Drug seeking patients?

krisssy · Dec 31, 2005

Thank you Leslee and Sandrat. I am in complete agreement with you. I had abdominal surgery last Oct. and was being treated with Oxycodone for PAIN.Four months after that, my husband took me to the emergency room for pain that was not being alieviated by the Oxycodone. Now if I was looked at as a drug seeker who had used up all my Oxycodone, I would have been in major trouble.

Even after telling them my Oxycodone was not working, they kept giving me IV pain medication. It took three different meds until one finally worked. Now what if the nurse and dr. thought I was a "drug seeker" , gave me no pain relief, and sent me home? I happened to have needed emergency surgery for a blockage caused by adhesions, and I was in the hospital for a week.

That confirmed what I have always believed. If a patient says he or she is in pain, treat the pain immediately, and then diagnose what the problem is. If the diagnosis is that the patient is an addict, for goodness sakes -treat their disease of addiction. When a person says they are in pain, they are in pain! It may be physical or emotional or yes, they may be an addict. Either way, a person yelling in pain in an emergency room is sick. There is no room for judgements, and every diagnosis needs to be backed up with evidence.

In answer to Patma's question, addicts in withdrawal can die. That includes alcoholics. They can also leave the ED and get their drug of choice or worse off the streets and die too-of an overdose. These people in withdrawal can be in excrutiating pain, especially from Opiates Addiction and Alcoholism are diseases and need to be treated just like any other disease!

sjrn85 · Dec 31, 2005

People in withdrawal can also develop hypertensive crisis, seizures...yes, it can be life-threatening.

MarcusKspn · Jan 9, 2006

I have had patients before that look like a textbook picture out of the "How to tell if your patient is only here for the drugs" guide. I have worked with nurses who have deliberately waited longer than necesarry to medicate their complaints of pain, justifying it by saying things like "I'm not going to support their drug habit", etc. I look at it like this: "Pain is whatever the person says it is, exitsting whenever the person says it exist", and if they have a legitimate doctor signed order for pain meds, they will get it.

Many people get hocked on pain meds because of pain in the first place. And quiting pain meds because they are hooked on them does not adress the pain that started the mess. They need professional detox and rehab to help them.

And no, an angry nurse refusing to give them the demerol they have an order for and cutting them off cold turkey is not professional rehab.

RNZenpeaceful · Jan 19, 2006

This is in response to those Nurses who have had, or have, some type of painful, chronic illness, but have had undertreated pain due to the misconceptions of others (usually co-workers who are have been blessed since childhood with wonderful health). I have had ulcerative colitis since the age of 11. I started to have severe abdominal pain and rectal bleeding, but for some reason, I did not want to bother my parents, so I told my best friend instead, another 11 year old girl. About 2 months after the onset of my symptoms, I passed out in my 6th grade Art Class due to severe blood loss. I was taken to a nearby hospital, and fluid/blood resucitated (my parents told me that I had "last rites,' a Catholic ritual for a person believed to be in extremis)...Anyway, missed almost the entire year of school because of wrong diagnosis, unresponsiveness to medications, etc. Not once was I given any kind of pain medicine, despite my quietly crying and having up to 40 bloody stools a day. I remember asking one of the nicer nurses if "someone could help me not have so much pain," and her reply was, "Sorry, we don't give pain medicine to children." At this point, all of my hair had fallen out from some type of chemo I was give, I weighed about 50 lbs and looked like skeleton! And I certainly was "drug-seeking," even though I had never heard of it.

Flash forward to year 2003.My gastroenterologist did not want me to have prednisone for a typical exacerbation of my UC, because a bone densometer test showed severe bone loss. Instead, I was prescribed a medication supposedly similar to prednisone (endocort) but without the risk of bone loss. The endocort did not work, but the GI dr said to "just bear with it."

About 6 weeks after the onset of my latest symptoms, I developed a fever of 105 and a very distended abdomen, with 25-30 bloody stools each day, and severe abdominal pain(which I had all along but it got much worse) My father drove me to the ER where I had been working for the past 12 years, and my friends/co-workers immediately jumped in to help me. My diagnosis was "toxic megacolon," and my GI dr was now making arrangements to send me to a big city hospital for a total colectomy. Blood and stat cipro IV

were hung. And one of my "best friends" told a another friend that "She couldn't really be in all that much pain...because she is smiling making little jokes with the staff, she is not even screaming in pain!" This "friend" even got into a side discusion with the staff, making sure that they understood that UC pain could not possibly be as bad as the migraine pain that she suffers from time to time! (fortunately for me, another friend and co-worker gave me the IV Dilaudid and compazine that was ordered, making my vomitting and severe "10 out of 10" abdominal pain much more bearable. I literally felt like I was going to die,especially when I had yet another bloody diarrhea stool. Thank God the dr treating me understood how very very sick I was and did not doubt my word that the pain was unbearable! And by the way, I have also suffered with frequent kidney stones/lithotripsies, since irritable bowel disease increases the risk of kidney stones. The same friend who did not believe that my UC pain was, well, painiful,recently described how her husband woke up one night with severe pain, which turned out to be a kidney stone, and berated him for being such a baby about a little pain!

All I have to say is, watch out, any caregivers who either have not personally experienced severe pain, or those who simply do not believe most people when they claim to be in pain, "because the patient is sleeping, or has a BP of 120/82, or is reading a magazine." Not every single person in pain is going to scream and cry: ask a Labor and Delivery Nurse!

"There by the grace of God go I."

redwinggirlie · Jan 19, 2006

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.
I realize there are genuine drug seekers out there, but the term is used much too often. I knew a nurse who was convinced that anyone who asked for something for post-op pain was a drug seeker. Wait until she has her hip fractured and replaced! I am much more concerned for the people whose pain is not adequately treated because of our moral judgements.
Pain has long been my pet peeve. I have seen people in pain asking for help and being ignored by uncaring jaded nurses who should've retired years ago. My friend's mother was in the hospital for pain control using a PCA (because of terminal lung cancer) and her IV went interstitial. Instead of changing it the nurse left it for the day shift to do. My friend's mother went for over 2 hours without any pain control. I just don't understand how people (nurses) can be so cold and uncaring. Wait until they have pain without a "medical reason".
ps
pain is a medical reason to be hospitalized.

You couldn't have put it better.

I work in an area where everyone on the floor is in much pain. We know that, and everyone is medicated safely for their pain. When floats work the floor, that is the only time I hear the "pain seeker" phrase.

I always remember, no matter what reason they are there, it is their pain, not mine.

krisssy · Jan 19, 2006

How can a nurse ignore a physician's order for pain control???????????

Many many people are put on pain meds for post surgical or other types of pain, and they get addicted to it. What are we as nurses to do, call them "drug seekers", judge them morally, ignore them???????????

It is our job to work with the doctors to figure out what to do. Do we keep giving them pain killers that they are addicted to? I think each case is different. My dad had terminal cancer, so it didn't really matter if he was addicted to the Oxycontin or not. He was in pain and dying. There are other cases where the person needs to be detoxed in a safe place and get services for the disease of addiction IF that is the case. There are other people who need to get off the pain killers, get detoxed safely, get addiction treatment, and gety reevaluated for pain control.

Each patient is an individual. It is a nurses's responsibility to figure out what is going on and what their patient needs in the form of HELP. It is totally unprofessional to say, "This is a drug seeker-no pain meds". I am comforted to read the last few posts and see that nurses are recognizing this.

How dare any nurse judge her patient. Even if the patient is strictly a drug addict with NO pain-the patient is still sick and needs referral to a rehab for safe detox and follow-up help. Krisssy RN MA MHPNP 2 be

SmilingBluEyes · Jan 19, 2006

I agree with fergus. I treat the patient's pain seriously and give meds as ordered/requested. Not for me to judge this one.

GLORIAmunchkin72 · Jan 19, 2006

Holy Cow!

Oxycodone:
In 1995 there was 1 death and 12 confiscations in the county I live in. In 1998 there were 17 deaths and 26 confiscations. Last year in 2000 there were 43 deaths and 73 confiscations.
Need more? The number of prescriptions of oxycodone increased from 316,000 in 1996 to 5.8 million prescriptions in 2000!!
Oxycontin has a street value of $40 - $80. each pill in our area.
This is a problem far greater than the problem of treating patients for chronic pain.

squeakykitty · Mar 16, 2006

[francescafree

registered user

the same friend who did not believe that my uc pain was, well, painiful,recently described how her husband woke up one night with severe pain, which turned out to be a kidney stone, and berated him for being such a baby about a little pain! ]

that "friend" is in the wrong profession

krisssy · Mar 17, 2006

Holy Cow!

It is my understanding that the more Oxycodone one takes, the more he or she will need to have the same effect. So if a person becomes out of control as the pills alter the mind, he or she can overdose. Oxycodone and all Opiates affect respiration. Too much , and you can stop breathing. That is why a patient cannot be turned away from an ED. Once we get the patient in, that is our chance to HELP by getting a family intervention and getting the person into a rehab immediately. You turn them away as a drug seeker, they may very well leave your hospital, get it somewhwere else, overdose and die. Krisssy

steelcityrn, RN · Mar 17, 2006

Whatever the pain is, either from a actual dx, or in someones mind, we are their to help and understand. As far as dx of fibromyalgia, there has been studies done a few years back of brain scans of pt's without F.M., and of those who were in actual pain with this syndrome. There were actual color changes on the scan of the pt's brain while in pain. Finally these folks were vindicated. Our job is to observe s/s of pain, relay all findings to the Dr, and follow the medication order as prescribed...period!

krisssy · Mar 17, 2006

Whatever the pain is, either from a actual dx, or in someones mind, we are their to help and understand. As far as dx of fibromyalgia, there has been studies done a few years back of brain scans of pt's without F.M., and of those who were in actual pain with this syndrome. There were actual color changes on the scan of the pt's brain while in pain. Finally these folks were vindicated. Our job is to observe s/s of pain, relay all findings to the Dr, and follow the medication order as prescribed...period!

I agree with you completely. My mother drove us all crazy with the disease of Somatization for her whole life. She is 81 and thank God, going strong. But until the invention of an antidepressant called Pamelar, the woman suffered in real pain-every part of her body. When the Pamelar worked, and the pain disappeared, I knew she was really feeling the pain. She was lucky to have found a medication that wasn't addictive. But her pain was real. Krisssy