I know this post is old but I'm going to add my two cents anyhow. So, when we have a patient who is an addict, we often times find ourselves reluctant to give them pain meds. We tend to say "Oh they're not 10/10 oh they're just drug seeking, they're an addict", etc. We are reluctant to give pain medications to patients because we do not want to be the nurse that lets the patient get high. But, who are we as healthcare providers to decide how somebody is supposed to feel? What it really comes down to is punishment. Most people will argue that statement but it's the trust whether we want to admit it or not. As a society, and even nurses, we have this subconscious urge to punish the addict. We do not want them to get high. Yes, part of it may be because we want to the battle the addiction but we also simply don't want them getting high and continuing with their drug abusing derelict ways. But remember folks, addiction is a disease! We are not God, it is not our right to say how somebody is supposed to feel.
Think about it, the hospital is the SAFEST place in the world for somebody to be under the influence of drugs! They have an army of nurses on their side! If they want a whopping dose of an pain meds and they're paying for it, the doc should order it, the nurse should give it, and the patient should be able to have it. In acute care, we are there to treat the issue that brought them to the hospital. And if they're there because they're having a slipped disc repaired or whatever, we need to treat the slipped disc. We are not addiction experts or professionals. In addition, we should not be scared to give a huge dose. Yes, on a normal person it might kill them and we would all lose our jobs but we're not talking about normal people here, we're talking about IV drug users. So if they're a heroin addict, they can handle exponentially more than you're average Joe.
Something else to think about.... people who are drug addicts are not always faking their pain. Very commonly, after prolonged drug abuse, a person's pain threshold becomes significantly lower. So a little bump that might make a normal person wince, may be incredibly painful for an addict. So when they say they're a 10, they're a 10. We are not to pass judgement.