[butter]

What do people think about the term drug-seeking patients? I guess I have a hard time with it because usually these people are complaining of pain and who are we to judge whether they are or are not in pain. On the other hand, though, they are usually patients who are hospitalized frequently but may not have any medical reason to be there besides pain. What are your thoughts?

[fergus51]

I think we are horribly arrogant to think that if we (the medical professionals) can not find a reason for someone's pain than it doesn't exist. Just think of all the different conditions that didn't even exist 20 years ago. Diseases like chronic fatigue and fibromyalgia are still mostly mysteries.

I realize there are genuine drug seekers out there, but the term is used much too often. I knew a nurse who was convinced that anyone who asked for something for post-op pain was a drug seeker. Wait until she has her hip fractured and replaced! I am much more concerned for the people whose pain is not adequately treated because of our moral judgements.

Pain has long been my pet peeve. I have seen people in pain asking for help and being ignored by uncaring jaded nurses who should've retired years ago. My friend's mother was in the hospital for pain control using a PCA (because of terminal lung cancer) and her IV went interstitial. Instead of changing it the nurse left it for the day shift to do. My friend's mother went for over 2 hours without any pain control. I just don't understand how people (nurses) can be so cold and uncaring. Wait until they have pain without a "medical reason".

ps
pain is a medical reason to be hospitalized.

[Huganurse]

What are the standards and criteria for diagnosis for "drug seeking patients" ??
How do we solve this problem of determining who is and who isn't a drug seeking patient.

[kona2]

Often pts whose pain is not being adequately relieved will watch the clock, and then ask for their next dose of prn pain med as soon as it can be given. Many nurses and docs interpret this as "drug seeking," b/c the pt is asking about pain meds freq. I find that any pt w/ a past hx of drug abuse often gets labeled as "drug seeking" even if they have legitimate c/o pain!!! It is VERY frustrating.

[cmggriff]

When someone invents a machine that can monitor pain like a cardiac monitor monitors heart rhythms, I'll stop believeing the patients. Until then, if it says it hurts, I takes its word.

[MollyJ]

Drug seeking happens, but I cannot say that I think of it happening in new post ops. I guess I think drug seeking is a little like pornography: most of us are hard pressed to define it, but we've met some situations where we might have felt that we were giving meds for other than pain relief.

To me, drug seeking issues don't strictly and always and only mean questioning whether a person's pain is legit. Since drug seekers can be nurses, the drug seeking issue encompasses adhering to narcotics control procedures and having an index of suspicion when alot of drug errors occur around one nurse. It means viewing that patient who gets pain rx's from 3 or 4 docs as a case management concern. That person needs and deserves a cohesive pain control program driven by one doc.

It means offering that person that cuts themselves and puts blood in their UA to mimic a kidney stone treatment as an option...and having real treatment options.

At times Kids and sometimes their parents DO sell their prescription Ritalin for profit. Ditto for Lortab and a host of other chemicals.

None of us like distrusting our clients and NONE of us like directly confronting our concerns, but it is part of the professional role. NONE of us should do confrontation alone. For inpatients, it should be a team that includes the patient and real listening should occur. For professionals, it should be supervisors plus some colleagues (with careful attention to confidentiality). For outpatients, they should be given an opportunity to work with a case manager. But ALL of us should have an index of suspicion for drug seeking concerns or else we will miss offering TREATMENT AS AN OPTION, be it improved main management modalities or addiction treatment.

Things are rarely black and white.

[mustangsheba]

I would rather err on the side of giving a "drug seeker" drugs than not medicate pain adequately. The percentage of drug seekers is miniscule. Why do the many have to suffer for the transgressions of the few? Many drug seekers have legitimate pain that has never been adequately treated. I refuse to police my patients. Our guidelines state we need to keep pain at a 3 or less. If a patient reports pain consistently greater than a 5, I call the doctor. My job is to assess and treat pain, not to try and second guess about motivation.

[moonshadeau]

I know of at least two people that we drug seekers that I have cared for. One was always looking for some kind of drug any kind of drug. He would literally throw himself to the ground on a daily basis(I have seen him do this, just like a little kid would with a temper tantrum) and then have to go through the whole routine of Xray and ER etc. I know that he was really seeking one day he told me "My hemmoroids have ruptured, I need something for pain". I asked him if he was bleeding. He said no, I know that they just ruptured. Another woman came in to the ER and just didn't look right. She complained of constant unrelenting pain. Then she would turn and converse like there wasn't a care in the world. I became really suspicious when I noted that she had been bouncing between different facilities in the area with the same complaints. She did admit to drug seeking.

So I guess my point is that there are drug seekers out there, but mostly you have to treat everyone like they have the pain that they say they do. Some people manifest their mental pain as physical.

And Fergus, not all nurses are cruel, cold and uncaring and that is an unjust remark. You should have said that PARTICULAR nurse was uncaring. I take offense to your remark and you are only further perpetuating the bad rap that nurse have by your generalization!

[Huganurse]

Oxycodone:
In 1995 there was 1 death and 12 confiscations in the county I live in. In 1998 there were 17 deaths and 26 confiscations. Last year in 2000 there were 43 deaths and 73 confiscations.

Need more? The number of prescriptions of oxycodone increased from 316,000 in 1996 to 5.8 million prescriptions in 2000!!

Oxycontin has a street value of $40 - $80. each pill in our area.

This is a problem far greater than the problem of treating patients for chronic pain.

[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.