Drug seeking patients? - page 2

What do people think about the term drug-seeking patients? I guess I have a hard time with it because usually these people are complaining of pain and who are we to judge whether they are or are not... Read More

  1. by   duckie
    As a newly licensed nurse, many years ago, I remember a young woman that was admitted to the hospital I was working at. This young lady(in her 20's) had Lupus and multiple other health concerns. She watched the clock and timed it perfectly for when she could have her pain meds. I remember the RN on duty always making nasty comments. (I'm not picking on RN's, but she was the only one that could give the injections at that time) This nurse would always say something like, "She can wait, she's not in that much pain." This young lady died within a week or so of admission. Yes she was a frequent admit and she did call for her meds as soon as they were available to her, but from the fact that this little lady had so many problems, and remembering the uncaring remarks I heard said, I always consider pain to be what is stated, as I cannot see inside their mind or feel what they feel. I remember this nurse being very upset once this young woman died and it DID make a difference in how she cared for others from that point on.( she was a very good nurse from the beginning it's just that she made a judgement in her mind) I have had residents that I felt called for pain meds, not because they were in pain but for the fear of pain, but since the meds were ordered, I gave them as ordered but when I have had true concern, I have asked the MD to evaluate for another medication that could be more effective. It's hard not to have human thoughts but I will never forget this young girl, and she influences the way I react.
  2. by   mustangsheba
    This will continue to be a problem long after we have joined Flo on the other side. It is especially hard if we have loved ones that suffer from addiction or untreated pain. Drug abusers tend to be treated punitively at times when it is appropriate to treat their pain aggressively just because they have a history. Every patient needs to be evaluated and treated based on their immediate needs with followup in the care plan for aberrant behaviors. At least that is my fantasy.
  3. by   jamistlc
    Originally posted by fergus51:
    <STRONG>I think we are horribly arrogant to think that if we (the medical professionals) can not find a reason for someone's pain than it doesn't exist. Just think of all the different conditions that didn't even exist 20 years ago. Diseases like chronic fatigue and fibromyalgia are still mostly mysteries. </STRONG>



    Greetings All Nurses,

    I get mad with that term as a person who has migraine HA's I have heard that said of me and my wife she too has migraines. It took many years of going from Chiropractors, nuerologists and such to discover I have TMJ. There were many times I would go to the hospital after days of a HA with no relief from OTC analgesics and anti inflamintory frugs! I would go and what would they give methergine and a script fot Motin. Yea like it was effective. It was my dentist who finally figured it out and confirmed with a pana xray! He treated my HA's and now I am painfree with episodes down to once twice a year. He treated it with a night gaurd and manipulation of the bite! It works I highly recomend it!

    As far as the term "Drug Seeking Behavior" it is one of those buzz words that really piss me off! Pain is subjective and I thought I was taught All Pain is real regardless of it's origin! To me that means even the person who is addicted is having pain when they say they are having pain! It does not mean only if you can find a physical cause! Even Psychosomatic pain is real ask any amputee about phantom pain!

    I think that if someone comes into your ER and is drug seeking you should think about what I just said and it is better than them self medicating it themselves!

    Drug seeking is a label that we healthcare providers use to label someone and labels lead to discrimination, are judgemental, and do not help the client. It gives us a sense of wellbeing, a supierority complex, and an out for not treating the pain or person how holistic is that?
  4. by   fergus51
    Originally posted by moonshadeau:
    If you reread my post again you will see I did not say that "ALL nurses cold cruel and uncaring". I said I have seen patients pain being ignored by nurses who are cold cruel and uncaring. I am a nurse so please do not lecture me about perpetuating the bad rap that I myself have. (I am not trying to be snotty or anything, I just think you didn't read what I wrote).
    ps
    It wasn't only one particular nurse. I have seen many and I will not apologize for calling them (not you and every other nurse) what they are.

    And Fergus, not all nurses are cruel, cold and uncaring and that is an unjust remark. You should have said that PARTICULAR nurse was uncaring. I take offense to your remark and you are only further perpetuating the bad rap that nurse have by your generalization![/QB]
  5. by   fergus51
    If you reread my post again you will see I did not say that "ALL nurses cold cruel and uncaring". I said I have seen patients pain being ignored by nurses who are cold cruel and uncaring. I am a nurse so please do not lecture me about perpetuating the bad rap that I myself have. (I am not trying to be snotty or anything, I just think you didn't read what I wrote).
    ps
    It wasn't only one particular nurse. I have seen many and I will not apologize for calling them (not you and every other nurse) what they are.

    Originally posted by moonshadeau
    And Fergus, not all nurses are cruel, cold and uncaring and that is an unjust remark. You should have said that PARTICULAR nurse was uncaring. I take offense to your remark and you are only further perpetuating the bad rap that nurse have by your generalization![/QB][/QUOTE]
  6. by   Kris10lnC
    HI butter,
    I've never worked anywhere except LTC, but there are nurses who have that "she can wait" attitude, Or other nurses say "it's all in her head". I find that medicating patients promptly cuts down on anxiety, and you'll find they don't hang on the bell an hour before they're due. My feeling is that if they're 90 and they say they have pain, they have pain PERIOD. But of course that's LTC.Maybe try offering Tylenol first? or watching them swallow meds? or see if your hospital would institute a policy for crushing those meds that can be crushed . (nother nurse posted that patients were taking their drugs to the street for sale)
  7. by   MollyJ
    I wanted to post once more before this topic dies a natural death.

    It is as important for a nurse to have an index of suspicion for addiction as a patient problem as it is for him/her to have an index of suspicion for atypical presentation of MI, aortic aneurysm, brain bleeds, ectopic pregnancy and all of those other problems that sometimes present subtly and look like many other things.

    That does not mean that we respond to bell lights and point the finger of suspicion and say things like, "You don't need/deserve this drug."

    Clearly, the first thing someone with an acute or chronic pain process needs when they are starting to make too many people uncomfortable about their pain med usage is a reevaluation of their pain management regimen THAT INCLUDES THEM. Are the right tools being used? Do we need to look at adjuncts? are their co-factors?

    How many of us would know how to differently manage our client's pain IF they DID tell us they had had a narcotics abuse/addiction in the past and wanted good pain relief but didn't want to go "back there"? Would it be "Toradol for you" or would we talk options with the client.

    We live in a very pro-pharmacological intervention environment in our world and in our practice environments. I am appalled when I see so many CHILDREN on 2, 3 and 4 psychotropic drug therapy regimens. Do not fool yourself into thinking that use of controlled substances without careful thought around the issues is always going to be cost-free. That is counter-intuitive to all we know.

    Let's be really fundamental about this. HOw many of you have worked with impaired nurses and been the case finder? I have worked with more than one and was never the case finder. I never even had a suspicion. That's wrong folks. We've got to get better at thinking about these issues or we will miss a problem that destroys lives and benefits from treatment as surely as early case finding of MI and those other phenomena I listed earlier.

    I believe (as do many in the addictions field) that our nursing ed in this area is relatively incomplete. I witness an awful lot of black and white thinking in the area. ie, ALL drug seekers are addicts. If a person says they have pain, I should give the prescribed regimen, no questions asked. Those are both polar statements and bound to "miss something" over time.

    Again, nurses need to learn more about the PROCESS of intervention in order to thoughtfully examine some of the issues that this thread has addressed.
  8. by   TopazStone
    I have medicated patients q4h for cancer pain, I have snowed patients, I have advocated for stronger pain meds, but I feel that the term "drug-seeker" is valid. I have an elderly patient who greets me with "Hi honey! Can I have my pain pill?" I have watched her outside, walking fine, begging for cigs; when she sees me, she hunches over and shuffles. She is unable to rate or describe her pain-- when asked, she takes a long time to decide on the site and how it feels. This woman also suffers from constipation and frequent falls-- wonder why? (Darvocet q4-6h PRN). She goes to one of our local "pill pushers" that will prescribe 6 NSAIDs, pain killers and ASA . . . Yes, she is an abuser, but the doc won't change her to a non-addictive pain med.
  9. by   Ellen in Ont
    I agree that we should be aware of the possibility of addiction in patients who constantly ask for pain medication. This has never stopped me from treating all requests for pain meds as legitimate, only allowed me to use my assessment skills in dealing with pain. Pain is one of my priorities and I treat it aggressively. However, I have seen a few cases where I believe they were misrepresenting their symptoms in order to get the meds. I work in an ICU/CCU and only last month we had a patient admitted with chest pain. He watched TV, read, joked with family etc when he didn't think we were looking. As soon as he saw us approaching his room, he turned off the TV, hid the book, stopped talking to family etc and started rubbing his chest and looking distressed. There were no change in his vitals, no ECG or enzyme changes. After treating his pain aggressively for about three days with IV Morphine, Nitro gtt etc.with no change in his complaints, the doctor ordered the IV Morphine changed to Tylenol #3. When I told the patient this, he became very angry, refused the Tylenol #3, stated he had "better stuff than that at home", also said "why didn't you tell me that the doctor was going to D/C the Morphine this afternoon - I've wasted hours here", and signed himself out. I still aggressively treat all complaints of pain but I also use my assessment skills to assess other reasons for frequent requests for narcotics.
  10. by   fergus51
    I just have to say that I don't know how I can determine if someone is genuinely a drug seeker. Behavior like joking or walking around doesn't mean someone doesn't have pain. I had back injuries from a car accident and that is how I coped with my pain and stress. I think we tend to believe that unless someone is grimacing and staying in bed all day they aren't in pain. It forces patients to act like that if they want their pain treated. Then they look like phonies and can be labelled drug seekers. I just don't know the answer to this problem...
  11. by   mustangsheba
    If you knew the answer Fergus, you would be standing before some committee on the Hill. This is an enormous problem. I will continue to treat pain aggressively. However, I would notice if a patient such as Ellen describes and talk to him about his behavior. However, outside of substance abuse treatment centers, the addiction that has been most prevalent in my experience is ETOH. Personally, I don't care if my LOL's are addicted as long as they are comfortable and the drug isn't causing falls. I have seen too many others who couldn't move and were depressed because no one addressed their pain. With pain relief, their quality of life improved immeasurably. As has been mentioned before and is a true story, bottom line is individual assessment.
  12. by   majic65
    Just a couple of thoughts on this HARD issue. the first--we should all know that pain meds are more effective when they are given on a regular schedule, rather than PRN--especially post-op pain. So the pt. who asks for her meds on time is in fact helping us medicate her properly.
    Second--has anyone else had patients who appeared to be drug users in the "outside world" who needed pain meds? I have,and I have also seen my peers refuse these patients meds, "because they are probably already addicted" or some other nonsense. In fact, a patient who has/is abusing drugs often needs more pain meds because of increased tolerance. In short, pain in pain and our goal as nurses is to help the patient cope with all the ways the disease system is affecting his life--and pain is a big part of that. Who are we to judge what hurts???
  13. by   mustangsheba
    Amen, Majic!

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