[l.rae]

Originally posted by nursegoodguy
As a nurse if they have an order for pain meds then I will give it as long as I don't think they are in jeopardy, but... There are drug seeking patients PERIOD!

Hey Guiseppi...on this we AGREE.....books are lovely...then there is the real world............LR

[caroladybelle]

I have been treated for depression for most of my life. Prior to prozac and the newer drugs, the treatment I was given was 2-3 mg of Xanax per day.

When I had to kick the Xanax habit - it was a hideous experience. When I finally kicked, I flushed about 200 tabs down the commode. I never want to even see a tab again. It is scary that people tellk me how good they feel taking it - I never felt any high from it -it was just medecine.

[pakRN]

I work with opiate dependent clients so my take on a "drug seeking patient" may be different then yours. It truly does exist and it's called addiction.
When I worked in med-surg the patient that complained about pain received meds. Some were opiate addicts, but most were genuinely in pain.
With experience, most of the time you will know who is trying to manipulate you.

[jude11142]

As a chronic-pain sufferer as well as a nurse, I understand firsthand how it feels to be in a hospital and not have control over the treatment of my own pain. I also know how it feels to be labled "drug-seeking". The subject makes me so angry. Until they can come up with a fool-proof test or something that can tell if somebody is truely in severe pain, I will beleive my patient and treat his/her pain. I hate to admit it, but I have had other nurses tell me at report,,,,"so and so is complaining of terrible back pain, just give her tylenol".......this pt has a prescription for narcotic pain meds, so why not give it to her? I have no problem trying tylenol first at times, but when you have a pt who is experiencing pain, many times if you wait too long to medicate, the pain gets worse, the pt feels worse and suffers needlessly. I do have problems with nurses who say, "so and so wants his pain med again"........well damn, he's only been waiting for hrs for it and why are you telling me this(often at report)instead of giving him his medication??
This is a touchy subject for me, but I refuse to let a pt suffer. If the doctor ordered pain meds for them, well then it's our job to assess our pt's pain and then treat it.


Just my opinion,

JUDE

[sanakruz]

Working in psych I have seen plenty of drug seekers. Usually it's benzos-Highly addictive and really just bandaid threapy for anxiety.( Anxiety can be a symptom of depression also, which carloladybell experienced).
My take on this- Something is " psychic-ly " wrong with this pt. Many individuals equate suffering with pain- but it's not the same thing.Pills=control over anxiety. Anxiety = suffering (not that I doubt this) Or- "Im suffering since my accident; my whole life changed in a minute. Now I 've got to have relief!"
We cant not identify this if we are to provide care for someone with drug seeking behavior.
I believe the key is to educate the individual about the addiction process in a supportive way. No one is a bad or weak person for wanting relief.
That said -It's really trying to work with someone in the throws of addiction!!!

[dianthe1013]

I have worked in a retail pharmacy. I've seen people who tried to refill a Rx for #120 Vicodin 5/500 (1q4-6h) after three days. I've encountered people who said, "Hold the NSAID, give me the narcotic." While sans lab jacket, I've heard teenaged patients in the pharmacy parking lot chat about how they needed more C-II Rx's so they could make more money at school. Hell, I've seen people come in with forged Rx's who were so high/negligent that they couldn't be arsed to spell "Tylox" correctly!

And it made me spitting angry. I'm non-PC enough to admit that.

Then again, I have felt what was, to me, the worst pain imaginable. When I broke my coccyx, yes, I gratefully accepted that Vicodin and Skelaxin cocktail. I couldn't have made it without those drugs - literally. Unfortunately, when my doctor gave me a follow-up Rx for Darvocet, I only took it the first day, because it made me have auditory hallucinations. Talk about scary as hell. I was too frightened after that to go back to taking anything stronger, so I took Tylenol. It was hard, I'll say that; I wouldn't do it to a patient of mine.

There are people who want drugs for legitimate relief. There are those who have various other needs, physical, mental, or monetary. I do find it a bit fairy-tale-ish to not admit to the existence of drug-abusing seekers.

Unfortunately, the whole thing reminds me of those IBM commercials with the imaginary, magical products. "There are no magic business beans." There aren't any goggles we can put on and say, "A-ha! I see now this man has no pain! He just wants morphine for the buzz!"

So everyone gets treated at their word. At least by most.

Donna

[sandyth]

While I did my preceptorship in the ER, the veteran nurses that worked there would point out the drug- seekers. They knew these people by name and "they would be allergic to everything under the sun; except Stadol and Morphine" Go figure. They visited the ER like every 2 days.

[krisssy]

I don't like the term "Drug Seekers". If a person is chemically dependent, that person is just as sick as a person who has any other painful medical disease. Chemical dependency can kill, so it is just as serious as any disease. So why would a sick person with a drug problem not be treated with just as much warmth, caring and compassion as we treat all other diseases. Because they have a choice? Maybe they haven't learned that they have a choice yet or how to cope with their disease yet. I don't believe that nurses are there to make judgements on addicts or anyone for any reason. A sick person is a sick person no matter what their disease. There is no such thing as a "drug seeker". There is a thing called a human being who is sick calling out to the nursing and medical profession to help him or her. What would happen if a nurse threw a "drug seeker" out of the ED because he was just "seeking drugs" and then he walked out on the street and overdosed. Isn't that the same thing as turning away a person with stomach pain who goes out onto the stereet and the appendix bursts and peritinitis sets in and he dies? Let's treat all sick people equally and get rid of the term "drug seeker"


Please note a 2 year gap in the posts on this thread.

[krisssy]

l.rae what would be so bad if you called in a social worker and tried to get the "Drug Seekers" help for their own disease of ADDICTION. Did you ever go through opiate addiction and experience the pain physically and psychologically these people feel. Whether they were initially given it from the streets or if they were in real pain and put on it, the withdrawal is horrible, and these people have a right to medical care just like anyone else.

[Patma]

Originally Posted by Sylvia

This is a tough issue. I agree that drug-seeking patients are in the minority and that we don't have a right to decide another person is not in pain. In nursing school, they teach you that "pain is whatever the patient says it is". Unfortunately, it's not that simple.

There IS such a thing as a drug-seeking patient and as nurses we need to use our assessment skills as well as our instincts and common sense or we risk doing a great disservice to those entrusted in our care.

I remember one patient who complained of horrible, agonizing pain for seven or eight months after his hip fracture had healed. He was on Vicodin and a morphine patch and still he reported pain. No one could find any physiological reason for his pain and he reported that all non-drug methods of pain relief (and believe me, we tried them all) were ineffective.

I reported and documented my findings and I spoke to his doctor no less than six times about what I felt was a drug problem. So did the other nurses, and we all continued to medicate him as ordered.

Finally, the doctor stopped ordering the pain medicine and put him on Methadone. Shortly thereafter, he overdosed on cocaine.

Maybe nothing could have helped this patient but I wish we had all been more aggressive about what we damn well knew was a drug problem and less concerned about appearing "judgemental".

If I've offended anyone with this post I am sorry, but I had to say what I feel.

I just had to respond to this post because you mentioned cocaine.

Today, when I was visiting my PM Doctor for my monthly visit, we sometimes get to talking about drug seekers and the like. I've been his patient now for over 18 years and have had nine cervical and lumbar surgeries during that time, but not all of them by him. The damage was from a birth defect and I have lived with it all of my life, but the last three years have been the worst. I was able to work for 31 years and retired when my health got so bad with chronic pain.

As in all cases of pain managment, a patient must sign a contract, must only use one pharmacy, must only receive narcotics from one Doctor, and must submit to a UA upon request, which has never been a problem. I follow my agreement with him exactly as written. He has never asked me for a UA and I told him I had to go by and get some bloodwork done for another Doctor and would he like me to have a UA done at the same time. He said to me if I had given him any indication that I was lying to him or violating my contract, he would have ordered one a long time ago....that remark made me feel trusted and respected.

I am 51 years old now, and my Doctor told me that some of his patients are my age and older who violate their contracts by using illegal drugs such as cocaine when they have not taken their legal meds as ordered and have run out, which of course throws them into withdrawal. My point is, where in God's name do Senior citizens get illegal drugs like cocaine? I would have no idea where to even go for something like that and besides I would be scared half to death of being arrested or worse dead from taking that crap. I mean we are talking about 50 and 60 year old men and women.

I asked him how he knew which ones to look out for and he said they are the ones who always "lose" their prescriptions, their teenage kids stole them, they left their medicine at the cabin up north while on vacation, someone stole their purse with the scripts inside, ask for early refills constantly from the Doctor's office, go to ER's all over town, or the pharmacist has called him and said a particular patient was always coming in early for refills and havings fits when they are told NO!

So, I would think if these particular patients end up in an ER and the ER staff call their Doctor, he could easily advise them of that patients's status with his office and the ER Nurse would know then for sure if they were seeking or not.

I would like to know if a patient presents themselves to the ER seeking drugs and are in full withdrawal, is that dangerous if they are not treated? I mean Patients that are on 600mg. of Oxycontin daily and with Actiq, Vicodin, etc. for break through pain.

I have met patients that are on unbelievable high dosages of narcotics and I wondered if they could die if they were not treated.