When Your Patient is an Addict...How to Deal - page 4

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 assure you, addicts know we are judged harshly, we are not stupid although perception seems to be given healthcare providers make certain their disdain is obvious. I have been clean and sober since 1989, no opiates and, except for one time, I never went to a hospital for anything just for this reason.
    Ended up in an ER once; the doctor hated addicts as did nurse; they really wanted me to know this; I never would have gone to a hospital for help of any sort for this reason. Congratulations, your message gets across.
    Last edit by SobreRN on Mar 17
  2. by   not.done.yet
    Quote from KatieMI
    First, it is a classical example of not ADDICTION, but ABUSE (i.e. using substance with a purpose other than assumed therapeutic action). Second, you have no idea what this elderly lady occupies herself once out of acute care. Plenty of them sit forewer in their PCP offices or shop around in search of more scripts.
    It was a story. I know what she told me and I believed her. I did not call her an addict OR an abuser. Her printout from the pharmacy listed no narcs. Texas has a centralized system to check if people are prescription shopping. Is it perfect? No. However, I had no reason to doubt this woman.

    It will not take you looking far into my posting history to see that I am a big proponent of caring for the marginalized and protecting the right of addicts to get good pain control, as all of us should be. It was a story. End of story.
  3. by   russianbear
    Quote from Rocknurse
    Why would you need to question a legitimate order? I am assuming it would be because you are trying to imprint your own feelings/agenda on to it. Personal bias and judgment are not reasons to question an order.
    How many people do you know personally who have died because of an epidemic that we play a role in? How high are your deductibles and premiums because of waste? If it affects me, I'll speak up, thank you.
  4. by   russianbear
    Quote from BostonFNP
    Under what parameters are you questioning the order? Is the patient somnolent, delirious, bradypneic? Or do you just not think the patient has enough pain to warrant getting an ordered dose?
    I'll give you an example. I can think of several patients who, the moment the attending sees their name puts in various orders for controlled substances before even knowing why the patient is there. That's how littl of a f*ck some people give about the problem we've caused. So I ask you, just because it's John Doe, we automatically order Dilaudid and Percocet. What is the medical justification for that? Is that prudent?
    Every now and then we get seekers in who don't know we have access to records of other hospitals in our system. The providers rarely check that prior to ordering Dilaudid. Not so they ever check OARS reports. However, when we let the provider know that the patient was in a different hospital the day before exhibiting seeking behaviors, the providers do cancel narc orders.
  5. by   russianbear
    Quote from not.done.yet
    It was a story. I know what she told me and I believed her. I did not call her an addict OR an abuser. Her printout from the pharmacy listed no narcs. Texas has a centralized system to check if people are prescription shopping. Is it perfect? No. However, I had no reason to doubt this woman.

    It will not take you looking far into my posting history to see that I am a big proponent of caring for the marginalized and protecting the right of addicts to get good pain control, as all of us should be. It was a story. End of story.
    The problem this debate always brings up is hat the people on the side of never question narc orders and requests by patients fail to distinguish between cases where pain is legitimate vs seekers. I've never heard anyone advocate for holding meds nor questioning administering pin meds to post op patients, patients with cancer, trauma, etc. The animosity comes from the people who come to he ER with vague complaints, not verified by diagnostics, and yell and scream and threaten until they get what they want and do this frequently because they know eventually the docs will give in as opposed to telling them they will not prescribe them controlled substances th do not have a need for.
  6. by   BostonFNP
    Quote from russianbear
    I'll give you an example. I can think of several patients who, the moment the attending sees their name puts in various orders for controlled substances before even knowing why the patient is there. So I ask you, just because it's John Doe, we automatically order Dilaudid and Percocet. What is the medical justification for that? Is that prudent?
    That's a really complex issue, why is John Doe being admitted and/or what is John Doe's history? To be honest, I don't know many providers that just order inappropriate narcotics, especially for those that are labeled as frequent flyers or seekers. I have a few patients that have addiction issues that I admit on a monthly basis or so and those are the ones I am the most stringent with, as I know their history. I would be very surprised if narcs were being ordered without some sort of medical justification. That is malpractice and unethical.


    Quote from russianbear
    That's how littl of a f*ck some people give about the problem we've caused.
    I see the ravages of the opioid-abuse crisis every day in clinic: it is one of the most difficult parts of my job. That being said, I still believe that all patients deserve to have access to a standard of care following major surgery. I also believe that the acute care setting is not the place to "cure" addiction.
  7. by   russianbear
    Quote from BostonFNP
    That's a really complex issue, why is John Doe being admitted and/or what is John Doe's history? To be honest, I don't know many providers that just order inappropriate narcotics, especially for those that are labeled as frequent flyers or seekers. I have a few patients that have addiction issues that I admit on a monthly basis or so and those are the ones I am the most stringent with, as I know their history. I would be very surprised if narcs were being ordered without some sort of medical justification. That is malpractice and unethical.




    I see the ravages of the opioid-abuse crisis every day in clinic: it is one of the most difficult parts of my job. That being said, I still believe that all patients deserve to have access to a standard of care following major surgery. I also believe that the acute care setting is not the place to "cure" addiction.
    Again, I am trying to distinguish between people with medical issues versus those who do not.
  8. by   heron
    Quote from russianbear
    Again, I am trying to distinguish between people with medical issues versus those who do not.
    So, how do you deal with people who have both medical and addiction issues? This is the point that PPs are trying to make, I think. It's not a strict either/or algorithm. Which issue gets prioritized?
  9. by   BostonFNP
    Quote from russianbear
    Again, I am trying to distinguish between people with medical issues versus those who do not.
    If you have the education, experience, facility privileges, and scope to determine that it's a different argument than not giving a post-op patient pain medication as the attending nurse because you personally feel the patient should get it (for whatever reason).
  10. by   russianbear
    Quote from BostonFNP
    If you have the education, experience, facility privileges, and scope to determine that it's a different argument than not giving a post-op patient pain medication as the attending nurse because you personally feel the patient should get it (for whatever reason).
    Id love to work in the hospitals you people work in where you never get people in the ED with vague pains, not confirmed by any diagnostics, demanding IV dilaudid. Same people who test positive for opiates in them (often other drugs), are difficult to get an iV in due to track marks, and repeat this behavior with frequency. Must be nice.
  11. by   EaglesWings21
    I would never treat my patient with disrespect for the simple fact that they are an addict. I know many addicts. My own father is an alcoholic and had a short opioid addiction after shoulder surgery. I do think that the way we treat pain is broken. The magic word for pain treatment is not always dilaudid and narcotics aren't always appropriate. It is disheartening when we try to use our knowledge to care for our patients the best way we know how only to be yelled at by the patients and frowned on my management because our HCAHPs weren't up to par.
  12. by   heron
    Quote from russianbear
    Id love to work in the hospitals you people work in where you never get people in the ED with vague pains, not confirmed by any diagnostics, demanding IV dilaudid. Same people who test positive for opiates in them (often other drugs), are difficult to get an iV in due to track marks, and repeat this behavior with frequency. Must be nice.
    Oh, please ... can the drama for a minute and try to understand that no one has claimed that addicts don't try to get over, especially in the ED. What we are tryng to explain is that righteous indignation, while lots of fun, is no excuse for sloppy, inappropriate care.
  13. by   russianbear
    Quote from heron
    Oh, please ... can the drama for a minute and try to understand that no one has claimed that addicts don't try to get over, especially in the ED. What we are tryng to explain is that righteous indignation, while lots of fun, is no excuse for sloppy, inappropriate care.
    Please show me where I've advocated inappropriate care. I, however, do not agree that enabling addicts is appropriate care. If a person's sole purpose for here ER visit is to get high, and this really does happen, that is not a reason for admission, nor should he providers be prescribing narcotics for them. If they have medical problems, including pain, we treat that. I happen to come from an inner city ER where we do just that. Known seekers have care plans. It reduces a lot of BS.

close