Drug Seeking Behaviors?

[JLN1129]

Okay, here's the problem.

I recently began nursing school. I previously was a waitress, and severly injured my back. This was (is) a worker's comp. injury, and the proper tests were not done to determine the extent of the injury. Although my doctor has told me this will never heal, and I will most likely be in some form of pain, moderate to severe, for my entire life, he has classified this injury as a sprain.

I can not get relief for this pain. I am on diclofenac 75mg and skelaxen 400mg, along with an untold amount of Motrin.

I have been to the emergency room several times, complaining of the same problem. They, of course, have labelled me as "drug-seeking", and each time I leave the ER with a rx for Naprosyn.

Is there any possible way to change the ER staff's opinion of me? Although, yes, I am a drug-seeking patient, I am seeking these medications for a legitimate reason...

I am so frustrated. I don't work at all right now, and I am so depressed by all of this that I find it difficult to just go to classes, let alone do the huge amount of work required of me. I desprately need help here.

[zenman]

My "BS" meter cranks up when someone says that "it will never heal." You have a lot of other avenues to explore, unfortunately you have to do most of the work. Check out this site for a start http://www.egoscue.com I recommend his books as the exercises are gentle and effective. Bodywork is also a plus; I've seen patients get much better with a few minutes of bodywork after they have had every kind of workup possible.

[mattsmom81]

My "BS" meter cranks up when someone says that "it will never heal." You have a lot of other avenues to explore, unfortunately you have to do most of the work. Check out this site for a start http://www.egoscue.com I recommend his books as the exercises are gentle and effective. Bodywork is also a plus; I've seen patients get much better with a few minutes of bodywork after they have had every kind of workup possible.

You are right, Randy, and the only reason I am still working as a nurse after two fusion operations to my spine is because I have been diligent on educating myself to keep myself and my body healthier. Physical therapy is so important. I've also stayed in nursing areas that cause less stress to my spine than general floorwork .

Howevery if my back was hurting, my priority would be to find out why and what I could do about it. Ignoring pain is not wise except in a few special circumstances, IMO. Getting into a physically demanding career is not necessarily the wisest first move right now for the OP, IMO. Finding out what's wrong and how to manage the problem would be my primary goal.

One must first get through those trying times of the stress and demands of nursing school before they can find those 'less physical' nursing positions.

So most of the responses here are reality based, IMO.

I hope the OP finds out what is causing the pain and wish him/her luck in managing it. I know from personal experience this is not always an easy task.

[BlueTang]

Recommend you seek help from a specialized pain control center; training courses I've attended reveal many alternative, under-utilized. and effective strategies.

[TCJan]

Question....I am a LPN, have been for many moons. I had a male patient who takes scheduled Methadone 50mg q.12hrs. He also has Percocet 5/235 and Motrin ordered, q 4hrs. As a new nurse on the unit, the guy asks me a half hour after I gave him his Methadone for a Percocet. I noticed that he was sitting in his chair bobbing his head in a stupor high soon after gving him his methadone, when he came to ask me for a Percocet. I have run across this before and have always called the doctor about it before giving it as long as I have an order to give it that closely,I'm covered, but I"m not going to do it if the order just reads q 4hrs. and the patient figures well I can get really high now if I take them together. I see this only in male patients with male doctors too, never would a male doctor give a woman all the drugs they want. Am I wrong in practicing nursing this way? Also, this is a nursing home and they have med/tech's giving the meds at times, not all the time I guess. Even the med/tech understood what I was questioning , she said he asks her for it too but she gives him tylenol, But, my preceptor that day wrote me up for what she said , he went and asked her if she would give it and she blamed me for not giving it and wrote me up for causing mental angish to the patient. She was also a nurse of 25yrs who was helping me give my am insulins and started to draw up Lantus(which is rarely given in the day time, couldn't figure that one out either) and Humolog in the same syringe, I stopped her and said, you can't mix those, she said well their clear to clear.....I said yes they are but they can't be mixed, it says so in the Drug Book, she said, well they never taught us that in school. I asked when she was trained and then told her Lantus has only been out for around 6 years I think. She said,well I"ve been doing it for long time and no one has died! Then, she at the end of the day after I spoke with NP who came in about this patients pain meds , she got nervous, the NP says well the guy just asked me to prescribe him a beer with his meals and cuz he is on Methadone, I said no, but she had seen many patients be on all kinds of narcotics at once, I said, yah if they are on Hospice or have cancer, but this guy is a amputee. She said call the pain med doctor he is the one prescribing for him.

I then turned around and saw this incident report that the preceptor had written me up on.....and I was in shock, I gave it to the NP and told her I can't believe this nurse writing me up on trying to do the right thing. She couldn't either. Near the end of the shift I told the preceptor and the scheduler that I was not coming back.....they didn't care. They are doing so many things wrong in that facility it would take a month to write all of it up. I think this nursing profession has gotten so corrupt that its hard for us who were raised in ethics and professionalism and morals to figure out how to function in such frustration and dysfunction anymore. And yes its us ole timers who get bullied and ganged up by slip shod greedy DON's and Adminstrators and their followers..........why don't we bombard our congressman and State Boards to clean this profession up for the health and safety of the patients????

[wayunderpaid]

This is long, brace yourself....

OP, just a few suggestions. Sorry this is pretty straight forward and sounds like non-caring. It is not. I am very sensitive with pain. I have some experience working with cancer patients, some of whom experience the worst pain possible, in the mist of an impending death. It is just that I know the way things are in the ED where I work and how nurses who work there have been jaded by years of experience of drug seeking patients.

1- You will not change the way others think. Whether they think you are drug seeking or not is not important. What you think about yourself matters more.

2- Perhaps you chose the ER because you felt it was the easiest route to control your chronic pain. The reality is that this is the medium a lot of people who are addicted to painkillers use. So you have to understand that nurses caring for people who come through the doors have heard all kinds of excuses from all kinds of people as to why they need narcotics.

3- As many people pointed out in previous posts, nursing is a career which involves a lot of lifting, turning, walking, and standing. Certainly, after clinical experience it is possible to have a non-clinical job, but those jobs usually require several years of experience. I urge you to completely examine yourself regarding this matter. I work with people who call out all the time because of different reasons. This often places a heavy burden on the rest of the co-workers, especially if no other nurses are found to replace the one who called out. You must understand that whether you have back pain or not, patients have to be cared for regardless. It is a cold harsh fact, but if you don't think you can be consistent with a schedule due to your pain, you should reconsider this career move (I would encourage to finish schooling however, as you try to find answers to your chronic pain).

So, here are my recommendations:

1- Stop using the ER for chronic pain. The ER is not the place for you to get treatment. First of all, you don't get treated well, you have been labeled, and most of all, the ER cannot provide you with the continuity of treatment that you need.

2- Follow the advice of a previous post, and hire someone to represent you. Sometimes just a phone call from an someone with a title who ends in Esq can move workers comp/insurance companies to do things you never thought possible.

3- Change doctors. If you have to use the ER for pain control, he/she is obviously not being capable of treating you. He/she either has labeled you as well, or does not have the kind treatment philosophy that you yourself are seeking through another medium (meaning the ER).

4- Get a second opinion. This means taking control of your own healthcare. Just because someone said this is permanent, it does not mean that they are right. Please find a good specialist who can properly understand your problem and follow a treatment path that can get you better.

5- Finally, if you think that you might be truly addicted to painkillers (I am not saying that, I am simply saying that you should make that call, if this is happening), you should get help. First for your pain, then for your addiction, if this is the case.

I truly hope that you can find a great and positive resolution to your pain and your career aspirations. Mighty possible you'd make a great nurse!

Wayunderpaid

[KarenGeorgeBSRN]

Good Morning!

Unfortunately this is wrong. You can continue to titrate up on LA medication as the client's tolerance increases. Tolerance and addiction are not the same and it is anticipated or expected that a client who is on opioid therapy will evolve tolerance; proper PM allows to titrate aggressively to reach a level of comfort in order QOL is attained.

I am running a bit late and did post on several of the "drug seeking pain topics this morning" however, WC has to treat your pain and our levels for determining chronic are below six months at this point; some are considered chronic at two. I agree with all here that a PM specialist is in order but as one of my other topic replies has shown for I have done a pain network for 10 years now; the DEA is closing down many good physicians; it is a political statement antagoistic to scientific knowledge and data in regards to the proper treatment of NIP.

Have a great day!

Karen G.

[KarenGeorgeBSRN]

Hi there,

Clients on Methadone typically are drowsy after taking their dosage; that does not mean they are "high" and if the physician wrote the order for 4 hours on the fast acting you do need to give it to the client if he asks. There was no medical contraindication you noted such as lowered respirations, or a diastolic less than 60; we cannot make value judgements on others it is not effective nor ethical practice.

Have a great day!

Karen G.

Question....I am a LPN, have been for many moons. I had a male patient who takes scheduled Methadone 50mg q.12hrs. He also has Percocet 5/235 and Motrin ordered, q 4hrs. As a new nurse on the unit, the guy asks me a half hour after I gave him his Methadone for a Percocet. I noticed that he was sitting in his chair bobbing his head in a stupor high soon after gving him his methadone, when he came to ask me for a Percocet. I have run across this before and have always called the doctor about it before giving it as long as I have an order to give it that closely,I'm covered, but I"m not going to do it if the order just reads q 4hrs. and the patient figures well I can get really high now if I take them together. I see this only in male patients with male doctors too, never would a male doctor give a woman all the drugs they want. Am I wrong in practicing nursing this way? Also, this is a nursing home and they have med/tech's giving the meds at times, not all the time I guess. Even the med/tech understood what I was questioning , she said he asks her for it too but she gives him tylenol, But, my preceptor that day wrote me up for what she said , he went and asked her if she would give it and she blamed me for not giving it and wrote me up for causing mental angish to the patient. She was also a nurse of 25yrs who was helping me give my am insulins and started to draw up Lantus(which is rarely given in the day time, couldn't figure that one out either) and Humolog in the same syringe, I stopped her and said, you can't mix those, she said well their clear to clear.....I said yes they are but they can't be mixed, it says so in the Drug Book, she said, well they never taught us that in school. I asked when she was trained and then told her Lantus has only been out for around 6 years I think. She said,well I"ve been doing it for long time and no one has died! Then, she at the end of the day after I spoke with NP who came in about this patients pain meds , she got nervous, the NP says well the guy just asked me to prescribe him a beer with his meals and cuz he is on Methadone, I said no, but she had seen many patients be on all kinds of narcotics at once, I said, yah if they are on Hospice or have cancer, but this guy is a amputee. She said call the pain med doctor he is the one prescribing for him.

I then turned around and saw this incident report that the preceptor had written me up on.....and I was in shock, I gave it to the NP and told her I can't believe this nurse writing me up on trying to do the right thing. She couldn't either. Near the end of the shift I told the preceptor and the scheduler that I was not coming back.....they didn't care. They are doing so many things wrong in that facility it would take a month to write all of it up. I think this nursing profession has gotten so corrupt that its hard for us who were raised in ethics and professionalism and morals to figure out how to function in such frustration and dysfunction anymore. And yes its us ole timers who get bullied and ganged up by slip shod greedy DON's and Adminstrators and their followers..........why don't we bombard our congressman and State Boards to clean this profession up for the health and safety of the patients????

[nanacarol]

First, don't sell your self out of a career in nursing. There are so many areas of nursing that do not require lifting 75#. It may be unrealistic for you to expect to be a bedside nurse but there is there area of Informatics, telephonic nursing, case management, to name a few. Now as for pain control, FIND a NEW PCP, workers comp or not, your health is your responsibility, find a physician who will hear you and provide for your needs. nanacarol