Ethical delima????calling in or giving meds to drug seekers???

Nurses General Nursing

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i work part time in a family practice office. i work for all providers at one time or another. we have a doc (lets call hime smith) that is famous for giving pain meds. he'll switch them from lortab, to percocet, to methadone, to dilaudid, to whatever. we have a pt that filled her methadone then 2 days later siad they weren't working and he gave dilaudid. orders demerol 150mg im for obvious drug seekers.

the nurses know if the pt complains of pain in the hosp, he doesn't think twice about putting them on a pca. (even had a lap chole on a ms pca. 45 min after d/c of drugs pt felt good enough to leave. go figure!)

we had a surgeon admit a pt under dr. smith's care d/t lortab/percocet abuse post-op with dx of narc. addiction, even though we are not a rehab facility. the pt left with a script for lortab. she had been getting percocet #300 previous to surg.

my question for all of you is.....when does this become an ethical question for me? working in the hospital and/or working in the office. i have told the doc repeatedly my opinion that these are drug seekers and they need help. i have said......"they walked in here and joked around....then needed 150mg of demerol????????" he disagrees, and when he does defend the pt he simply says pain is subjective. uh, yeah, but can't you think for yourself? :uhoh3: i like the doc as person. very interesting company and good conversation, but don't i have a line where i am enabling these drug seeker too???? i might add no nurse at the hospital would let him be their doc. he is scary most of the time...and in difficult cases we know the pt would have a much better chance with another doc.

i have recently heard talk around the office that i might soon be offered a job working full time for this provider..(i'm full time right now med-surg) ethical delima or not....i know it sounds like i've made up my mind....but i would like your imput.

Specializes in Critical Care/ICU.

The doctor is correct. Pain is subjective. Many people need large doses of narcotics to control their pain. Especially if they've been in chronic pain. I'd rather have a doc that listens to me when I say I'm in pain than one who raises the red flag of drug seeker when I walk in the door. (I'm not on pain medicine, just being rhetorical.)

But you know the man, I don't. You work with the patients, I don't.

Ethically, it's a worse offense to undertreat pain. Ethically it's a worse offense not to believe a patient when they state pain.

Not there aren't drug addicts and drug seekers out there. It's a tough call.

Sounds like you've made up your mind already. Good luck in finding a position you're comfortable with.

right on!
Ditto.
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It is the statement about calling in drugs that puzzles me. I did not think you could call narcotic scrips in to pharmacy. I thought everyone had to have written script with no refils.

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Schedule III narcs like Vicodin, T#3, Lortab, etc. can be called in.

Schedule II narcs like Percocet, OxyContin, MS Contin, Dilaudid, etc. require a script. (There are some pharmacies that will accept a faxed script for these meds if they rec. a hard copy w/in the required time frame, but that generally only applies to hospice cases and may vary from state to state.)

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i work part time in a family practice office. i work for all providers at one time or another. we have a doc (lets call hime smith) that is famous for giving pain meds. he'll switch them from lortab, to percocet, to methadone, to dilaudid, to whatever. we have a pt that filled her methadone then 2 days later siad they weren't working and he gave dilaudid. orders demerol 150mg im for obvious drug seekers.

the nurses know if the pt complains of pain in the hosp, he doesn't think twice about putting them on a pca. (even had a lap chole on a ms pca. 45 min after d/c of drugs pt felt good enough to leave. go figure!)

we had a surgeon admit a pt under dr. smith's care d/t lortab/percocet abuse post-op with dx of narc. addiction, even though we are not a rehab facility. the pt left with a script for lortab. she had been getting percocet #300 previous to surg.

my question for all of you is.....when does this become an ethical question for me? working in the hospital and/or working in the office. i have told the doc repeatedly my opinion that these are drug seekers and they need help. i have said......"they walked in here and joked around....then needed 150mg of demerol????????" he disagrees, and when he does defend the pt he simply says pain is subjective. uh, yeah, but can't you think for yourself? :uhoh3: i like the doc as person. very interesting company and good conversation, but don't i have a line where i am enabling these drug seeker too???? i might add no nurse at the hospital would let him be their doc. he is scary most of the time...and in difficult cases we know the pt would have a much better chance with another doc.

i have recently heard talk around the office that i might soon be offered a job working full time for this provider..(i'm full time right now med-surg) ethical delima or not....i know it sounds like i've made up my mind....but i would like your imput.

run away as fast as you can. have you personally ever called any scripts in to a pharmacy for this dr? unless you have the dr signature on a prescription pad that is kept in a chart, he just might say you called in the meds without his knowledge.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
LOL!! :rotfl: Sorry, I couldn't help it, but isn't is Tweety!!

Thanks for the laugh, and I hope you don't mind it being at your expense 3rdShiftGuy!

OMG, I missed that. Yep I'm not a Twitty, I'm Tweety! :rotfl:

Carry on. :)

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Specializes in Emergency.

I don't have any real advice to give you, just a story i have to tell, and how I've learned.

i started my nursing career in a small community ER, and a "known" patient came in for pain and the doc ordered 175 demerol IM, i questioned the order, and was told, "that's what she needs, blah blah", i gave the med and the patient was still stable, and discharged home.

1 month later, this same patient came to my ER via ems for wrecking her car, several duragesic patches on her body, and way more soma gone than shoulda been. this patient ended up a level one trauma, bought a tube, and got lifeflighted out, from what we could tell she was paralyzed from the accident.

I don't know the outcome of this patient, it just made ME see how the medical community "helps" with an addiction. I still feel bad for contributing to her addiction.

Pain IS subjective, and it seems to be an ethical dilemma I deal with everyday in the ER. it seems to me that when one doc starts the addiction, it makes it so that other docs NEED to continue it for pain relief. I mean JACHO is for pain control, so we do what we have to to relieve it.

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OMG, I missed that. Yep I'm not a Twitty, I'm Tweety! :rotfl:

Carry on. :)

You guys are the best! LOL! :rotfl:

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Schedule III narcs like Vicodin, T#3, Lortab, etc. can be called in.

Once again, I thought the rules on above drugs had been tightened up over a year ago.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
......it seems to me that when one doc starts the addiction......

I think also there should be some personal responsibility on the patient's part. The patient you spoke of had to know she wasn't using the meds as prescribed by putting several duragesic patches on her body. I realize the clutches of addiction is strong but and it's not fair to "blame" the patient for the addiction, but it's also not fair to blame the doctor, (Now, I'm not talking about candyman doctor feelgoods like the one's who take payment for supplying drugs to addicts like Rush Limbaugh's doc. Because there are some drug pushing MDs out there.), anymore than it is fair to blame McDonald's for a persons heart disease, or a cigarette company for a patient's COPD.

But you're right, it is an ethical dilmena.

edited: I hope I wasn't sounding too judgemental against the addict. I understand someone in addiction isn't thinking clearly and has a physical/phychological addiction to the narcs.

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Specializes in Home Health Care,LTC.
the doctor is correct. pain is subjective. many people need large doses of narcotics to control their pain. especially if they've been in chronic pain. i'd rather have a doc that listens to me when i say i'm in pain than one who raises the red flag of drug seeker when i walk in the door. (i'm not on pain medicine, just being rhetorical.)

i right now suffer with chronic pain. i do need large doses of pain meds. i try not to take them unless i am in major pain so mostly i just suffer all day long. b/c it is hard to get pain meds.

but you know the dr. and you know what you stand for and what you want and need to do.

good luck to you,

angie

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Specializes in SICU-MICU,Radiology,ER.

I think this is a big dilemma for nurses.

On one hand we are supposed to advocate for the pt no matter our prejudices. We are supposed to tx pain and suffering.

On the other we bear a responsibility to help persons to seek help like recovery.

I was in a situation once were a known addict and seeker was in for a surgery. She did need pain control. This was of course an issue for a few. One of the charge RN's stated that it wasnt our place to debate her addiction, rather it was our obligation to tx her pain. I supported that.

However, in the ER I would be horrified to find that a seeker I treated went out and injured and or killed another perseon.

What to do?

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Your right about addicts in for surgery. I found out from an experience on our med floor. Pt was constantly complaining of pain and finding it hard to get pain meds. She was a chronic abuser to the point you could easily see the track marks and she could tell you exatctly where to get an iv stick. I was never personally her nurse, but if you work on a floor with 20 beds (max) you know what is going on.

Anyway they finally after a couple of days found out what was going on. I know that the nurses who doubted her felt bad. Now in the ER....that's a whole 'nother ballgame.

Thanks for all your great posts and points of view. That's why I came here!

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