Drug seekers

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I'm sure this has been posted before and I would appreciate any links to good threads on the topic. I am a new nurse and struggle with giving strong opiates like Dilaudid, etc to people who are clearly pain seeking. I feel dirty. Yesterday I had a gentleman who was ordered 1mg Q6. He was a clock watcher. As soon as that six hours was up, he was on the light. The reason he was getting this is because during the previous shift he threw such a fit yelling, screaming etc to have it the physician ordered it. Looking through his history, this is his pattern. Usually in the ER he yells and screams and demands IV Dilaudid. In this country there are a lot of people addicted to opiates because they are often over prescribed and these types of things feeds into that. As a nurse, one of our responsibilities is to encourage health and I feel more like I am contributing to a societal problem than helping a patient in situations such as this.

I don't want this to be a "pain is what the patient says it is" argument. I am talking about the rare instances where someone is clearly a drug-seeker.

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Specializes in Critical Care.

I don't think anyone is "pain seeking". Most hospital patients are "drug seeking", people with a heart failure exacerbation come seeking lasix, people having an MI come seeking nitro, morphine, etc. People seeking pain control are not necessarily intending to abuse the drug. I find people who assume someone is a drug abuser because they are a "clock watcher" to be a red flag. IV dilaudid has an effective duration of about 2-4 hours, so if it's ordered q 6hr any patient, regardless of whether or not they are seeking to abuse the drug or using it appropriately, will likely be asking for it when it's due since it's long since worn off by then. Was he admitted solely for the purpose of giving him dilaudid?

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I don't think anyone is "pain seeking". Most hospital patients are "drug seeking", people with a heart failure exacerbation come seeking lasix, people having an MI come seeking nitro, morphine, etc. People seeking pain control are not necessarily intending to abuse the drug. I find people who assume someone is a drug abuser because they are a "clock watcher" to be a red flag. IV dilaudid has an effective duration of about 2-4 hours, so if it's ordered q 6hr any patient, regardless of whether or not they are seeking to abuse the drug or using it appropriately, will likely be asking for it when it's due since it's long since worn off by then. Was he admitted solely for the purpose of giving him dilaudid?

I mistyped, I meant to type "drug-seeking." So, a person who is sitting in bed, on the phone, laughing, BP is great, HR is great, snacking on chips is truly experiencing 10/10 pain. Doesn't add up to me I guess. This particular patient has a history, based on his physician notes, of "numerable admissions complaining of vague pain, then becoming angry demanding IV Dilaudid." He is a non-compliant in his medication regime for diabetes, does not take his HIV meds, etc. This admission was for chest pain. All markers were negative, etc. Not only was he getting Dilaudid, he was getting Percocet along with it. Administered together.

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Specializes in ORTHO, PCU, ED.

If you're only having to give him IV Dilaudid Q6H you are so fortunate as many of my pts get it ordered Q1H PRN. And let me tell you, if it's ordered and they claim to have pain and have decent blood pressure and are easily arousable with good O2 sats you pretty much don't have a choice but to give it to 'em. Sad but true. It's hard. I know. It makes you want to scream. But it's called PATIENT SATISFACTION.

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Specializes in Critical Care.

I think that's more of failure the admitting and previous physicians. This is what pain contracts are for, particularly if they have had "numerous admissions complaining of vague pain", they should get worked up for an actual source of pain, including cardiac, and after that they only get opiates for confirmable pain sources. Otherwise I would just give it as ordered so long as there are no contraindications, that will cause far less grief for than trying to fight it.

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Specializes in Oncology.

I hear you, OP. I know you feel like you are contributing to a problem. That may be. However, you are but an insignificant part of this patient's life. By fighting the system of giving his pain medication as ordered, it causes a lot more stress on you and guess what? If the patient is truly addicted, you are not going to "cure" them of their addiction by withholding or delaying a dose. You are powerless over another person's addiction. You can't fix it. So might as well give those pain meds and move on with your life. You can mention it to the prescribing doctor if you wish, but likely the doctor is already aware and feel their hands are tied as well. Malpractice, patient satisfaction, etc. When or if the patient wants to get help, they will seek it. Sometimes they have to hit a rock bottom first. Others never seek sobriety. Either way, not your problem. Might want to head over to the recovery forum and look around. There is a lot of good info there.

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Specializes in psych, addictions, hospice, education.

You're not going to fix the patient by not giving what the doctor prescribed, during a short hospital stay. Actually, you're not going to fix the patient at all. That's up to the patient. Addiction is a huge bear to fight. Someone who is addicted to painkillers has true, extreme pain when his or her medication wears off. It's not up to us to decide now is the time to fight it, or to say "tough cookies--you're drug-seeking and I'm not falling for your shenanigans" whether that's the case or not. If the patient is in extreme pain, of course he is drug-seeking. I'd be drug-seeking too, if there was a drug that I knew would help.

Fight the battles you might win.

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Specializes in ED; Med Surg.

I found out a long time ago that dumping the judgement makes your life a lot easier. Sure some of them are drug seeking and you know it. But others here are right when they say you can't fix it. If their vitals are ok and they are alert I give them what is ordered. And that dosage isn't a lot--most of mine get 2 mg every 2 hours or even 1 hour.

What you CAN do is to push it very...very...very slowly.

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Specializes in PDN; Burn; Phone triage.

I sometimes wonder what the efficacy of al-anon meetings would be to nurses who struggle with caring for possibly addicted and/or drug seeking patients.

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Specializes in Med-Surg.

I don't find dilaudid 1mg IV along with Percocet being all that alarming.

By six hours the dilaudid has long worn off. He probably has a tolerance built up also, requiring more frequent and stronger medication to achieve adequate pain relief.

If you suspect a patient is truly drug seeking, you can't change them. It's not worth exhausting your emotional bank worrying about it. Give what's ordered, as long as the patient is stable, and go on with your shift.

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Specializes in ICU.

In my opinion if you are working in acute care, you give the medication as requested if it falls within the alloted time and safe hemodynamically wise. You shouldnt feel "dirty", or that you are contributing to their addiction. Sure they are probably addicted, we see them all the time, but you know what, you are not there to change them at this moment in time. You are not there to rehab them. That is between the patient and the doctor. You can discuss concerns with the doctor, and they may decide to adress it further with the patient, wean the dose etc, but its not on you to "help" this person stay way from narcotics just because they are clock watchers over your 12 hr shift and you will probably never see this patient again. And they have built up a tolerance to these medications. yes its their own fault if they abuse drugs, but that doesnt mean their pain isnt real. But this admit is not the time for you to interject your bias.

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Specializes in ICU, LTACH, Internal Medicine.

It is not even a question of being judgemental or not for me, just strictly practical matter:

- is the pt clinically stable without obvious signs of pain or whatever he claims it to be (yes/no)? (if no, then I have other things to worry about)

- is situation warrants call/referral, by policy and/or common sense? (yes/no, in yes included known h/o addiction, "chronic postops", cancer, some chronic wounds, broken bones, etc., if they do not have established plan and pain management on board already)

- if yes, whether he is seeking drugs for getting high or not, can I REALLY do something at all THIS SHIFT? (yes/no)

- does the patient/family indicated they are feeling kinda uncomfortable with "getting sumethin' for ma' pain" a bit way too often? (yes/no, and, yes, some of them are concerned about addiction)

- additional point: do I want to get in trouble today (yes/no):roflmao:

If I got "yes" on 3 or 4, I may consider closer assessment, maybe some education, call pain management, explaining our tactics we use on opioid weaning, teach non-pharmacological techniques, etc. I work LTACH, so we have time to figure things out. We almost never see quick dose escalation unless it is cancer or something clearly terminal, and some patients got weaned from high dose, IV or being on clock. Otherwise, it was not me who made them addicted, and also not me who enables them to continue (that's provider), and also not me who will be able to cure their addiction (that's up to them and for the Lord). I am here to support them in more or less functional condition so that they hopefully might get better, and if they need their endorphine receptors artificially stimulated for that, it is fine with me.

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