[teeituptom]

Kind of like saying what came first the chicken or the egg, I know. Now I have worked ER for a very long time. And all those drug seeking patients of the past and present. Im now seeing their children come in with the same multitude of bogus drug seeking complaints. Now what this makes you think is ahah there really is a drug seeking gene in some people. But then is it really genetic or is it learned behaviour.
Just think that while growing up, you see one of your parents always going to the ER and getting lots of attention and drugs from their significant others and the positive reward of getting doped up for their behaviour. Does this tend to make you exhibit the same behaviour when you grow up and want attention or drugs to feel better. Or is there really some unknown, unmapped gene that causes all this behaviour.
I've noticed the offspring drug seekers all have the same allergies their parents do, so that they can get the same meds their parents do. Now I can see allergies as a genetic trait, but what about drug seeking. In fact, I know one family of drug seekers that covers 3 generations of their family. Wow, just think, Multigenerational drug seekers. Boggles the mind.

Does anyone have any answers or input

[TazziRN]

It's both. The chemical dependency can be inherited but the behavior is learned from watching Mom and Dad going to the ER weekly and getting stuff.

[traumaRUs]

Hmmm Tom - interesting. While environmental allergies can be genetic, drug allergies are not usually genetic. I would go along with this being learned behavior.

From the National Jewish Hospital website comes this (with some help from Siri):

"Who gets allergies to medications / drugs?
There are two criteria to become allergic to a drug: a genetic predisposition for allergy, and at least two exposures to a given medication. Without the right combination of genes, the immune system will not overreact and make IgE antibodies against the medicine. If the ‘right genes’ are present for allergy, the immune system must first become sensitized to the medication (first exposure) before it can mount an allergic response (second exposure).

Women appear to have an increased risk for adverse drug reactions. Children whose parents are allergic to at least one drug have a greater chance of being allergic to drugs than children whose parents are not allergic to drugs."

http://www.njc.org/disease-info/dise...dications.aspx

[andhow5]

Ahhh... I've often wondered this as well.

I've seen a couple of families of "multi-generational seekers", and of course they are allergic to "everything except that one medicine that starts with a D... di... dil...dila... you know what I mean!"

In their cases (the families I've dealt with), I think it's all attention seeking behavior. And as far as their allergies go, they are lying through their teeth. My favorite response I've received after asking, "What kind of reaction does this medicine cause?" was, "It wasn't strong enough."

In the MGDS'ers (multi-generational drug seekers) I deal with, they usually all manage to show up within minutes of one another, sharing a cab, or sharing an ambulance, demanding drugs and a taxi voucher.

*sigh*

I know that I'm fighting a loosing battle with the seekers about what a TRUE allergy is. They don't want to hear it, they just want their regular fix.

Blah! I'm sorry; at one time I had a point in mind with this point, but I have rambled far from it, LOL!

[Altra]

Originally Posted by andhow5

In the MGDS'ers (multi-generational drug seekers)

A new acronym to remember ... Love it!

[TinyNurse]

I don't think it's genetically inherited rather a learned behavior.

On top of that, have you ever heard the mom (seen 10 times this year in the ED) asking "why don't you give her something for pain? she needs something for pain!!!

[teeituptom]

then they all get what they want, whatever that is

[purplemania]

It is really a sort of mental illness to be a drug-seeker. Do you assess for that?

[ZASHAGALKA]

Originally Posted by purplemania

It is really a sort of mental illness to be a drug-seeker. Do you assess for that?

It might be sort of a mental illness to be a drug seeker, but at 3am, in the ED, it's not a mental illness being addressed, but the 'emergency' that isn't.

Our ED's are not the places to deal with long term, long fix psychiatric problems.

As far as assessing for it: if such pts were interested in seeking treatment for such underlying problems, they wouldn't be in the ED at 3am for a very different kind of 'fix'. The problem is that the need for the fix that brought them to the ED completely obliterates in such pts the ability within themselves to assess for such things.

Drug seekers have a completely misaligned Maslov Hierarchy of needs. For example, we know that it's pointless to address housing situations in people that can't breathe. And it's pointless to address mental health status of people that place the next fix so very much higher on their hierarchy of needs. Simply put, since THEY can't assess for it, it is nigh impossible for US to provide any action for which such assessments would reveal a need. If they don't get what they came for, the vast majority will seek it elsewhere, no matter the rationale and no matter what OTHER treatments are offered.

My first job was at the VA with a drug tx unit. We HAD the option of offering such treatments at no additional cost to our pt populations. My experience: the only pts that benefitted from such options were the ones that came SEEKING such options; not their next fix.

I took care of a pt the other night that left the hospital AMA w/ a bp of 240/140 (because she wouldn't allow the continuation of her nipride gtt). Why? She'd been in long enough to need her next hit of crack and nothing and nobody was gonna stop her from going to get her next fix. I had two choices, tie her down or let her go. And since she was as lucid as her baseline allows, that really eliminates one of the choices. There's a very real distinction between her true needs and her drug warped perception of needs. And no amount of assessing for it will change such perceptions.

I told her point blank, "If you leave, you will likely die, if not tonight, within a few days or weeks. If you stay, you can seek the help that will allow you to see your grandchildren grow up." Response: "I know but I'll be OK". Sigh.

~faith,
Timothy.

[sjt9721]

Great topic Tom, followed by several excellent replies.

For many MGDS's, I really think it's the attention rather than the high. "Pay attention to me, I'm hurting. Make me feel better right now."

My big point of wonder is how have we turned into a society of wimps? I really think that some people expect to go through life without ever feeling any inkling of pain or discomfort. At the slightest twinge of being uncomfortable, they come running in before trying any OTC remedies. C'mon people...get real! (Drug companies could save a lot of money on those ads...sometimes I wonder if anyone listens to them!)

How many times have many of us worked with a headache, or cramps, or after over-doing it in the gym? I'll bet we swallowed some Tylenol or Motrin, punched in, and got to work!

My 2 cents...for what it's worth.