narcotics

Specialties NP

Published

Hello fellow NPs. I have a question for each of you. Do you have to deal with pts that abuse narcotics and how do you deal with them. In the clinic that I work at their are so many pts that are just narcotic seeking. A prime example is, I saw a pt approx 3 wks ago. He actually had scheduled an appointment for abd. pain every time that he eats. When I started assessing him I started having the feeling that his stomach pain was really no that important and really was not a problem because he had been dx with IBS approx 2 yrs prior. So he asked about pain medicine refill, I told him that his doctor (who practices in the same office) had priviously sent his his scripts in, he did not realize this however when I explained this to him, he right then said that he had IBS and he will change his diet at home. I was speechless b/c he just let me know in his own words that he did not actually have a problem afterwards I let him go. That is a typical today. I am so frustrated. I guess it has gotten around that I will no refill the doctor's chronic and acute pain medicine, so today guess what I have no pts assigned to me today.:cry:

Specializes in Advanced Practice, surgery.

We are very lucky we have pain specialist and guidence from an addictions team within easy reach so this type of patient would be referred to both and dealt with by the people who are better able to deal with it.

Specializes in Nephrology, Cardiology, ER, ICU.

I deal with it on a daily basis. In IL, we have just been given schedule II prescribing priveledges but they haven't got the logistics worked out yet. I am very careful about my documentation (even if I have to chart from home) so I keep close contact with my prescribing of narcotics. Also, does your state have a statewide electronic way of checking to see where and what and who is prescribing narcotics for your patients? that has helped us tremendously.

https://www.ilpmp.org

Specializes in Nurse Practitioner/CRNA Pain Mgmt.

Narcotic abuse/misuse is a HUGE problem in this country. Having worked in Pain Management, I've learned to be cautious and have learned how to assess patients who are indeed in REAL pain and those that are "working the system".

My advise to those NPs working in areas other than Pain Management who are faced with patients with opiate needs is to perform a really thorough baseline assessment on the cause of their pain. ESTABLISH a strict and professional AGREEMENT with the patient laying down YOUR rules of how to dispense and take narcotics AND have a RANDOM TOXICOLOGY screening every so often, making sure that your patient is indeed taking prescribed narcotic. AND, if any illicit drugs show up other than what one expects to be present, THEN dismiss that patient from your practice OR substitute NON-OPIATE meds instead.

I had a chronic pain patient confess to me a long time ago, that she only took the necessary opiates, enough to show up on her urine test in the office and that she would SELL the rest to meet her financial needs for the month. She was 73! Needless to say, eventhough her intentions were from financial need to live, it was WRONG! I had to dismiss her from the practice.

This is the SAD reality of today. People desperate for money because they've been laid off work, etc, are turning into one of the easiest illegal market of prescription drugs diversion.

Be careful!

V.

I am new to the field, less than a year expierence and I thought that I would actually be helping people, and well I know that I am. However I have seen nurses just burned out because they are being abused by people who feel that it is there duty to insure that the doctors keep their narcotic supply up to "their standards". Xanax, lortab, percocet, methadone, constantly over and over again. The poor ladies at the front office, the receptionist, they get phone calls constantly, cursed daily by narcotic abusers. I am all for treating people who what is to be thought of as serious pain. I also realize that pain and anxiety is totally subjective, who am I to say that someone is not in pain or is not having acute anxiety. But those who take 90 lortab 10 in 15 days, or those who curse you because they get darvocet and want lortab from the doctor that is abuse that am just tired of receiving. :banghead:

Specializes in Pain Management.

In my office, we are required to run drug screens at least once a year on all our narcotic-using patients, and supposedly governmental regs are suggesting we do it more frequently. Be sure to become familiar with the lab that you use because you will have questions.

For example, we recently discovered that in some patients that have been using oxycodone for long periods, their urine will be clean for the oxycodone but oxymorphone might show up. This has only happened once, but it might happen again...

Specializes in Nephrology, Cardiology, ER, ICU.

I deal with nephrology so many of my patients don't urinate. Here is what I do:

1. If I am the one prescribing narcotics, I'm the only one. I check frequently with the website to ensure they aren't going elsewhere.

2. If I am suspicious about them selling narcotics, I only give liquids: tylenol #3 elixior and lortab elixor, ativan also comes in liquid.

These two steps have helped me tremendously and sets the tone for my relationship with these patients.

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