Drug seeking patients?

[butter]

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 in pain. On the other hand, though, they are usually patients who are hospitalized frequently but may not have any medical reason to be there besides pain. What are your thoughts?

[nurse T]

I just went to a seminar called 'Pain, The fifth vital sign'. Put on by VA. Due to JCAHO 2000 revised standards for pain assess and management. It was reported that hospital ER's will be expected to relieve pain immediately rather than waiting for assessment to be completed. Through research, JCAHO discovered severe health problems resulting from unrelieved pain. Too lengthy to write here but as ex: Severe acute pain is a major risk factor for chronic neuropathic pain,, unrelived acute herpes zoster pain WILL develope post herpetic neuralgia 6months to 9years later unless pt recieves aggressive analgesic TX in the acute phase. Also pts with more severe pain before amputation are at greater risk for more severe phantom limb pain, can be avoided with preop epidural blockade. I work in hospice and must teach pts pain management: take meds routinely to prevent pain from getting out of control, it's too difficult to play catch up if pain is already too severe. I find many of my pts with chronc pain have already discovered this on their own however have done so without the benefit of nurse education. This results in pts scrambling to take whatever they can get their hands on without the knowledge of the medication's expected effects, onset, duration etc. This would appear to other professionals as drug seeking behavior, I call it pain relief seeking behavior. Many physicians are in a hurry to meet JCAHO standards and prescribe without assessing the duration, quality and intensity of the pain. Nerve type pain will not be relieved with opioids, some antideppressants such as elavil and antiepileptics such as neurontin have proven to be very effective at nerve pain relief. We changed our nursing assessment form to include all aspects of pain in the vital sign section for all pts, not just hospice.

[P_RN, ADN, RN]

I totally agree about the meperidine. We had one guy sieze in the bathroom, hit his head on the sink and had a cva as a result.

Another time we had a patient who went into status from meperidine and died!

Both were SSC patients and both were patients of the same doc. He then started using dilaudid. No bad effects that I can remember, except having to give 5 or 6 amps at a time. The straight push into the central line of demerol gives a "rush" you don't get from many other narcotics. I'm sure that's why some ask for it that way.

The docs would usually leave the IV fluids on the total admission time (usually about a week) mainly to help the nurses but also to avoid any excess heparin from flushing so often.

P

[Fgr8Out]

Margo McCaffery, speaking at a conference on Pain Management, said words to this effect: The term "drug seeking" is derrogatory, has no clinical definition, implies lying on the part of the patient seeking pain relief and puts Nursing in an adversarial position with their Patient.

Definitely NOT a place we as nurses want to be.

In addition, McCaffery stated the following: Say you have a headache, or a toothach, or you smashed your finger with a hammer, or you have some undefined ache and you're looking for Tylenol or Motrin or some medication to treat it. You're "Drug Seeking". ANYONE experiencing pain... and this is pain as defined BY THE PERSON EXPERIENCING THE PAIN, as NO ONE ELSE can define anothers pain... deserves to be believed. To believe anything less is tantamount to calling that person a liar. Our responsibilities as nurses do not include this sort of behavior.

You may have your suspicions about patients and their complaints of pain. But very often, we as nurses FORCE patients into assuming behaviors that they think they need to exhibit, in order to receive proper pain management.

When someone says they have pain... THAT is the bottom line. And from my perspective, so long as that individual is tolerating the medication, with a mininum of side effects and maintains an appropriate level of sedation, as well as adequate respirations... I will continue to medicated them as indicated on their orders. The patients generally progress better, are more in agreement with the rest of their treatments (i.e. walking, coughing, using their incentive spirometer), and are less anxious and restless because they know that their primary need for proper analgesia will be met.

Peace:)

[Heartsofangels]

This sure is a tough one. I have a pt with a spinal infarct, so she can't feel or move her legs. She is constantly c/o pain. She receives a med every 4 hours now. It was PRN. She was tough b/c some of us thought she really wasn't in that much pain and some did. It was hard to tell with her. If she asked me for her med I would give it to her if she was due. Recently we found out she has a kidney stone. So she's always in pain. I feel if a pt is c/o pain I am not to judge them and say they're not. I don't want to see anyone become addicted to pain meds either. We usually try to figure out the source of the pain and take it from there.

[shannonRN, BSN, RN]

~"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. "fergus51

~"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???"majic65

i don't think i could have worded it better. i totally agree with you both! :wink2:

suzannasue, unfortunately i understand where you are coming from on the "sprain" issue. in high school, i sprained my ankle. well, it turned into a fairly common injury since i was on the dance team. all of my team members thought i was lazy and just wanted to sit out of practice. i saw multiple doctors and they all ignored my pain and discomfort. when i went to nursing school (4 years later), i learned what an mri was...i decided to find a doc who would let me have one done. i couldn't handle an eight hour shift, and i couldn't imagine not doing bedside nursing. i needed to know what was wrong with my ankle. long story short, i had to have ankle reconstruction surgery (pebble size pieces of fibula in my ankle joint, no ligaments left, and tendons that were 2x the normal size due to chronic inflammation)! i owe my doctor tons....the pain has almost disappeared. :kiss

my experience taught me that it is unfair to judge someone's perception of pain.

[teeituptom, BSN, RN]

Howdy Yalll

from deep in the heart of texas

Drug seeking patients are a pain in the ass, but look back at what has made them this way. We see all these drug seekers come into the ER, but the easiest way to deal with them and avoid complaints and arguments is just to give them a shot and a script and say good night yall. Now I dont agree with this. But if your er or doctors office is being slammed with patients sometimes its just easier to take the path of less resistance.

keep it in the short grass yall

teeituptom

[YukonSean]

I become somewhat frustrated when we on the list turn into apologists. The expression "drug seeking behaviour" describes just that: patients who come into the hospital looking for drugs. Psychiatric and Emerg nurses must know that we are not talking about people with chronic conditions. In fact, if one is suffering from a terminal cancer, for example, what difference does it make if the patient develops opiate addiction?

Genuine drug seekers are those who come in looking for a fix. Have you seen someone diagnosed with cocaine dependence, polydrug abuse, and personality disorder, who malingers in order to obtain narcotics? This is where the problem lies.

More often than not, the drug seeker is a frequent flyer in your Ambulatory Care centre. As I have stated before on this network, I am a strong advocate of managing chemical dependence and Axis II presentations as outpatients, with shared care plans, that allow even locum physicians to maintain continuity of care.

To say that it is "just easier" to placate drug seekers is unethical, not to mention dangerous (from both the physiologic, and liability, points of view).

[Lulu]

Think of it this way: someone is c/o pain indirectly related to a painful stimuli that has become resistant to most usual doses of pain meds. So they need more, more often than normal.

[caroladybelle, BSN, RN]

As on Oncology nurse, I have to accept the patient's report of pain in most instances. However, I have a sister (paranoid schizophrenia/bipolar disorder) who abuses drugs. So I see both ends of the spectrum.

I would rather that my patient with a pain causing disorder be able to get proper pain relief than be more restrictive, to prevent pain meds getting to drug abusers. One of the things that I have learned over the years, is that a drug abuser will find drugs no matter what, while the honest patient will just end up suffering. Also, I have had many patients with cancer (especially vietnam vets, that saw the effects of opiate use in the orient) that will do anything not to use "Demon Morphine" because they don't want to seem weak or be painted as a druggie. The constant pain impairs their ability to function, eat and enjoy what life that they have left.

However, I have also had patients who used their disease to use the max pain meds, push the staffs' boundaries and buttons. After giving the max narcs/sedation, I have walked in to find them snorting cocaine/using amphetamines. It gets very aggravating.

One thing that isn't addressed, is drug seeking of other meds. The little old lady that destroys their bowel function w/inappropriate laxative use, or who wants a refillable antibiotic script for "the sniffles", or people who abuse synthroid/insulin to lose weight, people who abuse inhalers or steroids for the resultant high. In Florida, cardiac meds have been stolen/diverted-use of procardia increases the high received from stimulants. Misuse of antibotics ENDANGERS EVERYONE by the proliferation of antibiotic resistant microbes into the population - but I don't see that making the same headlines as oxycodone abuse. :confused:

[coleen]

I am replying to this post because it brings alot of suffering to mind. I worked in Urgent Care and they had an index box - in it were the names of people who they considered to be drug seekers - some were called over by other clinics or pharms but most were put in there due to the PA or NP's judgement on a first time visit and some were considered drug seekers because they had a family member who's name was in the box! I know this box was illegal but it was their bible. Many times when they would look at the incoming schedule and see H/A or back pain - they would go running to the box. If a person didn't look well to do or had a beard or teeth missing - they were definately drug seeking! I am a recovering substance abuser and I cannot honestly say what should be done - but I know this - if a system for pharmacies were set up by computer I would have gotten help long before I did - and these pain clinics need to have their patients tested for compliance if they are giving out oxycontin like it's candy. I became physically addicted, built up huge tolerance and yes when I went to ER - I WAS IN TREMENDOUS PAIN - physical withdrawl off of opiates is the worst pain you can imagine. I now have good sobriety and plenty of clean time but I feel like I'm treated differently now by Dr.'s. Even a sore throat turns into a psych diagnosis. As soon as they see recovering addict in the chart - all their listening skills go out the window and you are still that awful "Drug Seeker" I recently had major surgery without any pain meds in recovery room or after -my choice. It's better to give it while pt is being monitored than not to give it and risk causing severe trauma. I hate when I sit down in report and the nurse before reports off - "The Darvoset Queen" needed a pill at 5 or So and SO is getting a little too fond of that morphine - So when I get on shift they are all in severe pain!! They are all over 90 - give them pain meds if it makes their life a little easier!

[l.rae]

QUOTE]Originally posted by nurs4kids

I am shocked by those of you who think the term "drug seeking" is invalid!

Big AMEN sister!!!!!! I work in the ER and if we dolled out narcs to everyone just because they asked there would be a perpetual line out our waiting room doors. For the most part we err on the side of caution especially if there is any hx of dx that could be causing pain. Generally, they get toradol or nubaine maybe some phenergan and are sent on their way with a rx for about 6-12 pain pills to get them thru till a DR's appt. I think this is very generous.. However, when they present to the ER telling you up front what drug thsy want,. what they don't want, when they get so mad when I bring Toradol in that they are yelling and swearing and calling me names...when they refuse to even try the toradol or nubain.....when they can tell me how many mg are in the syringe by eyeballing it.....when they present to the ER so many times I know their hx by heart, YET they NEVER follow up with their PMD.......and on and on and on......Yes Virginia......there really are drug seekers......and they must be addressed for the safety of the patient as well as the staff! HOW IS OFFERING SOMEONE TORADOL OR NUBAINE COLD OR CRUEL? I don't get it.......LR

[OBNURSEHEATHER]

Originally posted by l.rae

Yes Virginia......there really are drug seekers..... [/b]

:rotfl:

Heather