how do you deal with drug seeker pts in med surg?

leslie :-D · Jun 17, 2007

keep in mind that if there is a hx of drug use, then most will require a higher dosage of narcotics.

some of these pts might actually still be in pain.

share concerns with the md and get md to talk to them.

some may actually need an anxiolytic.

if they get what they need and still continue being disruptive, firm limit-setting may help.

but i'm usually pretty insistent that the doc personally talk with them.

and don't forget to document in detail.

leslie

ktwlpn, LPN · Jun 18, 2007

I agree with the above-make sure they have adequate narcs/anti-anxiety meds ordered and administer them promptly.You are not going to change long term behaviors like this during a short acute hospitilization.You've got to medicate to keep them comfortable and co-operative to enable you to treat their "real" medical problems.Don't drag your feet when meds are due-don't withhold them-if you do that I am betting the other problems will be minimal...

icuwant2rn · Jun 18, 2007

I agree with giving them their narcs as soon as they can have them, most of them will be on their light 15min before they can have the next dose of their PRN just to remind you they can have it :uhoh3: .

Also I let them know upfront that we will NOT be able to make them pain free, but will try to keep the pain at a tolerable level. And I do try to get them some Ativan, Valium, etc. as a PRN if not a scheduled drug as this seems to help.

EmmaG, RN · Jun 22, 2007

I agree with giving them their narcs as soon as they can have them, most of them will be on their light 15min before they can have the next dose of their PRN just to remind you they can have it .

My favorites are the ones who put in an advance order for the next dose as I'm giving the med.

Trauma Columnist · Jun 22, 2007

Dealing with drug addicts is difficult in any healthcare setting. However, as earle58 pointed out, they will need MORE pain meds (narcs and anti-anxiety agents) then the patient that isn't an addict. So...it is important that the provider be upfront with these patients and enlist their assistance. If they are a heroin addict, tylenol #3 isn't going to cut it. You can however, use methadone, morphine, dilaudid to assist with pain management. You can also consult with your Pain Management service (anesthesiology).

Other things to consider: addicts have poor nutrition usually. In order to heal wounds, a nutrition consult might be in order. These patients are not the nicest to deal with sometimes. However, it is important that the patient be involved in his/her own pain management by being honest about their drug use.

ladylynx · Jun 25, 2007

We are having more and more pts adm with real med surg probs, but are also drug addicts. They are incredibly non-compliant and constantly demanding drugs. Their bizzaire behaviors and constant whining and crying for narcs is so disruptive. Their roomates are afraid to go to sleep. Staff are tied up dealing with them and cannot give appropriate time to the other pts. How do you deal with this? How can you keep the druggie & the roommate safe and still care for the other pts? :angryfire

You should also think about the fact that they too are sick. "Drug-seekers" (the word I really hate to use) have a history also. Many come in different forms and many started because of some kind of pain. But the stats from those in healthcare recognize the truly sick patient outweighs the amount of "drug-seekers". Giving pain meds, sleeping pills, and anti-anxiety drugs on time and as ordered often heals the sick person faster and will get the non-sick person discharged quicker.

In regards to safety...if someone is in an unsafe situation give them the "complaint hotline" that is given to them upon admission (many forget they have at bedside). Sometimes this number is directly to Administration. Then there is always security. They often joke with me on how hard they work when I am their. Oh, well, "safety first" is what they say and I went to school to become a nurse not a security officer.

TalldiNY · Jul 5, 2007

I like the ones who tell you what pain medications they will or won't take. Then proceed to tell you when they are so stoned the words are barely comprehensible that they are still in pain, in between the snores.

Rule of thumb for new nurses. If they're snorin' they don't need it.

ladylynx · Jul 5, 2007

I like the ones who tell you what pain medications they will or won't take. Then proceed to tell you when they are so stoned the words are barely comprehensible that they are still in pain, in between the snores.
Rule of thumb for new nurses. If they're snorin' they don't need it.

Until you've had a chronic pain problem, please don't withhold meds because someone is sleeping. Sometimes exhaustion takes over, but when I have a migraine, I only wake up with a worse migraine if I had not taken anything. Pain meds do have side effects and believe it or not pain meds work in different ways affecting different receptors. For example, Morphine is considered the strongest, but it is not the most effective. Although you get the "high" (as nurses often call it) it does not take away all types of pain. It's like taking Tylenol for a toothache, when Ibuprofen works better.

Work with Hospice and you will learn much about pain and what works by talking with the patients. I wish everyone would remember Anatomy and Physiology 101...pain and sleep are different parts of the brain.

EmmaG, RN · Jul 5, 2007

Until you've had a chronic pain problem, please don't withhold meds because someone is sleeping. Sometimes exhaustion takes over, but when I have a migraine, I only wake up with a worse migraine if I had not taken anything. Pain meds do have side effects and believe it or not pain meds work in different ways affecting different receptors. For example, Morphine is considered the strongest, but it is not the most effective. Although you get the "high" (as nurses often call it) it does not take away all types of pain. It's like taking Tylenol for a toothache, when Ibuprofen works better.
Work with Hospice and you will learn much about pain and what works by talking with the patients. I wish everyone would remember Anatomy and Physiology 101...pain and sleep are different parts of the brain.

You're right, of course. But I make a distinction between patients with chronic (or acute) pain and those who are 'drug seeking'. They do exist. The sad thing is, many lump all of these people together, and those who are truly in pain and not simply wanting the high do not get the relief they deserve.

Melina · Jul 8, 2007

This is a great article about pain management for those with a hx of drug abuse. These patients have as much of a right to pain relief as anyone else. By helping them trust that you and the doctor will adequately relieve their pain, you may find they don't "bother" you as much for PRN meds. Please let us know how things go. Pain management is such an interesting topic.

~Mel'

Pain Management in Patients With Opioid Abuse.pdf