Overuse of opiates?? Opinions? - page 7
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
Aug 26, '04for those people in physical pain, narcotics are appropriate....
but the stark reality is, there are definite narc seekers to feed their emotional pain and addictions, and it is those people that some of us are talking about, that can make it unfair to those who are actually suffering.
i highly doubt there are nurses that automatically deem all patients med seekers.
and as a nurse that was instrumental in implementing a pain mgmt. protocol at my former place of employment, i represent thousands of nurses who are genuinely sensitive and sympathetic to those who suffer, and who are quite experienced in assessing pain.
but it's those few bad apples that can bruise the entire population.....
Aug 26, '04Quote from teeituptomAddiction may be a disease
but the question here is
Is it my job to feed an addiction
But my point is: How can you be so sure it is an addiction? Do you just "know" by the way they look or act? How do you know that their behavior isn't due to pain? Isn't pain subjective? You are supposed to take it as they say it is. Nurses are not the ones to decide whether we should give a pain med that is ordered when the patient asks for it. The Doctor orders it and it is his call , not ours. The only reason I think that we should withhold ordered pain medicine is if the Pt is too out of it to need it. No Nurse is supposed to feed an addiction and I doubt that they were admited for "addiction treatment" or you would be working on a detox unit. It is your right to practice nursing the way you see fit though, it is your license and reputation. I know that some Doc's are clueless when they over order pain meds to the point where it is almost dangerous and the pt is always doped, but it is our responsibility as nurses to advocate for the pt and try to get something changed or at least try to suggest a pain consultation. You shouldn't punish the pt just because you think he is a "junkie". That's just not right. And patients do know when you are doubting them and I am sure that they sense that and makes them feel very worthless. What if that "junkie" really is in pain and you choose to withold or "not feed his so-called addiction?" I believe that would be very poor nursing care. That's just the way I feel. (Not trying to offend or attack personally)
Aug 27, '04Quote from teeituptomHave you heard of pseudoaddiction? It's when pain is undertreated and the patient acts like a drug seeker, clock-watching and always seeking more. It looks like addiction but they are just trying to get out of pain.Addiction may be a disease
but the question here is
Is it my job to feed an addiction
I did have a pt with substance abuse problems today . . . I confess I didn't run to get him morphine when he complained of back and buttock pain. I told him to try getting up to a chair first (and I know he could) because anyone would have pain after sitting on their rather large butt all day. He wouldn't even consider getting up, and he didn't say it was because it hurt too much to get up. He just blew me off. If he won't even consider another suggestion, well, I do think that's probably drug seeking.
Oct 9, '04Teeituptom's remark about people 'driving around w/ fentanyl patches', etc. is particularly offences.
I was diagnosed about eight years ago w/ severe stenosis and degeneration of my C-spine, resulting in nerve compression and damage. This began as a gradual discomfort which progressed to intractable neck and arm pain, as well as numbness, parasthesias, and decreased motor function. (they started call me 'ol dropsy' when I was scrubbed-in)<!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" oreferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"/> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"/> <v:f eqn="sum @0 1 0"/> <v:f eqn="sum 0 0 @1"/> <v:f eqn="prod @2 1 2"/> <v:f eqn="prod @3 21600 pixelWidth"/> <v:f eqn="prod @3 21600 pixelHeight"/> <v:f eqn="sum @0 0 1"/> <v:f eqn="prod @6 1 2"/> <v:f eqn="prod @7 21600 pixelWidth"/> <v:f eqn="sum @8 21600 0"/> <v:f eqn="prod @7 21600 pixelHeight"/> <v:f eqn="sum @10 21600 0"/> </v:formulas> <vath o:extrusionok="f" gradientshapeok="t" o:connecttype="rect"/> <o:lock v:ext="edit" aspectratio="t"/> </v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" alt="" style='width:11.25pt; height:11.25pt'> <v:imagedata src="file:///C<img src="http://allnurses.com/forums/images/smilies/biggrin.gif" border="0" alt="" title="" class="inlineimg" />OCUME~1JANETO~1LOCALS~1Tempmsohtml1\01clip_image0 01.gif" o:href="http://allnurses.com/forums/images/smilies/embarassed.gif"/> </v:shape><![endif]--><!--[if !vml]--> :imbar<!--[endif]-->
I have had THREE cervical fusions, which kept me out of a wheelchair but left me w/ permanent nerve damage. The result of this is chronic pain, including episodes of severe breakthrough pain. (Think of a hot poker being jabbed into your posterior neck several times daily!) Otherwise, I am in my mid-thirties, of average weight, happily married and a very good nurse!
I am also on a 50mcg Fentanyl patch, prn hydrocodone 10/325, as well as other non-opioid medications. I will (hopefully) have a spinal stimulator implanted within the next two months. Up until two months ago, I was working full time as the Neurosurgery Coordinator for a major community hospital. NEVER ONCE have I EVER felt, behaved, or been accused of appearing 'medicated', seeking drugs, or using poor judgment. On the contrary, if I were to NOT take my meds, or have a patch that's a 'dud', the ONLY thing that kept me from driving, working and functioning as a human being and a nurse, was the PAIN. My colleagues were aware of this, and would be glad to support me without pause if so challenged. I resigned from my position because it required a 25% clinical aspect, which was intolerable due to the pain. I was forced to give up my love - perioperative nursing. It was a devastating blow.
Before I was an O.R. nurse, I did a stint in correctional nursing (both med-surg and psych), I dealt daily w/ drug seekers and addicts.
The significant difference between addiction and dependence is this:
Addicts have no pain and seek medication to escape life.
Med dependent people are prescribed medication to prevent pain, and to return normalcy to their life.
God help any nurse who doesn't treat EVERY patient w/ compassion and understanding. One day, you or a loved one might have this same situation, although I wouldn't wish this on anyone.
As nurses we do NOT have the right to judge. If a physician diagnosis a pt w/ chronic to severe pain, it is our duty to assess that pain and administer the prescribed medication as ordered!! Our conscience may require that we report potential abuse, HOWEVER, pain is still SUBJECTIVE, and the moment we forget that, the moment our ability to treat our patients w/ subjective compassion is lost.
Oct 19, '04I'm almost afraid to post my opinions. Let me start off with this - I graduated in May of this year and will be the FIRST to admit that my experience is limited. I have seen patients in severe pain whose pain was discounted only to discover later on that their pain was real and the delay in diagnosis was detrimental. I have also seen patients who became addicts having never touched an illegal drug but from developing a dependance after receiving pain meds for a legitimate medical complaint. I dislike oxycontin intensely. When a patient's oxycontin is discontinued, they suffer withdrawal symptoms including abdominal and bone pain. It isn't pleasant. Oxycontin used for terminal illness or chronic, unrelieved pain I can understand. Oxycontin for the treatment of more transient or temporary pain, I cannot. When the med is discontinued, the withdrawal pain is real - the patient doesn't know it is withdrawal, they just know that they are in pain and return to their PCP or the ER for something to stop the pain.
Follow the doctor's order? That's all well and good but, sometimes my conscience nags me to consider the toll it is taking on the patients' lives. There are many cases of patients who became addicted to oxycontin and whose lives were ruined by it. There is a campaign to ban oxycontin in some of the Canadian maritime provinces - even some MD's are pushing for the ban.
Yes, pain is what the patient says it is - but, we need to ask ourselves (as one poster has already stated), what is CAUSING the pain? If the cause cannot be cured, then by all means, continue long-term pain medication at a maintenance dose that allows for life to be lived. But, if the pain is actually due to a physical dependance on pain medication, then gentle withdrawal is necesssary and should be assisted and the patient should be counselled about the withdrawal. Individuals addicted to street drugs will seek assistance with their addictions when THEY are ready. But, if the addiction is to a prescription medication and there is no longer a physical need for the med, then the medical system has CREATED the problem and should take the responsibility for it and the steps necessary to correct it.
Oct 19, '04This thread has been an interesting read.
I've been doing research into pain and am working on competencies for our nurses who, as Fab4 has said, are working with outdated information.
I have a number of sites that relate to pain but I'm looking specifically for something I can use to write pain competencies for our nursing staff.
Any ideas? We really need to educate our staff.
Oct 20, '04I work in a small rural hospital within 10 miles of the Interstate. We get migraines, severe neck pain, etc. in the middle of the night to our ER. No insurance and just passing thru the state. A few tears and doc orders morphine or demerol and off they go in an hour. Guess a junkie could get quite a night stopping along the interstate hospitals. Especially with HIPPA and not being able to contact the other hospitals about wheither this person has been there tonight. Before HIPPA we found many who had been at the previous hospital on the Interstate. One night a woman came in doubled over,crying with lower back pain. She writhed and carried on so in front of her 15 yr. old daughter. I went to see if the ER nurse needed help and was sucked in by this scene. My heart broke for her and i asked why she(the nurse) hadn't gotten her pain meds ordered. Come to find out she was a monthly visitor with ailments that could never be proven. Once she got admitted for possible kidney stone..she ordered those meds hourly and sat on bed playing cards with her daughter. So druggy she could barely get the words out. Wanted food and to go outside for a cigarette. It made me sick. The next day i found out when she never had a kidney stone the doc she was using for this told her on no uncertain terms was she ever to seek treatment from him again.We were gonna send her to the University hospital as our ER doc at the time was not sure what was going on..they refused to take her with just her name given. Of course HIPPA kept us from knowing why.
Oct 20, '04If the medication is due, and the patient states pain, you need to give the medication...period! If you follow the physicians orders quickly, you won't have all that time lost on judgements. Go have a coffee , and thank god your not in that situation!
Oct 20, '04I have a confession to make. I am judgemental. One of the patients who frequently visits us does so by swallowing inanimate objects or some other sort of self harm actions. This latest admission, he bit his hand so he could get admitted--this was his suicidal gesture. There is no question he wanted narcotics. There is one specific MD patients love to see because they know they can get narcotics from him. So initially he got roxicodone. Most of the nurses, myself included, protested this order. The logic was that 1 it enables him; 2. it takes away a bed from someone who can benefit from it. Noone was doubting he was in pain, but we weren't going to reward his behavior. When the psychiatrist saw him, all narcotic/benzos were forbidden.
Another patient I have is a paraplegic who is on : diazepam 15mg BID; methadone 20 mg QID; baclofen 20mg BID; methadone 20 mg 1/2 hour before we get him up and into his wheelchair. Is he in pain? No question about it. Is he a drug seeker? No question about it. Do I withold his meds? Never except on one occasion when he was going through septicemia. He was unable to speak an understandable word, produced no urine and barely able to follow the simplest of commands and his vitals were a concern. When I came into his room and assessed him, I would have sworn he was cheeking meds and attempted an OD. I believe medicating him would have been a detriment to my license.
I may be incorrectly interpreting previous posts, but it seems some say that giving pain meds is a black and white situation. I don't believe that is necessarily the case. We do treat for pain based upon what the pt says, or if the pt can't communicate, based on what we assess. We as nurses should give meds whether we feel they need meds or not, unless we feel the medication will further harm the patient. Another thing to note is that when treating previous drug users, often they require many more meds to achieve the same pain relief as someone who has never abused drugs, so that should be taken into consideration.
Oct 20, '04Don't mistake my post..this was an exception and a proven abuser. I am all for pain meds, and believe no one should have to experience it. There are multitudes of meds available, and in my opinion there is no reason for anyone to suffer needlessly. I am quite liberal with prn pain meds. But that situation I described was a woman who should have been applying for an acting job, she surely woulda own the oscar for her performance. It was blatant that she was using the system and us as nurses to get drugs. I resent her taking my time away from my patients that night. I pulled her old chart that night and she had pulled this many times at our hospital. However if she were to seek psychiatric help that would be another story.
Oct 20, '04Quote from niteshiftnutif he was saying he would leave ama over a cheeseburger and higher dose - i think i would get the paperwork ready and remind him he will get the bill for it since he is leaving ama - and let him sign out - wowjust 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
Oct 20, '04I learned cynicism from my drug seekers. I am the first to offer pain meds to patients with genuine pain and a reason for the pain. BUT I learned from folks like Patient X who would be admitted for exacerbation of COPD and get an aminphylline drip...and nubain with phenergan every 4 hours, IV push, for pain. She would walk up to the nurses station 5 min before her dose was due so she could get a cup of coffee and her shot. Then she would proceed to stay awake for days on end, sitting on the side of the bed with her perpetual cup of coffee, swaying drunkenly but refusing to lay down to sleep. It is safe to assume she didn't want to sleep thru a due time for her shot.
This made me cynical. She is just a small sample and not an isolated incident.
My time in the ER has taught me that patients don't understand the pain scale very well and that they think if they report anything less than a 10/10, they won't be treated for pain. I try to qualify the 10 rating by giving an example to women of active labor and to men of having a limb severed, LOL. I don't think people can accurately judge the pain scale until they have experienced a true 10. By the same token, when I know a person has a hx of cancer or some illness/injury that puts a 10/10 rating in perspective, I am VERY likely to take their report of a 6/10 as significant pain in relation to other people....but our profession is not one of concrete one-size-fits-all treatment.
I don't think I have ever refused to give pain meds to a patient before. I think my source of aggravation stems from the ones who stalk you in the hall when their dose is due and you have a full load of patients who need stuff but they are in the halls, following you, standing at the nurses station watching every move you make until you can get to the drug box and draw up their meds.Last edit by ScarlettRN on Oct 20, '04
Oct 22, '04No arguement here just wanted to share something I have been thinking about . I work in LTC and often I wonder about pain meds in the elderly . We have some pts known as clock watchers. I don't judge but oftentimes I worry about the effect some pain meds have on the healing process ( some pts are so "relaxed" they rather sleep than attend therapy) Also I worry about the cognitive effects pain meds have on an unstable elderly resident or those suffering with dementia . I would welcome more education on pain and its management , particularly in the elderly .