Overuse of opiates?? Opinions? - page 4

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,... Read More

  1. by   UM Review RN

    i mean, 100mg of demerol every hour?
    i believe the max daily dose of meperidine is 600 mg, or no more than 48 hours of therapy before d/c, else the patient runs the risk of neurotoxicity.

    indeed, i once had the honor of calling a doc in the wee hours and informing him that his prescribed dose of demerol was too high and i wasn't going to give it, on the advice of our pharmacist.

    doc transferred the patient off to another unit. patient got the med as prescribed--and went into convulsions later that weekend.


    but on the normal shift, i have to agree with tom--i try not to judge. i came to that philosophy because of a patient who was in excruciating pain for over a week while test after test came up negative--except the last one. turns out the patient had a large kidney stone that had been somehow blocked on other tests, and finally was seen on the last (it was so long ago, i don't recall the exact test). by this time, i was giving the pain meds, but not much sympathy, until i saw that report. pt subsequently got relief when the stone was removed, and i learned a very valuable lesson.

    i'm sure there are drug addicts and malingerers out there, but i'm not super and i don't know it all, so as long as the med and the dose is safe for that patient, i'll just give the meds.

  2. by   RN Rotten Nurse
    Quote from JimmyMallo
    I think one of the BIG problems I see is that we are nurses are so damn judgemental. If a patient has standing orders for narcs and states a specified pain level the nurse gives the drug, there is no judgement call orders are orders. If the person is an addict that is the DOCTORS fault! Why would we as nurses say something like a few addicts ruin it for everyone!!! We despense medication ordered by doctors, if a doctor orders narcs for an addict them I give the drug if I start looking for addicts I see one in every patient and quality of care suffers. Why would I give the addict the power to lower my overall nursing care? If he talks the doc into narcs then he has a problem, but it's not my problem. Pain is little understood and poorly treated in general and I feel nurses should be more open in general to pain management. If you serve a few addicts to help 1 patient in genuine pain who looks OK to you then I say good job. What is it that makes drug seekers soo important to nurses that we alter our care based on our perception of how patients like the meds? Bottom line, it is the person who is in pain that is important not the drug seeker. If everyone gets their ordered meds every time we would have happy patients and happy addicts and less stress on ourselves trying to find the difference.
    I believe it is OUR problem. It is societies problem as well. I'll tell you why it bothers me to dope up our drug seekers. First of all, many if not most of them are unemployed. Most are usually on medicaid and other forms of government assistance. Everytime I cater to a drug seekers request for demerol and such I'm thinking--ok, the government is going to take even more out of my paycheck so I can pay for this loser's drug habit yet I won't be able to pay for my child's college tuition. Do you really not see a problem here?
  3. by   fab4fan
    Do you feel the same level of indignation at other Medicaid recipients such as non-compliant diabetics, smokers who get CA, chronic heart pts. who continue to smoke and eat the wrong diet, etc?

    Even an addict is entitled to pain relief, and that may include the use of narcotics. This is not my opinion, it is in all the current literature on pain mgmt. (Surely you don't suggest that a "seeker" should have surgery/broken bones/sickle cell crisis and just "suck it up.")

    I mentioned in a previous post that I'd had a bad exp in the ED with a judgemental nurse. Because I had been in the ED before with migraines, she immediately labeled me and blew me off. Thank God the ED doc didn't, or I may not have lived.

    Unless someone is gifted with the ability to see inside a pt's body and know for a certainty that his pain is real, IMO it's better to give the pt the benefit of the doubt.

    And we ALL pay taxes for things we don't agree with. That's life in an imperfect world.
  4. by   Jay-Jay
    As a migrane sufferer, I can certainly appreciate stories re. having pain ignored and being thought a drug seeker (though this hasn't happened to me...I have a terrific G.P. and my migranes rarely get bad enough to need more than Tylenol #3.)

    HOWEVER, recently I experienced the flip side of the coin.

    We had a patient who had fallen on broken glass, and suffered a deep puncture wound to her backside, which became infected. She kept complaining of unrelieved pain, and asking the nurses to intervene with the doctors for more pain meds. She was a very good manipulator, and had most of us fooled. The docs were fooled too, and gave her pretty much whatever she wanted.

    She died of an unintentional drug overdose.

    The other side of the coin, people. I still feel like **** about it, and wish we could have done something to prevent it happening.
    Last edit by Jay-Jay on Aug 9, '04 : Reason: Typo
  5. by   NiteShiftNut
    i guess since i'm the one who originally posted this, i should clarify---i was not talking about every patient with pain meds ordered..............i was actually doing nothing more than venting after a long frustrating night of dealing with a known addict. i have decided to adopt the "i could give 2 ****'* and a **** less attitude" if the doc knows that the patient is merely a drug seeker and they still choose to enable their habit-wonderful!!!! if everyone just wants to jump on the bandwagon and get stoned out of their minds for the rest of their miserable lives-wonderful!!! dole it out baby!!!! i say the more miserable unemployed crack addicts the better. it's job security. i give up. i have to pick my battles, and i'm tired of this one. i will serve up the high with a smile on my face and a skip in my step from now on--and besides--it's just easier to give em what they want.
  6. by   KarafromPhilly
    HOWERVER, recently I experienced the flip side of the coin.

    We had a patient who had fallen on broken glass, and suffered a deep puncture wound to her backside, which became infected. She kept complaining of unrelieved pain, and asking the nurses to intervene with the doctors for more pain meds. She was a very good manipulator, and had most of us fooled. The docs were fooled too, and gave her pretty much whatever she wanted.

    She died of an unintentional drug overdose.

    The other side of the coin, people. I still feel like **** about it, and wish we could have done something to prevent it happening. [/QUOTE]

    Something like...assessing the patient? I must be missing something here--??
  7. by   canoehead
    I have also seen a patient claim a pain level of 10/10 when shaken from a stupor like sleep with resps 6/minute. At that point do we medicate her (pain is what the patient says it is, and she says "Yeah" when I ask her if she needs more meds) or do I make a judgement that she's going to kill herself if I do what she requests.
  8. by   kids
    Quote from RN Rotten Nurse
    I believe it is OUR problem. It is societies problem as well. I'll tell you why it bothers me to dope up our drug seekers. First of all, many if not most of them are unemployed. Most are usually on medicaid and other forms of government assistance. Everytime I cater to a drug seekers request for demerol and such I'm thinking--ok, the government is going to take even more out of my paycheck so I can pay for this loser's drug habit yet I won't be able to pay for my child's college tuition. Do you really not see a problem here?
    This is the EXACT reason I won't so much as go to the dentist without a recent x-ray showing the titanium screws and rods that hold my spine togather. God forbid I have something happen (root canal, broken ankle, surgery) that my maintainance meds aren't enough to treat the pain.

    I did want to point out that because the Social Security Admin works with individual states many people receiving disability also receive Medicaid. And if anyone thinks it is easy to get SSD they are sadly mistaken as several disabled members of this board can attest to.
  9. by   Jay-Jay
    Quote from KarafromPhilly
    Something like...assessing the patient? I must be missing something here--??
    I want to clarify: this was a home care patient. I did do an assessment on her, before sending her off to the doctor with a note. On the note, I gave vitals (pulse was elevated, BP was not, she was diaphoretic.... something going on, but acute pain? Chronic pain? I wasn't sure!) So, I asked the doc to CALL ME. He/she didn't bother. If he/she had, I would have said, "Look, maybe you know this patient's history better than I do. I think she MAY be a drug seeker, but I'm not sure." Instead, the doctor just gave her what she asked for.

    The last time I saw her, I could tell she had too much medication on board, but she (supposedly) was just about to leave to go to see her doctor, and wanted me to hurry up with my visit so she could leave. I decided to let the MD look after it. Afterwards, I wondered if she had actually kept the appointment. I think two of her nurses called 911 before finally getting her admitted to hospital. The first time she refused to go. By the second time, it was too late. Unfortunately, there is only so much the nurse can do to help someone who does not want to be helped.
  10. by   pricklypear
    Nut, people seem really vicious on this subject. I see your point, about the patient who simply will not be pleased. I think you are describing a patient who thinks that the more he complains, the better the meds will get. He doesn't realize that there is a limit to everything, and it is beyond your ability to manufacture the perfect medication for his discomfort. Then you have the doc who is frustrated and says "tell him NO more" Leaving you to deal with it. You can only do so much. It doesn't really matter what you think of his motives, your job is to assess and medicate. I don't consider myself a substance abuse counselor. I don't care if it is 2am, if the patient SAYS he's having pain, the doc needs to do something about it. Even if he gets a phone call every hour all night. I do think you should be allowed to vent without being attacked, though. That way you can get it out, and go back to work and do whatever you have to do. You were not by any means attacking everybody who complains of pain. You were not withholding medication because you though he was faking. You were just frustrated!! Chin up:wink2:
  11. by   fab4fan
    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.
  12. by   canoehead
    Quote from fab4fan
    canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.
    I know that, but even if she is in pain should we let her kill herself with meds? Seriously, I don't know what to do in this situation, and it's not just one patient. Many, many patients come through my hospital, and we drug them until they can't walk straight, but their reported pain level remains unchanged no matter what med is tried. (I'm talking years of repeated admissions). If we give them narcs IV they report some relief, but only for a half hour or so, but the sedation effects last and last. Do we keep giving more med?
  13. by   fab4fan
    Perhaps what should be looked at is which narcs are used, and if the docs are adding unnecessary sedatives. When a pt is in pain but is oversedated, the first thing you look to eliminate unnecessary meds that can cause sedation, not the narcs.

    Perfect example: "Phenergan potentiates Demerol and makes it work better." Current studies have proven that it does not do that, that it adds to the sedation, and it actually lowers the pain threshold."

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