Patient's drug of choice-all of them?

  1. 0
    Repeat drug overdose patients are difficult to treat. We all are probably aware of the complexity of addiction, but one particular patient we have baffles me. Drug of choice-any of them. Over-the-counter, street, prescription, you name it. It seems like this person feels bad and if one pill for a particular symptom works ok, twenty are better.

    Were I a prescriber, I'd be very hesitant to give this person anything at all due to the liability, but a provider can't really leave them untreated either. What do you think?

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  2. Poll: Would you recommend meds of any type for a patient that repeatedly overdoses?

    • Yes

      50.00% 8
    • No

      50.00% 8
    16 Votes
  3. 16 Comments...

  4. 2
    Personally, I think that they should treat the patient with appropriate meds, but only fill 3-4 days worth at a time.
    michelle126 and prettyinblu like this.
  5. 1
    *edited because I'm an idiot*
    xtxrn likes this.
  6. 2
    If at least one medical surgical nurse could be on shift at the psychiatric units, maybe THAT is where these patients could be after they get out of the ICU. Repeated medical treatment for the chronic OD'rs usually doesn't help their real problem, addiction. Until of course, they have become so brain damaged they can't seek drugs anymore and have to live their lives as a little child.
    I think that is a good idea, send them away with scripts for only a couple days, and send them away with a PCP and or psychiatric appointment already made.
    What're ya gonna do? If they say they are in pain, we have to pretend they are and give them the meds until they score as dangerously obtunded on the pain flow sheet.
    Not_A_Hat_Person and xtxrn like this.
  7. 0
    That's what's weird, though, it's not just your typical drugs of abuse. The key problem is anxiety for this person. They think, "I'm stressed, my blood pressure is high, better take 20 of my propanalol.". It's like that with any symptom when this person is stressed out-cold medicine, anything. Just to treat the anxiety.

    With narc addicts, our clinic manages them on a weekly basis for their meds. A week worth of anxiety med (non narcotic) would still kill this person.
  8. 1
    The most common OD I've seen thus far is from acetaminophen and antidepressants
    TheOracle likes this.
  9. 2
    Quote from opossum
    The most common OD I've seen thus far is from acetaminophen and antidepressants
    And those are SO lethal..... Saw several of the APAP teen girls = and one did die; liver crapped out.

    The real addicts are going to OD d/t being gorked before the needle comes out of their arm, and topping it off. The "anything in the medicine cabinet" drama -screamers are going to find something to end their suffering over the 15 year old boy who dumped them

    True junkies- 72 hour holds in detox beds (harm to self or others).

    Dramatic teenage girls (and a few boys), need a life, not drugs. IMO. Inpatient psych for their happy butts- in case there is something going on that she/he won't disclose.

    Someone with acute pain - refer to pain management with a 3 day supply (and have some sort of arrangement with a specific pain management doc w/ED.... get in within 3 days. If they KEEP missing appointments, and come back for a refill, NO).

    But w/poll question- not a yes/no--depends on situation and actual risk/drug being considered.
    elthia and nightengalegoddess like this.
  10. 1
    Quote from opossum
    The most common OD I've seen thus far is from acetaminophen and antidepressants
    I think (correct me if I put the wrong words in their mouth) the OP is talking about ODing on meds that you would not think of as meds someone would use to try and OD. The OP gave the example of a beta blocker...not exactly the type of drug a "thrill seeker" would take too many just for the fun of it (like a pain killer). Also, if they wanted to OD for the sake of harming themselves, I would think they could buy those drugs at the pharmacy (APAP, etc.). Anyway, I would think the doctor would have to treat the condition (hypertenson, for example) or they would need psychiatric help if the are unable to have the Rx. and have the risk of taking all the pills.
    JeneraterRN likes this.
  11. 8
    I would say that if a person is repeatedly overdosing on medications due to anxiety, then their anxiety is not being adequately addressed.

    I think we, as a society, do a terrible job at managing mental illness. I think that someone as you describe needs a great deal of support and supervision, but the resources just aren't there.

    It's sad, really.

    I think that as things are in this day and age, the prescriber is really between a rock and a hard place.

    I can't answer the poll question because I really think it is more complex than a simple yes or no.
  12. 1
    Quote from psu_213
    I think (correct me if I put the wrong words in their mouth) the OP is talking about ODing on meds that you would not think of as meds someone would use to try and OD. The OP gave the example of a beta blocker...not exactly the type of drug a "thrill seeker" would take too many just for the fun of it (like a pain killer). Also, if they wanted to OD for the sake of harming themselves, I would think they could buy those drugs at the pharmacy (APAP, etc.). Anyway, I would think the doctor would have to treat the condition (hypertenson, for example) or they would need psychiatric help if the are unable to have the Rx. and have the risk of taking all the pills.
    Precisely. This person's anxiety has been so difficult to treat because of this behavior. This person somehow believes that pills of any kind are the answer. I've personally been in on her care for three OD's and I haven't been there that long nor am I there all the time.
    xtxrn likes this.


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