When Your Patient is an Addict...How to Deal - page 2

Jake is very sociable, and has a lot of …colorful friends who visit him in the hospital. He’s quite likable, because he’s intelligent, funny and clever. He’s not bad-looking, but at 35, his lifestyle... Read More

  1. by   SobreRN
    I've encountered 'Jakes' admitted with absurd things who would come right out and tell me they were Heroin addicts so I pushed it fast & did not dilute. Really I saw no rationale for doing it any other way, policy didn't dictate otherwise and all those 'Jakes' have a ton of tolerance. When I worked acute care the 'Jakes' thought I was the next best thing to sliced bread and at end of day dealing with them was much easier when they just got what they wanted.
  2. by   Avid reader
    Nutella, spread the insight today. Well said. Excellent response
  3. by   SobreRN
    They have tolerance; I flush it really fast, after all we are in the untenable position of making everyone happy all of the time so if I can make them happy by getting them high so be it. I don't work in acute care any longer but this is way down the list of reason why...
  4. by   twinmommy+2
    I once had a patient who was a frequent visitor, that was blind from uncontrolled diabetes. She had a watch that had an alarm that vibrated, and she set the time for every two hours so she would know when her PRN pain meds were due. As nurses we have to make a decision that their addiction is not our problem, we medicate per orders in a safe manner and go home at the end of the day. Our patients who have addiction problems do experience pain, and at a greater level than those who are not addicted. We can have conversations with our providers about how they are treating their patients for pain. It's good to have that conversation.
  5. by   not.done.yet
    It isn't always "addicts" either. I had a lady of advanced age who was in for a chronically recurring problem. She always requested Dilaudid be the narc prescribed from the hospitalist and, at this particular hospital, they always obliged. She would call for it on the dot of when it was allowed to be given again. On the day she was to discharge I spoke with her about switching to oral hydrocodone so we could be sure her pain would be controlled after leaving. She raised her brows and informed me that she didn't take pain meds at home but when in the hospital she "let herself have the Dilaudid". Apparently it was a little treat she allowed herself to compensate for having to be hospitalized. That was eye opening!
  6. by   Rocknurse
    Quote from SobreRN
    I find it odd anyone has such issues over other folks addiction; hubris and judgement although the author appears to recognize some of it. I've held a personal theory for some time that the nurses' who react in a strong & negative manner have past or current issues with an addict and/or alcoholic much closer to home than the patient (i.e. untreated AlAnon.)
    The reaction is just out of proportion to the situation, I don't see nurses carry on that an NPO patient thinks they are 'starving' 2 hours into NPO status and really, I would not say people who cannot go 2 hours without thinking about food have a healthy relationship with food.
    Repulsed? That is extreme although when I was in acute care I did find myself mildly annoyed by everyone saying pain was 11/10 but they are addicts and addiction is a disease...I actually have more respect for street drug addicts and just go to their connection rather than exploiting overcrowded ERs and playing that it is not an addiction if the nurses pushes it; at the end of the day if it is safe to give and it is ordered I just don't care if they want to get high, I am not their 12-step sponsor.

    This. People are way over complicating this and getting all judgmenty. Keep it simple. Is the med ordered? Is the med due? Bingo. Do it. Move on. Not your circus, not your monkey.
  7. by   BostonFNP
    Quote from Lev <3
    I have dealt with many "Jakes" and I will dilute their pain medicine and push it over the recommended minutes.
    Do you do this for all your patients requiring pain medication of just the ones you assume are "drug seekers"?

    Quote from russianbear
    Drug seekers are a drain. They drain resources.
    The elderly and people suffering from terminal cancer are a drain on healthcare resources too. Should we just stop treating them too? Just withhold their pain meds or cut off all care?

    Quote from Rocknurse
    This. People are way over complicating this and getting all judgmenty. Keep it simple. Is the med ordered? Is the med due? Bingo. Do it. Move on. Not your circus, not your monkey.
    Exactly. Withholding post-op pain meds because of an unqualified diagnosis not only is discrimination but may actually lead to increased costs are poorer outcomes. The periop period is not the appropriate time/place to "cure" someone of their addiction.
  8. by   russianbear
    Quote from Rocknurse
    This. People are way over complicating this and getting all judgmenty. Keep it simple. Is the med ordered? Is the med due? Bingo. Do it. Move on. Not your circus, not your monkey.
    And there are no risks involved with never questioning an order?
  9. by   russianbear
    Quote from BostonFNP

    The elderly and people suffering from terminal cancer are a drain on healthcare resources too. Should we just stop treating them too? Just withhold their pain meds or cut off all care?
    Sonif soneone is admitted for [insert diagnosis] and he is a coke addict we should supply him with a steady dose of cocaine? We should provide alcoholics a shot and a beer every two hours? Crystal meth PRN?
  10. by   SobreRN
    I find it odd anyone has such issues over other folks addiction; hubris and judgement although the author appears to recognize some of it. I've held a personal theory for some time that the nurses' who react in a strong & negative manner have past or current issues with an addict and/or alcoholic much closer to home than the patient (i.e. untreated AlAnon.)
    The reaction is just out of proportion to the situation, I don't see nurses carry on that an NPO patient thinks they are 'starving' 2 hours into NPO status and really, I would not say people who cannot go 2 hours without thinking about food have a healthy relationship with food.
    Repulsed? That is extreme although when I was in acute care I did find myself mildly annoyed by everyone saying pain was 11/10 but they are addicts and addiction is a disease...I actually have more respect for street drug addicts and just go to their connection rather than exploiting overcrowded ERs and playing that it is not an addiction if the nurses pushes it; at the end of the day if it is safe to give and it is ordered I just don't care if they want to get high, I am not their 12-step sponsor.
  11. by   SobreRN
    There is a rationale for pain meds. Coke & Meth don't do anything for pain.
  12. by   BostonFNP
    Quote from russianbear
    Sonif soneone is admitted for [insert diagnosis] and he is a coke addict we should supply him with a steady dose of cocaine? We should provide alcoholics a shot and a beer every two hours? Crystal meth PRN?
    Cocaine and crystal meth are illicit substances that are far outside the standard of care for treating post-operative pain. While there is perhaps an argument for letting alcoholics have a small amount of alcohol to prevent DTs rather than CIWA protocol, it doesn't apply here either.

    I am not sure if this was a serious question or just a red herring, but getting back to addiction being a drain on resources. What is there to do about it? Do you think that holding dilaudid after an appy is going to cure the addiction?
  13. by   smf0903
    I have never quite grasped the thought process behind holding/rationing pain meds for an addict when they are in hospital for some acute process which results in pain. We have a lot of addicts (heroin is a HUGE issue in our area, one of the highest rates per capita in our state) that come to us for whatever reason. Cutting someone open will result in pain whether you're an addict or not. Acute bouts of pancreatitis result in pain whether you're an addict or not. The only difference is that an addict may require higher doses of pain meds to control/cut through the pain.

    These are my issues: The patient who shows up religiously every three days in ED for pain. Said patient is with pain management. Patient knows darn good and well we will not go outside the parameters of the pain management contract. Same patient knows that #1, "chest pain" gets them to the front of the line in ED, and #2, no matter who they demand to see (all the way up to hospital president) they will not get any pain meds outside of their pain management contract. But they try every. single. time. and waste the time of RNs, supervisors, etc.

    My other issue is the patient who decides to bring their illicit drugs to the hospital and shoot up in their room when no one is in there. Or you remove a patient's socks and needles and baggies fall out. Or flip a pillow and have a syringe with God knows what go flying across the bed. I'll admit it pisses me off to no end to walk into a room to find a patient gray and not breathing because they took something.

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