Overuse of opiates?? Opinions?

**canoehead, BSN, RN** · Jul 10, 2004

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?

KarafromPhilly · Jul 10, 2004

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?

If I had been you I would have smiled and waved bye-bye. I mean, why get bent out of shape? He'll get what he wants in an hour or two, and you have one fewer patient to report off on, so everybody's happy...right? Personally, I don't ever let myself get sucked into a :crying2: vortex of neediness because by definiton whatever I do, it won't be enough.

Tweety, BSN, RN · Jul 10, 2004

Moia, again thanks for sharing and thanks for understanding. I'm so sorry for your experience, and am distressed to think it is probably happening to many other people. I hope I was clear from my post that I do call the docs, and do give the pain meds. I would rather have the pain med, and give the pain med when a patient states they are in pain, than make a judgement on whether they are lying or not, that's not my place.

I also have the experience of assessing a patient "who was a whimp" or a drug seeker on two occasions. My gut said "no there is something seriously wrong here". Both cases the patient had serious problems that requried immediate surgery, and proper treatment was delayed due to poor nursing judgement or rather nurses passing judgement.

I also have known personally a drug addict, who would make up things to get drugs. He spent so much time in doctors offices and ERs it was very sad. I'm no longer friends with him and it's been a while since I last saw him.

Anyway, my point is there are patients that challenge us and frustrate us with all kinds of diagnoses. Isn't it o.k.to sometimes say "I'm frustrated" or "they are driving me crazy", and still be a good compassionate nurse?

leslie :-D · Jul 10, 2004

Isn't it o.k.to sometimes say "I'm frustrated" or "they are driving me crazy", and still be a good compassionate nurse?

don't even question that tweety.....

while it is heart-wrenching to see those people unnecessarily writhe in pain for fear of being chastised, the stark reality is that there are still those few that do try us and would even give Mother Theresa a run for her money.

NiteShiftNut · Jul 10, 2004

all i'm saying is, i have no problem giving pain medicine for legitimate pain. and 99% of the time i truly believe my patients when they say " i'm having pain that is a 10" ok. let's give you some pain medicine. the situation i was refering to was nothing like that. this patient is a known iv drug user who contracted various infections from dirty needles on several occasions, and is on his 3rd md because he fired the first one for not giving him enough drugs and the 2nd one fired him. his current md has stated to the nursing staff on more than one occasion that, " i am at a loss for what to do with this guy, i have cleared him medically on hundreds of occasions, only to have him dream up some totally unrelated ailment 2 days later and show up in the er wanting his iv demerol." he refuses psych treatment for all of his various addiction issues. this patient is not having pain. the only pain anyone is feeling is the pain in my head after dealing with his nonsense all night, and the chest pain i get when i can't care properly for my other 7 or 8 patients because i'm battling with him. so, to everyone who has real pain and anxiety over their illness or injury, i truly have empathy for you. but i refuse to be empathetic to drug addicts who are just looking for their next high and a free meal. p.s. i have had this same patient tell me to" push his iv demerol "real fast" because the doctor says i need it that way" :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

Tweety, BSN, RN · Jul 10, 2004

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.

stressednurse · Jul 10, 2004

OK add LTC to this pain management dilemma. 105# 72yo wears 175mcg Demerol patches changed Q48hr. Takes PRN perc q4hr and klonopin TID. Usually seen dozing in her wheelchair, when awake she is on the call light for more meds. The narcotic use has been going on for about 30 years with her. History is fractured hips and ribs and an arm at multiple times and now spinal compression fractures. She has pain I am sure somewhere under everything else but is either complaining or unconscious and after so many years of the narcotics would probably die during detox so why do it? When awake is paranoid and gonna sue everyone for not doing what she wants now. Oh yeh she is also anal fixated because of irritable bowel and demands questran as a preventive. (I have found her in the bathroom for 3+ hours digging herself out.)

Can we fix her....NO, can we make her comfortable, PROBABLY NOT...can we deal with her...As nurses with the right approach YES.

She put herself there, we are not responsible for her being the oldest living drug addict and we can make her last few years kinda comfortable.

How did I deal with this? The doc made most of her PRNs regular scheduled meds so we as nurses don't have to decide if she really needs it or not.

**canoehead, BSN, RN** · Jul 11, 2004

I'd give the meds, as she will not change unless she wants to.

My cynical point of view is that I am happy to give the meds if it will make them happy. I have a problem with people that are so stoned they can barely speak, but bang the call bell, and yell into the hall that they are getting no attention, from that cold heartless nurse, meanwhile I am neglecting other patients, and on the phone with the doc, getting enough drugs to kill an elephant, and even then they want MORE, MORE, MORE!!

teeituptom, BSN, RN · Jul 11, 2004

I dont argue anymore

I just deal whatever the doctor orders

life is easier

but aint it scary when you glance over to the car next to you

their radio is blasting

their cell phone is glued in their ear

and they are using stadol nasal spray while driving

we have become a chemical driven society

I get by with a little help from my friends

oh I get high with a little help from my friends

SCARY

mscsrjhm · Jul 11, 2004

OK add LTC to this pain management dilemma. 105# 72yo wears 175mcg Demerol patches changed Q48hr. Takes PRN perc q4hr and klonopin TID. Usually seen dozing in her wheelchair, when awake she is on the call light for more meds. The narcotic use has been going on for about 30 years with her. History is fractured hips and ribs and an arm at multiple times and now spinal compression fractures. She has pain I am sure somewhere under everything else but is either complaining or unconscious and after so many years of the narcotics would probably die during detox so why do it? When awake is paranoid and gonna sue everyone for not doing what she wants now. Oh yeh she is also anal fixated because of irritable bowel and demands questran as a preventive. (I have found her in the bathroom for 3+ hours digging herself out.)
Can we fix her....NO, can we make her comfortable, PROBABLY NOT...can we deal with her...As nurses with the right approach YES.
She put herself there, we are not responsible for her being the oldest living drug addict and we can make her last few years kinda comfortable.
How did I deal with this? The doc made most of her PRNs regular scheduled meds so we as nurses don't have to decide if she really needs it or not.

She is 72 years old, living at a nursing home, having lost everything that she worked for all of her life, right?

My kids have promised me psychedelic mushrooms and spiked brownies at every meal if I ever end up in a nursing home. They figure as long as I am just going to be sitting there, might as well have a good time, and develop an appetite. (Don't start screaming--they are kidding)

Okay, true, my kids can be scary, but they have a point. This is how that woman handles life. We all do the best we can with what we have. It is a free country, and this is one of those freedoms that we tend to want to quelch.

I just pass the meds, leave the moral issues to the patients.

fab4fan · Jul 12, 2004

Not to be too picky, but Demerol is neither measured in mcg, nor delivered in an extended-release transdermal patch.

deepbreathe · Aug 7, 2004

I agree with the whole pain issue. Somehow, we as a society have become accustomed to the idea that pain free is the best way to be. The problem with that is that it really means anesthesized. We need to educate our patients on the dangers of opiate use, the problem with narc use when it comes to really needing pain relief ( i.e. post-op), the problem with not moving enough after surgeries ( due to over medication), on and on. Chronic narc users need to be counseled and put into a pain program whose goal is to eventually give alternative ideas for relief, and to get to the root of the problem. The primary MDs or Surgeons need to be spurred on to write the orders for pain evals. It puts restrictions on the use of meds, puts out the info to the ERs in town, the pharmacies, and eventually helps the patients live a better life. Please! have the fortitude to suggest this to your docs...they'll listen. I work in a PACU, just last week I gave 300mg. of Demerol, 20mg of Morophine, 100 mcg of Fentanyl, and 25 mg. of Phenergan to a back surgery patient who was still proclaiming pain at a level of 10, wide awake, on room air at 98%, less than 40 min after general anesthesia....c'mon, this is rediculous!!!! JCAHO standards need to be fully read, understood and interpreted, read them yourself, and lobby for the intelligent use of medication, and the professional judgement of the RN. Abusers are fully aware of their rights in regard to pain relief.