Overuse of opiates?? Opinions?

Nurses Safety

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would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. :uhoh3: :uhoh3: :uhoh3: :uhoh3:

I'd like to start by admitting that I am not a nurse. I am intensely interested in all things medical, probably because I am a chronic pain patient. I used to be a social worker, before chronic pain almost ruined my life. Now, in reply to your post. Yes, there are too many people faking illness/pain just to get opiates and/or attention. Are doctors to blame? That I'm not too sure about, maybe blame simply lies with the addict. Unfortunately, the addict has made it very difficuly for those of us in real pain. Because of a car accident, I have more problems than I have time to go into but they boil down to sever pain, every minute of every day of my life. It took almost four years for me to finally be diagnosed, and given an opiate analgesic. If there are doctors out there who are overmedicating, I sure never met one. I've read dozens of posts from ED nurses, and keep seeing "pain is what the patient says it is". I have never been given the benefit of the doubt, I have been treated like a drug seeker even before I'd ever taken an opiate and couldn't have named one if my life depended on it. In the begining, I didn't ask for meds, I asked to be cured. Now I know that a cure, is not going to happen, and I've learned enough to ask for meds. I have only been taking them for about a month but I can tell that I am on my way to having some semblence of a life again....and it only took 4 years.

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NiteShiftNut,

There are patients that are addicted and they show up in every unit of the hospital. Doctors supply high doses of narcs to these patients while they are admitted and during outpatient treatment. WHY? I don't know. Lack of caring or understanding about pain management perhaps, possibly because these patients do have real chronic pain and over time become addicted because the doctor has allowed them to become dependant rather than looking for the real problem or solution. I medicate patients that I know are in pain as well as those that ask for ordered pain meds even when they "look" fine. The reason: because I have a family member with chronic ABD pain that is often overlooked and almost cost her her life because several nurses and physicians thought that they knew better what "real pain" looked like. She was labeled a drug seeker in the ER and sent home. She was misdiagnosed several times. We heards lots of apologies while she was on the vent fighting for her life. Pain that would put me on my knees, she has learned to function with. Pain that most people couldn't tolerate, has become her way of life. It is not up to us to judge another persons pain. As a nurse, we advocate for the patient. Ask for a consult with pain management or social services. DO something to give them an alternative. Just please don't judge.

Gator

That was beautifully stated. You seem to be a very caring person :)

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just to clarify, i did say 100mg of demerol every hour. yes. and the most disturbing part of that situation was the fact that the patient wasn't even slighty affected by such a large dose. he was still awake, cursing at the staff, threatening to leave ama if we didn't call the doctor and get him more pain medicine and a diet order that would allow him to eat a cheeseburger. please, if you are in that much real pain, you would not be thinking about a big mac. i agree that there are people who are in real chronic severe pain, i don't doubt that, and i believe many times they fall through the cracks because we are so used to seeing the drug seekers that we become suspicious of everyone, but 9 times out of 10, these patients are just looking for a high and a free meal and the doctors are more than willing to hand it to them. i know my complaint is a waste of breath, i might as well be beating a dead horse, but thanks for letting me vent. :stone :stone :stone

i have to say that although i've been to the er many times due to my chronic pain, i have never requested a meal. one time, i did request to be admitted and knocked out. seriously, i was in so much pain that i pleaded with the nurse to make the doctor give me something that would knock me out for about 12 hours because i'd been awake and in agony for three days straight. they gave me a shot of something, i don't recall what, i doubt that i even asked because i didn't care, as long as it worked, and it did work. after maybe 30 minutes i could feel the pain slipping away. after about an hour, i noticed that my stomach was growling and i remember thinking " i hope that i can get home and eat something before this wears off." so, maybe the requests for food aren't always a sign of a drug-seeker.

just playing devil's advocate :)

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I hope I wasn't sounding judgemental becaues I was merely relating. Yes, a patient says he is in pain and we do what we have to.

It's when you give them 125 mg of Demorol and they give the academy award winning performance of a lifetime and you wake up a doc at 2AM, get yelled at, go into to give them their new pain medicine and they are sound asleep, off the floor smoking, eating calmly, laughing at a TV show or yaking on the phone. Only to have the show repeat itself in another hour when they are in severe pain again. Judgement, no. Frustrating yes.

Do we need to be able to honestly vent our frustrations without being labeled judgemental? Absolutely.

I just HAD to respond to this one. As a chronic pain patient, with an average pain level of about 8, I have to say that any patient who can sleep, eat, or laugh probably is faking to some degree. I know that some people say that chronic pain patients get used to the pain enough to learn to function, but that's crap. I have been dealing with my pain for 4 years and I assure you that I have not become used to it. I was not on pain meds until about a month ago, and even now, with strong medication, I am in some degree of pain all the time. So I can understand your frustration. Most of them probably are faking but until someone invents a device that can accurately diagnose a patients pain level, it seems that you wonderful nurses are just stuck. If all else fails, look at this way...at least you made the addict happy for another day so maybe he didn't go out and steal meds from his poor old grandma, or break into your house to steal your TV and trade it for a dose of Morphine.

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Specializes in Med-Surg, Geriatric, Behavioral Health.

Used to work the detox in the past. Let's see, the difference between a hard core opiate addict and a chronic pain sufferer?....light years. If you've worked in detox and in med/med-surg, you can spot the differences fairly easily...I say this from an objective standpoint... not judgemental. The body never lies. The personal histories are quite often without comparison. Using an analagy, it is like comparing a seizure disorder with a person presenting with pseudoseizures. The presentation may be unfortunately confused for the other, but the crux of the problem is dynamically different. Yes, it can be teased out objectively. You just need to know how to observe.

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We just had a 19 yo on our floor that had her nipple pierced several months ago and has been in the hospital every month since. In the beginning I'm sure the pain was legitimate from the infection and nerve involvement, BUT this week she was on our unit getting 5mg morphine(Q3hrs), AND 30mg ms contin(scheduled tid), AND 2 percocet every 4 hours. She still complained that it wasn't enough. She would ask for the morphine and as soon as she got she would be up and out the door to smoke!!!! This drives me crazy, if you are in that much pain then how do you get up to go out and smoke!!! Somethings I will never understand I guess.

You don't. Trust me. I am a smoker myself and the one and only time I got adequate pain management in the ED, I certainly didn't worry about having a cigarette. There's a time and a place for everything, and I had my smoke at 4am after I was home and the shot had unfortunately worn off.

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Sometimes it isn't about pain it's about safety. I had a chronic back pain patient who had ordered IV Dilaudid every 2 hours and she wanted it every 2 hours. Other pain meds included Oxycontin 240mg Q12. There were many times her respirations were six, she's nodding off and demanding her meds. There were other times you thought she was psychotic as she'd be on the phone calling the hospital operator about her dogs. In these instances, I called the resident and explained I didn't believe it was safe for her to get meds and documented my observations and interventions. The patient was very unhappy, nasty. Maybe she was in pain. However, I'm not going to give IV dilaudid to someone in this condition.

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Specializes in Med-Surg, Geriatric, Behavioral Health.

MedpsychRN....been there too. Totally agree.

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Moia, thanks for sharing your story. Gives a nurse much to think about.

I can't say I've seen anyone talking about using pain medicine to feel superior

Well, let me assure you that the patient feels that you are using it to feel superior. We feel as if the nurse holding the needle is the nurse who rules the world

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Moia, you've got to admit that there are people out there who come for meds because they want the high. They are not in the majority, but they exist and they are frustrating.

I had a guy who said he had back pain, and had a long history at our hospital. I beleived him, took over his care fom the nurse who had become frustrated, and did 1-1 care for 2h, about 30 minutes of that was talking to the doc trying to convince her to try another med...after all if he was in pain it might help, if he was a junkie what did we care if he got a little more medication? He claimed he couldn't move (literally) lying in bed in a slightly twisted position, saying it was the only way to ease the pain.

The way I got more med orders from the doc was to agree to stress to the pt there would be NO MORE, but he would get recurring doses of what was already ordered. So after 1-1 treatment of a very needy guy he gets up out of bed, puts on his jacket, grabs his suitcase and walks out with nary a limp or wince. Tells us on his way that he will sue us for not giving him the IV Dilaudid that he so desperately needed...I'm telling you if it had happened in church we would all have been speaking in tongues!

So where is a nurse supposed to vent after giving all she has to a twit like that?

There's venting and there's judging. You are clearly venting. Some here are judging, complaing, and allowing this subject to alter how they treat and perceive pain. That's when it becomes a problem.

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NiteShiftNut, with those patients you really do feel like you're shooting them up don't you? I actually had a patient smiling and practically drooling as I was giving IV demerol. I truly felt like I was shooting up a junkie. :)

But we can't let this one case jade us to people's complaints of pain. It's best to treat all complaints as legitimate and take it from there. One of these times this patient is going to come in with a genuine problem and it's going to be missed.

So to answer your question. It seems to be the concensus that pain is actually undertreated and narcs are not overly prescribed. I need to remember that.

Well said! :) :) :)

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canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.

Why is it that when those of us who vigorously advocate for pain mgmt. speak up, the people who have a problem with certain pts tell us to lighten up..."we're just venting"? Well, maybe I am just venting too, after seeing pt after pt suffer unneccessarily because he didn't have adequate pain meds, or suffer because a nurse made him afraid he'd be an addict if he asked for his meds too frequently/became irritated with him because he needed his meds q 4h ("Clockwatcher!").

The most irritating factor is that many of the comments like those expressed here show that the "venter" has not bothered to seriously update himself/herself on the new principles in this area.

So, yes, I do get a bit hot under the collar. I was already chastized by the people in the ED forum for defending chronic pain pts., and now it's happening here. I guess I don't have the right to vent.

Please keep venting! Vent for the chronic pain patients like myself so maybe someone else will be saved from suffering level 8 pain for 4 damned years before anything is done about it. Vent for the patients who, like me, are easily intimidated by doctors and don't know how to say "Listen to me, I am in agony 24/7, please do something". Vent because it's not fair to be in agony and go to the ED in tears only to have a nurse roll her eyes as soon as he/she hears the words "back pain". Vent because this kind of attitude from doctors and nurses cost me 4 years of my life, which happened to include the birth of my youngest child and most of my memories of his infancy are of me crying in pain, battling WC, doctors, going to physical therapy for an injury that hadn't even been diagnosed yet. But hey, if the doc can't find the problem on the first try just send the pt. to physical therapy, that cures everything, right? And it's not like they didn't give me meds. They gave me all the 800mg Motrin I could handle, even though I had a history of ulcers. But that's okay, they took me off of them when I began to vomit blood, and they were nice enough to ask me if I wanted a prescription for tagamet or if I just wanted to buy it OTC. Vent because after 4 years a wonderful NP that my mom recommended finally found the 2 herniated disks, bone spurs, arthritis, SI joint problem, stenosis, and a totally unrelated ovarian cyst. Another 3 months and I finally found a doctor who listened, confirmed my diagnosis and promptly prescribed opaites that at last relieve some of my pain. I think those are all good reasons for you to keep venting. We need more medical professionals like you. Vent, and Vent LOUD!

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