Question regarding narcotic addiction

  1. The nurses and aides have been arguing for some time about addiction. A nursing student told a nurse that a patient cannot get addicted to narcotics IF they only take the medication when they are in pain and they take it as prescribed concerning time and dosage. Makes sense. She said a pain specialist came to her university to discuss this with them.

    Many nurses disagree. Our hospital is notorious as one that believes if you take a narcotic pain medication more than once a day then you are addicted. If an order is written for 1-2 pain pills the nurse will only bring one, even if pt requested 2. Then, if one hour later same pt is still in severe pain they will not administer the second pain pill. Is there anything wrong with taking the second pain pill an hour later than receiving the first?

    Can anyone give me some good reliable links regarding these questions while posting your thoughts? It angers me that people think if you take a narcotic then you are an addict. Right me if I'm wrong, but I always thought an addict takes medication without having pain, purely to get high and takes more than the required dose.

    A pet peeve: the nurses that roll their eyes when I tell them that a pt needs pain meds even if they're post op. Like I said, we are notorious.
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  2. 25 Comments

  3. by   augigi
    There is no excuse for giving inadequate analgesia from ignorance about addiction.

    Great link for the issues:
    http://www.ahrq.gov/clinic/medtep/acute.htm

    There is just so much research about this topic that it's unforgiveable to be so inflexible from lack of education. It's so much harder to relieve pain than to prevent it.

    Do you have a pain management department/specialist you can organize to talk to the unit as an in-service?

    Grrr.. this is a pet hate of mine.
  4. by   Tweety
    Good grief, I can't believe nurses in this day and age still think that a patient who needs pain medicine in the hospital will become a drug addict. Hmmm.........they've had their belly sliced open to remove their colon.......better be careful with the pain medicine because they might become a drug addict these few days they are here. sheesh..............

    Good luck. Sounds like a pain inservice is needed. Good luck with gathering up the information.
  5. by   augigi
    Can't figure out how to attach it (too big) but have a couple articles if you want to PM me your email addy.
  6. by   RebeccaJeanRN
    Quote from bethin
    The nurses and aides have been arguing for some time about addiction. A nursing student told a nurse that a patient cannot get addicted to narcotics IF they only take the medication when they are in pain and they take it as prescribed concerning time and dosage. Makes sense. She said a pain specialist came to her university to discuss this with them.

    Can anyone give me some good reliable links regarding these questions while posting your thoughts? It angers me that people think if you take a narcotic then you are an addict. Right me if I'm wrong, but I always thought an addict takes medication without having pain, purely to get high and takes more than the required dose.
    One is NOT an addict because of taking meds that are needed. Pain control is a good thing and denial of that pain control, especially when ordered, is cruel and not within the standards of nursing practice. However, that being said I'd also like to offer that an addict often doesn't seek meds to get high. After one is addicted, meds are sought after just to feel normal and avoid withdrawal. The fun part is usually over for the real addict. We were taught not to concern ourselves about the idea that our patient, who is now post-op and asking for pain med, may also have had an outside drug problem before entering the hospital (at least with regard to giving pain control). We were told to give the pain medication as ordered and to consider pain management as a humane practice, regardless. Your fellow nurses are practicing against the current standard. Current nursing texts should have lots to say that you can copy and quote about pain management standards and goals. I remember one study about how people healed faster and were released from the hospital sooner, when their pain was managed better from the get-go.
  7. by   NRSKarenRN
    have you checked our many website links posted here: pain management resources

    especially:

    what is pain:

    avoiding misconceptions in pain management
    one main reason for this undertreated pain is the existence of several myths and misconceptions regarding pain management. goal of this summary to dispel these myths and misconceptions.
    free registration required.
    http://www.medscape.com/viewarticle/418521


    nursing2002 study reveals nurses know pain but not narcotics
    research over the last 20 years has shown that fewer than 1% of patients who use a strong narcotic to control pain become addicted, even when they use the drug for 6 months or more.

    algorithm for pain assessment and management
    ahrq: government guidelines for acute and chronic pain:
    assessment and management of acute pain assessment algorithm added 4/23/06
    assessment and management of chronic pain assessment algorithm added 4/23/06
    management algorithm


    adult pain management staff education --has pain scales shown
    http://www.med.umich.edu/pain/apainmgt.htm


    does your facility have a pain management specialist on staff??
    if not, please ask nurse manager for inservice as sounds like facility not keeping up with jcaho standard that pain be assessed and treated adequately.
    Last edit by NRSKarenRN on Sep 26, '06
  8. by   Tweety
    Good links Karen. I was going to go to my school's website and look for some scholarly articles, but those are great because they list references.
  9. by   NRSKarenRN
    from nursing spectrum:

    the whys of pain mismanagement: is your bias showing?
    lorraine steefel, rn, msn
    [color=dimgray]masthead date july 02, 2001
    http://community.nursingspectrum.com...e.cfm?aid=4349

    though less than 1% of any patient population becomes addicted to pain-relieving opioid analgesics, many nurses believe the percentage is much higher, which leads to bias and subsequent undermedication.

    i encourage everyone to read pain : clinical manual
    by margo mccaffery and chris pasero --the nursing experts in pain control




    http://www3.us.elsevierhealth.com/pain/preface.html


    just added to pain resource thread:

    city of hope's pain management resources added 9/06
    multiple educational articles, books and publications listed
    Last edit by NRSKarenRN on Sep 26, '06
  10. by   vamedic4
    QUOTE Many nurses disagree. Our hospital is notorious as one that believes if you take a narcotic pain medication more than once a day then you are addicted. If an order is written for 1-2 pain pills the nurse will only bring one, even if pt requested 2. Then, if one hour later same pt is still in severe pain they will not administer the second pain pill. Is there anything wrong with taking the second pain pill an hour later than receiving the first?

    The answer to your question is NO, there's nothing wrong with it. If the doctor orders it for pain, then it should be given. And if it's not effective in relieving the pain, he should be called back and other options should be given to the patient.
    It is unfortunate that nurses should be so ignorant of pain issues, but until you've expereinced it yourself-be it acute or chronic pain, you have no idea.


    Sounds like your nurses need some SERIOUS education about pain issues. I'm with others here, as pain management is a HUGE pet peeve of mine. Several doctors at one facility I used to work felt the same way as the nurses until they were adequately educated...unfortunately it's not just nurses out there who are inadequately informed.

    People who take narcotics therapeutically often do so to PREVENT painful episodes, such as those that occur with conditions like cancer pain, migraines, neuropathies, et cetera. All of these patients are followed by physicians and closely monitored in terms of dosage and effectiveness.
    They become dependent on these meds because their bodies have become accustomed to the effects in their system- the main effect and the ENTIRE REASON THEY TAKE THEM is for relief of pain. Does this mean they are addicted?? NO. Does this mean they will suffer withdrawal if they don't take the meds?? YES. Withdrawal results from a lack of the therapeutic level of the medicine in the patient's body.
    Example, patient takes 30 mg MS Contin 3x/day for chronic back pain. If they have always done this dosing regimen, then cutting their dose to twice a day will cause them to suffer withdrawal symptoms because the level of drug they are "accustomed" to is not in their system. Eventually their bodies will recover and adjust to the new dosage, but it doesn't mean they're ADDICTED. I hate that word.

    vamedic4
    hoping to clear the air
  11. by   NRSKarenRN
    Do doctors and nurses say that Hypertensive patients are "addicted to their blood pressure meds" despite need for increased dosage to control elevated BP?

    Do doctors and nurses say that Diabetic patients are "addicted to their diabetic meds" despite need for increased dosage to maintain control over elevated blood sugars???

    Then why should patients with pain be treated any differently?

    To have adequate relief to be able to function in daily life is all most people with acute/chronic pain are asking for...
  12. by   bethin
    Quote from NRSKarenRN
    Do doctors and nurses say that Hypertensive patients are "addicted to their blood pressure meds" despite need for increased dosage to control elevated BP?

    Do doctors and nurses say that Diabetic patients are "addicted to their diabetic meds" despite need for increased dosage to maintain control over elevated blood sugars???

    Then why should patients with pain be treated any differently?

    To have adequate relief to be able to function in daily life is all most people with acute/chronic pain are asking for...
    You bring up a very good point. And thank you for the links.

    I'm sick of a pt asking me for pain meds, then when I tell the nurse they roll their eyes and say they don't look like they're in pain. Guess what I do when I'm in pain? I watch funny movies. It helps take my mind off of the pain while the meds are working. So I make very sure if I'm a pt that no one finds me with a smile on my face.

    If an addict rolled into the ER because he had a compound leg fx, would we refuse to give pain meds? Of course not.

    I work tomorrow and will be speaking to our staff development educator about a possible inservice, and I will provide her with the links. I think it should be mandatory.
  13. by   jerseyboy
  14. by   Kirsti1181
    Nurses refusing to give pain meds is a big pet peeve of mine too. I suffer from chronic back pain and have to take narcotics daily to function. Yes, I have built up a tolerance to my meds but I am not addicted. But yet anytime I have to list my meds, I usually get a sarcastic "...and you're on this because?" or a not so subtle eye roll. If the patient needs something for pain, it should be given. It is not our job to determine whether or not the patient is really in pain, it is our job to assume that pain is what the patient says it is and to treat it accordingly.

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