about how to NOT appear like a drug seeker IS a drug seeker looking to buck the system.

Especially if a person has hung around allnurses reading about drug seekers, who, granted, are a frustrating lot. It can make a person in pain a bit apprenhensive about presenting to a ER.

We can get jaded and judgmental working around folks who try to trick the system. And that can show up when a person, in real pain, comes into our ER. I work very hard not to get jaded.

Plus, even "junkies" can get kidney stones . . . .

steph

Thank you so much for using the very line I used when talking about this subject with my wife.

The fact that seems to elude many posters on this thread is there are far more people that come into your ER with actual pain than people who come in seeking medication for recreational use.

How many of these posters have actual experience in pain management? I read one post speaking of having elevated VS and not laughing with whomever you are with. In reality elevated VS are a classic symptom of someone in withdrawal. A person who has chronic pain will not exhibit elevated VS even with an exacerbation.

Regarding laughter or smiling, different people and cultures handle and express their pain in different ways.

In the hospital I work at, we can bring up a patients records in a keystroke and be able to tell when the patients last visit was and what it was for. Unfortunately in my hospital there are many who don't use this information. I recently witnessed a NP cut a scrip for Tylox, and when the patient stated that it made her sick and asked for Vicodin told the patient that the drugs were virtually the same and that she could either fill the scrip to Tylox or wait to see her dentist (this young lady was well dressed and had a nastily abcessed tooth). I was astounded at the way this girl was treated and as a new nurse I said nothing at the time.

I still can't understand why we are so afraid of treating the "5th" vital sign as we do the others. If someone is in pain aren't we supposed to treat it? I've seen in my time as both a student and as a nurse so many instances where a nurse will roll their eyes, or comment on a specific patient when that patient asks for pain medication. The bottom line that people that ask for pain medication are all med seeking, it's that the vast majority are seeking meds to alleviate their pain not get high.

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

Also - people forget to make the distinction between dependant and addicted. Dependant is sometimes necessary for people with chronic pain, they will become dependeant on a medication to have their pain controlled and that is a known fact and it is acceptable - in fact sometime you have to explain this to the patient because they dont want to use medication adequate for pain control. Addiction without pain is another case.

When I worked in the ER, anytime we could pull up prior records we did. But then we had a few seeker types who would try to change their names in the hopes nobody would recognize them.

tvccrn, ASN, RN

762 Posts

Specializes in Critical Care.
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.

This comment just shows one of the reasonings that people are worried about it. That there are others out there who judge them because they ARE in pain and have been in pain multiple times and haven't suffered quietly. That they have attempted to get the treatment they deserve for their pain has lead so many people to be unfairly branded as drug seekers.

I have a different take on it. To me, and of course there is always the exception, if a person looks to be in extreme pain AND is worried about being a drug seeker, it signals that they aren't being treated adequately and need something now to ease the pain. Then they need to talk with their PCP about a different approach to have stave off attacks.

What is a shame - truly - is that people even NEED to be worried about being taken seriously, ......

This just sums it all up for me.

tvccrn

vamedic4, EMT-P

1,060 Posts

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

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

Thanks...

I only came up with the idea bc my wife is a chronic pain sufferer (migraines) and we do everything we can to avoid the ER. Sometimes it's just unavoidable though.

vamedic4

getting ready for a nap

Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

all patients pain should be addressed .we shouldnot judge people.but we are human too.its shame people worry about appearing as drug seeeker when all they want is pain relief .but not all pain ,as we all know ,needs to be treated with narcs there are a range of drug options avail.even drug addicts need ppain releif however if someone has chronic pain issues they should have a med plan developed for them by their pcp .of course adjustments will need to be made and emergencies do occur .the other issue is some people don't see md's and use er as primary care .so it is a complicated issue .and there is a diff .b/w dependence and addiction .my dad had neuropathy severe d/t diabetes and was on pain meds narc and other to control his pain ,even used tens,but he was reluctant to take the meds d/t side effects.i also have had severe pain d/t diverticulitis requiring 2 trips to er both ended with hospital admissions and i know what meds work for me and what doesn't and i tell them .i am also fortunat to have wonderful dr's.

Specializes in Emergency Nursing.
Someone who wasn't a drug seeker wouldn't even be concerned about this.

I totally agree. It sounds like this person wants all of their ducks in a row for the next ER visit.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
I totally agree. It sounds like this person wants all of their ducks in a row for the next ER visit.

Yep that's exactly what it sounds like :rolleyes: .:nono:

Here's hoping the OP gets care from kind, nondismissive professionals if and when they need it.

belfry

42 Posts

Specializes in cardiac.
Someone who wasn't a drug seeker wouldn't even be concerned about this.

I disagree! I had a kidney stone earlier this year, and had 10/10 pain, vomiting, elevated BP/HR/R, the whole nine yards. I was given toradol + phenergan...didn't do a thing but make me drowsy...still in the same pain, still vomiting. No change after the second dose. After a bit they gave me something else (don't recall, was either demerol or dilaudid) Knocked the pain (and me) right out.

So now I am concerned that if it ever happens again I will either have to be inappropriately medicated for an hour until the other drugs prove ineffective, or look like a drug seeker when I say, "Um, the only thing that worked was something that started with a "D"." Tell me that won't get me a special note in my chart!

So be careful not to judge too quickly. I am not a drug seeker under normal conditions, but that pain made a true believer out of me...I would slap your granny to get drugs under those conditions!

vamedic4, EMT-P

1,060 Posts

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

Belfry's situation underscores the need to have someone with you who can help you to explain what is going on...a husband, wife, parent or significant other. In many cases, someone who can tell staff how things are affecting you can help you in your quest for releif.

And yes, even those patients with pain specialists, neurologists, et cetera DO WORRY about being perceived as "drug seeking". To say that they don't worry about it is naive at best. They worry that they won't be treated, they worry that staff say things like "oh, she's just here for a fix"...occasionally when I have to take my wife to the ER, I have overheard this...mostly from nursing staff. The docs are less worried or judgemental, one call to the pain management doctor at 0200 is enough to defer any questions about her need.

As if it weren't enough that the entire family is there at 0200 on a school night???

Again, people are individuals and should be dealt with on an individual basis.

Workin' workin' workin' again tonight

vamedic4

WillowBrook

32 Posts

I totally agree. It sounds like this person wants all of their ducks in a row for the next ER visit.

Yes, which is exactly why I identified myself as a former Heroin addict in my initial post :rolleyes: ....don't you think if I was trying to get information on how to appear legit so I could scam drugs I would have left that particular piece of history out of the equation :rolleyes: :madface:

fotografe

464 Posts

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.

Not so true in my case. I had undiagnosed esophageal spasm for 25 YEARS! I woudl go to the er in so much pain I was sure I was having a heart attack. After years of taking NSAIDs for spinal pain. I finally realized these things were often triggering the esophageal pain. I found a GI doc who treated me for the spasm and told me to stay off the NSAIDs. When I had to go to the ER for severe spinal pain (2 ruptured discs) I explained I could not take NSAIDs. The nurse, in front of me, told the MD when he came in that I was "allergic" to NSAIDs and then rolled her eyes. I tried to stop her and say I wasn't allergic but sensitive. In the end, they gave me iv toradol, which did indeed take away the back pain, but it sent me into the worst esophageal spasm EVER -- so much so I was sure I was going to die right there. I read later that GI irritation, even when given iv, is a side effect. So they ended up having to give me morphine to stop the severe pain they caused. All because they thought I was lying and a seeker. 25 years of trying to find relief from the pain certainly gave me insight to what works and what does not.

ERNP

189 Posts

Specializes in ER, critical care.
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!

You're a good woman. I am pretty sure that chronic pain management wouldn't be for me.

We have one of the pain management docs in town that does some occasional ER moonlighting. I have seen him discharge patients from his practice in the ER for violating their pain management contract. You should see their faces when he walks into their room.

We are fortunate to have computer access to other system hospitals. So when we pull someone up, we can see when they have made a "7 ERs in 7 days" tour for a toothache. The state has recently made prescriptions filled available via the internet for those who apply for a password.

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