Drug seeking patients? - page 5
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
May 2, '02~"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.
May 2, '02Howdy 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
May 6, '02I 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 , 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).
May 30, '02Think 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.
May 31, '02As 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.
Jun 8, '02I 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!Last edit by coleen on Jun 8, '02
Jun 8, '02QUOTE]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
Jun 8, '02Originally posted by l.rae
Yes Virginia......there really are drug seekers..... [/B]
Jun 9, '02I'd much rather get it for a migraine than Demerol!
Nubaine has always stopped the pain where as Demerol makes me feel stupid and cranky...and in pain.
Jun 9, '02I have a history of ulcerative colitis - full bowel involvement, per biopsy result - for 13 years. I have very well controlled GI disease w/asacol and holistic treatment. Unfortunately, I do have the erythema nodusem/autoimmune mediated febrile arthralgias at times. As this is an inflammatory problem, the only drugs that will ease the pain are Anti-inflammatory drugs. Unfortunately, virtually all anti-inflammatory pain meds cause GI bleeding and are generally contraindicated in UC.
I have had several MDs order narcs for me (doesn't relieve the pain well but makes me too stoned to care) and wonder why that don't work. There are times that I would kill for some Toradol, but they won't prescribe it for me. Anaphylactically allergic to Tylenol - respiratory arrest. So most of the time, I just stay at home, and take Ibuprofen on my own.
With Demerol, you really have to worry about normeperidine (metabolite) intoxication/overdose? - it can happen after a few doses or after many - it is very insidious and unpredictable. Demerol is not a good drug for pain at all, but I have had plenty-o-docs order for me and other patients.
Jun 19, '02Hello,
This is very long, I'm sorry but it's necessary.
I am new to this BB and this topic really caught my attention because I am a chronic pain patient.
Over the course of the last seven years of chronic, unrelenting, burning neuropathic pain I have been on the butt end of health professional's attitudes regarding treating pain pt's pain.
A little bit about me to understand from where I come.
I was working in a busy NICU/SCN in a local pediatric hospital when I got "pulled" to the transitional care unit(PICU step down). I had been a nurse for 23 yrs when I was injured lifting a patient on the vent- he was only 35 lbs but for whatever reason it caused me to have a neck and rt shoulder injury. The house supervisor told me she would write up the incident but never did. By the time I found out that she hadn't my opportunity to file for WC had expired-30 days in my state.
My doc treated me conservatively with Rx and ice then heat. Eventually, he finally agreed to PT at my insistence because I was getting worse. He gave me Skelaxin and told me to take Ibuprofen for the pain. PT just made me worse by the day and especially when one of them got the bright idea of doing cervical tx. My doc refused to let me off work during this time.
About 3 months after the injury, I began to have color and temp changes in my rt arm and hand(dominant side). The nature of the pain began to change to burning and if anything or anyone touched my arm it would hurt and that sensation wouldn't go away for several hrs only to let up and come back. I was diagnosed with Reflex Sympathetic Dystrophy also now known as Chronic Regional Pain Syndrome.
Several months later as trophic and sudomotor changes continued to worsen I had an EMG/NCV. The temp of my fingertips was 69 degrees and my shoulder was 81 degrees. During this time I was accused of malingering and making it up. The neuro said it was because the room was cold. Doc finally prescribed Darvocet. Didn't help. Was referred to NUMEROUS specialists and given NUMEROUS dx and didn't know whom to believe.In between, I had numerous nerve blocks, epidurals, stellate ganglion, lumbar sympathetic etc. that did not give relief for more than a few HOURS. Finally, saw an OS who was a cervical spine specialist. Had ACDF at C4-5, C5-6 for spondylosis and nerve compression. He sent me to the National Institute for Neurological Disorders and Stroke. I underwent diagnostic testing which basically along with clinical symptoms confirmed my dx. Next had surgery for shoulder decompression and acromioplasty. Was told I had neurogenic thoracic outlet syndrome and would need extensive PT and surgery along with another shoulder decompression. Doc also did a sympathectomy which proved to be a disaster because the pain returned with a vengeance.
I was at the lowest point of my life in excrutiating pain. I suffered nerve damage to my brachial plexus and also phrenic nerve damage so even breathing was difficult.
I also had tachycardia and chest pain during this time. After a cardiac cath I developed a pseudoaneurysm which to this day I believe would have been prevented or discovered sooner if I had not had a nurse who was "pulled"! I was hemorrhaging and underwent a vascular repair 2 days after the cath. During the repair I also had a huge whole in the saphenous vein repaired. Then the doc LIGATED my FEMORAL NERVE. When I woke up I was screaming in unbelievable pain. Guess what??? They BLAMED IT ON ME because "you know, you pain patients feel things worse than most pts."!
Again, 2 days later at my insistence a groin exploration was performed where it was discovered that he had made a bad mistake. He even had the decency to CHARGE ME for the surgery to free up the nerve.
The RSD spread from my abdomen to my toes- internally a Pap and pelvic causes horrible pain- my leg and foot turn blue and are swollen and freezing at times. I have lightening jolts of electrical sensations stabbing me without warning. My clothes are almost intolerable to wear. I've been back to NINDS to participate again in diagnostics and the researcher was also able to make some suggestions regarding meds for the tachycardia and the profuse sweating that is present in episodes numerous times per day. A good day is when I only have to change my clothes 4 times.
I also have Fibromyalgia/CFIDS ( 16 out of 18 positive tender points), Myofascial Pain Syndrome, Postural Orthostatic Tachycardia syndrome, and suspected lupus.
Did I engage in "clock watching?" You damned right I did. It's called pain behavior and it happens when a pain patient is undermedicated! It also happens because most short acting narcotics begin to wear off in 3 hours and most patients realize that it will be a while from the time they ring their call bell until the actual time a nurse comes to their room with their pain medicine and that's IF the nurse is given the message by the person answering the lights/intercom.
Now about Oxycontin and MS Contin. Thank God for those meds. I am now on MS Contin. It allows me to take the Rx on a regular schedule only 2-3 times/day instead of every 3-4 hours. It's easy on the liver. It helps to keep the pain as manageable as possible. Addicts are responsible for their own behavior and will do almost anything to get their drug of choice for the high it causes. Pain patients just want relief from pain.
Do I fear my pain? Yes, I sure as hell do and you would also if you felt like you were on fire- it's now in 3 quadrants of my body. Thank God it is transient in my left arm.
Please don't judge me for my pain. It has come at a HUGE SACRIFICE. I am unable to work at what I loved and dreamed of all my life. I no longer have the income and I do not have Rx insurance because my husband lost his job and I am on Medicare with no Rx benefits. My medicine costs almost $600.00/month OUT OF POCKET. I am unable to do things such as camping, tubing, and all the fun things I used to do. My husband has to cut my meat- yes, even in restaurants.
Our families have had to suffer right along with us and watch us become someone they don't recognize from the toll pain takes on a person. They are immensely relieved when meds such as Oxycontin and MS Contin allows us to go out once in a blue moon.
What have I learned and what do I suggest? Definitely, that Palliative and Hospice care should be taught in nursing and medical schools. Nurses should be taught that if they are going to say something about pain patients or people using pain Rx's- KNOW the difference between PHYSICAL DEPENDENCE, TOLERANCE, and ADDICTION!
Don't try to guess if I'm in pain or if I FEAR it. It is inappropriate for you to guess unless you know for sure or strongly suspect misuse. If you see behavior that causes you to be suspicious then document it and confide in the doc. You demean patients when you automatically suspect them of abuse without reason or evidence. TRUST ME, WE ALREADY FEEL TERRIBLE ABOUT OURSELVES BECAUSE WE HAVE TO TAKE THIS MUCH MEDICINE TO FUNCTION.I would bet that sometimes when nurses think the doc isn't listening to them- that the doc really is ignoring you if you are using the wrong terminology. ADDICTION is absolutely different than PHYSICAL DEPENDENCE.
Clock watching is something all pain patients do until they are on adequate pain management if ever they are. A lot of us are on very large doses of morphine or codeine, methadone, etc. Doses that probably scare you but they make us functional so we can sometimes get out of bed and experience some joy in our lives.
Since pain is now the "5th vital sign" you owe it to your patients to educate yourself as much as possible about pain management and the terms that are used. Schedule an inservice with a pain management physician.
Until I have personally gone through this horrendous experience I was guilty of all the same behavior as some. I think back a long time ago when a doc may have ordered Demerol 50-100mg for a postop patient and that I probably chose the lowest dose because I was opiophobic and terrified of "overdosing" the patient. But, the patient suffered because of my ignorance and naivete.
Most of us are really frightened of what is happening to our bodies. I certainly never thought that I would be in this shape at age 49. Pain meds allow me to hold my grandson for a few minutes.
I'll trade places with anyone who wants to volunteer.
I am not looking for a fight nor do I need one. My purpose in replying is to try to help you see the other side from a fellow RN.
Please do a search on Reflex Sympathetic Dystrophy or Chronic Regional Pain Syndrome if you are unfamiliar with it. You might be the person who someday sees the symptoms in a patient when the doc hasn't been able to.I'm at the point in my life when I will no longer feel that I have to apologize for my pain.
Most of the time you can't see a patient's pain unless you look very closely at things like facial expression, guarding, body language.Just remember if you judge a person harshly about their pain and need for medicine that someday what goes around comes around. I hope you don't ever have to find out the hard way what it feels like to be left in terrible pain without hope for relief because someone doesn't believe you or accuses you of being a drug seeker. Even pain management physicians have a hard time telling with some and they have way more education in the matter than nurses get.
Thank you for allowing me to express my opinion. Again, I apologize for the length.
Jun 19, '02OK, I'm not even going to finish reading all of these posts. I am simply going to (yet again) remark on the primary complaints/concerns nursing seems to have with medicating patients who they feel are "drug seeking" and try to dispel myths and provide education so that those of you who still have this negative mindset can put your little minds at ease.
First, I want to squash the part of this thread in which certain nurse(s) feel Nursing is responsible for deaths attributed to drug overdose, in particular, oxycontin abuse. Drug abuse and death have occurred for centuries, even before Nursing existed. If not oxycontin, then another drug will be utilized. Yes, oxycontin prescriptions have increased but not all of this is due to drug abusers. It's a great drug for it's purpose. Period. Misused, it most certainly can be lethal, as can any narcotic. But again, to imply that Nursing is to be held accountable for any deaths attributed to the "abuse" of this (or any) drug is complete BS.
"Drug Seeking Behavior" - "No healthcare professional has the right to deprive a patient of appropriate assessment and treament simply because he/she believes the patient is lying...When the care giver conveys to the patient that the report of pain is not accepted, this amounts to accusing the patient of lying" (M. McCaffery, Fall 2001). The term "drug-seeking" is a label and a nonmedical, derogatory term. A "myth" and one that Nursing itself perpetuates. We (the collective "we") expect our patients to "act" in a certain way to demonstrate they are having pain. Could this not be the very reason our patients begin to develop behaviors such as clock watching, grimacing when we are in their presence, moaning and the like???? If Nursing notes a patient happily engaged in conversation with family or friends, there is an automatic assumption that the patient must not be in pain. Let's remember that talking, laughing, joking, CAN be coping mechanisms for someone in pain. Thank GOD because, can you IMAGINE how stressful it would be for everyone if those in pain spent their days writhing in pain, audibly moaning and crying out loud???? "Lack of pain expression does not necessarily mean lack of pain!" (M. McCaffery Fall 2000). I don't know about the rest of you, but when I have a headache, backache, toothache or other condition that causes pain, I head straight for the Ibuprofen (tylenol, aleve and the like) to hopefully reduce or alleviate the pain. Guess that makes me drug-seeking, huh?
Remember, too, that sleep or sedation is not an indicator of pain relief either. Many of the medications we give our patients (phenergan, droperidol, benedryl) produce sedative effects which can lead Nursing into the false sense that a patient isn't in pain when, in fact, they are very much in pain and simply unable to awaken enough to be eligible to receive further narcotics. "Sleep or sedation may be mistakenly equated with pain relief, but patients in severe pain can fall asleep; sedation isn't the same as analgesia. In fact, patients may use sleep to help control pain" (AJN).
With regard to sedation/respiratory depression... Nursing needs to understand how to assess sedation and properly use sedation scales. Watching an individual's response, particularly with the first dose of an opioid, is the safest, most effective way to administer an opioid (M. McCaffery Fall 2001) adjusting the dose of the medication as warranted. "No patient has succumbed to respiratory depression while awake" (APS, 1999, p.23).
Nursing is known also to use the label of "addiction." Opioid addiction is a disease and the official DSM-IV term is substance dependence. The definition is: "Psychological dependence. Pattern of compulsive drug use characterized by continual craving fo an opioid and the need to use the opioid for effects OTHER than pain relief (or for non-medical reasons) (M. McCaffery, Fall 2001). Additionally, there is Physical Dependence and Tolerance. The latter two can occur in patients who receive long term narcotic treatment for pain, but this does not negate the fact that these individuals may continue to experience pain. In the case of someone who has developed Tolerance, "tolerance to analgesia may be treated with increase in dose." So long as a patient is able to tolerate an opioid without significant respiratory depression, they may be safely medicated. Again, refer to the earlier reference on assessment of sedation/respiratory depression.
Another misconception is the idea that there is no known physical cause of pain, or when pain is chronic rather than acute. The cause of pain can't always be determined. Deal with it and treat the patient's report of pain. You don't have some magical, infallible assessment tool so accept what data you do have... the patient's report.
Personal Bias - Whether we want to believe it or not, our own personal biases do exist and they do have an impact on the care of a patient in pain, sometimes with a negative effect. Physical appearance, gender, age, race/culture and our own personal experiences all help to develop our own definition and attitude regarding the presence of pain. People whose lifestyle conflicts with our own morals/ethics may trigger a bias and affect the way in which we care for them or accept/deny their report of pain. Is this a basis for good Nursing? Absolutely not.
As Nurses, we are in a position to provide the very best care for our patients in pain, assuming we have the proper tools in place. Let's not allow misconceptions, biases and myths to cloud our minds. Accept and act on the patient's report of pain; proceed with appropriate assessment and treatment.
"Although I was probably fooled by some patients, I never failed to help someone who did have pain" (M. McCaffery, Fall 2001). Good motto to follow.
Jul 3, '021. Vital signs are not accurate indicators of pain.
2. Behavior is also not an accurate way to measure pain; pts. will do things to distract themselves from pain.
3. Sleep/sedation does not equal pain.
4. Misleading a pt by giving NSS IV push and letting them think it is a pain med is ILLEGAL; placebos MUST be given with pt consent. You will have no leg to stand on if a pt finds out and tries to sue.
5. Calling someone a "drug-seeker" is an inflammatory a judgemental statement, and is considered inappropriate in any of the reputable pain mgmt. materials.
6. Everyone, including addicts, has a right to appropriate pain control; there may even be times when giving an addict a narcotic for a limited time may be appropriate and even necessary; again this is in reputable pain mgmt literature, e.g. AHCPR guidelines, ASPMN literature, etc.
7. Pain is whatever the pt says it is, and exists whenever the pt says it does--M.McCaffery MSN, RN
8. In line w/ #7, the pt self report of pain is the most reliable indicator of pain.