Addicts in the ED

Guest374845 · May 24, 2017

That's what social work is for. You said yourself the pt was there seeking drugs, so I'd lose no sleep over a discharge. If the pt was there seeking help, detox, etc then I'd find them something. Addicts have to show some readiness for any attempt at or entry into treatment to be successful.

amzyRN · May 24, 2017

We have a social worker who does that kind of thing. It's kind to try to offer them help. I have told an addict that was caught malingering that all this charade was wasting his life and that he needed to get help for this. He underwent a CT with contrast. Some of these addicts put their health at significant risk for a little bit of dilaudid. That is a swerious problem This particular patient pretended to be paraplegic but was caught up walking around in the room. He was very convincing. I think it is unethical to pretend with some people that they don't have a problem and just discharge them. It's better to tell somene they have a serious problem and hand them a list of resources.

~Mi Vida Loca~RN, ASN, RN · May 24, 2017

I just want to point out not all ER's have social workers and not all that do have them around the clock. I'll leave it at that because I am not going to get involved in a debate about addicts.

Guest374845 · May 24, 2017

I think we, as nurses, SHOULD debate.

So, not all EDs have 24/7 social workers, check. It's not ethical NOT to help out a patient with a substance abuse problem, check. Both good discussion points.

Mine: I don't think it's ethical to use drugs or waste hospitals'/nurses'/doctors' time seeking, and I have absolutely nothing but disdain for drunks and dope fiends and make near zero effort to "assist" them.

JKL33 · May 24, 2017

When you have a chance, do a little of your own research into your local resources - ask a variety of your colleagues, your manager and educator, the hospital social worker if you have access to one, check online for things in your area - this will probably get you much further than asking any one individual. It's probably also a good idea to run your findings by your manager for approval to refer patients to the sources of help you come up with, since you are officially acting on the hospital's behalf in your role.

One thing that hasn't been mentioned yet that could get a little sticky for you 'in the moment' is that some patients such as the one you describe will not be happy with your well-intentioned resource/referral for help with their condition. They may not agree/acknowledge that they need the kind of help you are suggesting and may take varying degrees of umbrage at your "assumptions". I make sure everyone has a PCP referral or refer them to contact their pain management practice, or give them info for a pain management practice. Every ED patient should have a referral for follow-up. Ideally you could have an addictions/detox referral (even if it's regional as opposed to local), a pain management referral, and a PCP referral...give all 3 of these and say something like, "Here are the numbers for a "family doctor", a pain management doctor if you need help managing your pain, and also I like to include the number for Local Help House because some of our patients are worried about their use of pain medication". Remain pleasant and neutral always. Both in your interactions with the patient, and in your own emotional processing of what you personally can realistically do.

~Mi Vida Loca~RN, ASN, RN · May 25, 2017

When you have a chance, do a little of your own research into your local resources - ask a variety of your colleagues, your manager and educator, the hospital social worker if you have access to one, check online for things in your area - this will probably get you much further than asking any one individual. It's probably also a good idea to run your findings by your manager for approval to refer patients to the sources of help you come up with, since you are officially acting on the hospital's behalf in your role.
One thing that hasn't been mentioned yet that could get a little sticky for you 'in the moment' is that some patients such as the one you describe will not be happy with your well-intentioned resource/referral for help with their condition. They may not agree/acknowledge that they need the kind of help you are suggesting and may take varying degrees of umbrage at your "assumptions". I make sure everyone has a PCP referral or refer them to contact their pain management practice, or give them info for a pain management practice. Every ED patient should have a referral for follow-up. Ideally you could have an addictions/detox referral (even if it's regional as opposed to local), a pain management referral, and a PCP referral...give all 3 of these and say something like, "Here are the numbers for a "family doctor", a pain management doctor if you need help managing your pain, and also I like to include the number for Local Help House because some of our patients are worried about their use of pain medication". Remain pleasant and neutral always. Both in your interactions with the patient, and in your own emotional processing of what you personally can realistically do.

^^^^ This!

Absolutely you can look into what options and resources are available and gauge the patient to see if they seem like they are hoping for help or a referral to help. There are a lot of places out there that some don't know about.

Tomorrow my 10 year old daughter and I are going to a veteran transitional living home to cook tacos for the guys. It's an 18 month program for Veterans that were at one time homeless and have served in the war and are at least 14 days sober. They can only house 18 guys but it's such a wonderful program. They are very strict and but they focus on the big picture not JUST the addiction aspect, but the PTSD aspect and other mental health factors, the slowly helping people back into functioning in everyday society again, transitioning to their own place. Etc. etc.

I had NO IDEA this place even existed and I worked in the local ER. I have also discovered there are other houses local churches help with. I am very involved with our veterans battling post war mental health and drug issues and one of the guys I was talking too who had been homeless for 1.5 years had no idea about the house I was talking about. So if this is something that truly pulls at you, you can spend some time researching and getting to know places that might be available so that you know next time if the opportunity presents itself. Unfortunately there is so much mis-information regarding addiction and lack of education that so many of our own colleagues rather just lump everyone up into one barrel and be done with them. Which is exactly why the problem continues to get worse.

amzyRN · May 25, 2017

I try not to judge people who have addictions because I don't know what their circumstances were to exacerbate certain problems. I know I have seen lots of veterans with drug problems, either alcohol or heroin. There are women who were abused and raped who develop drug problems. I tend to read prior visits of patients like these who come in to gauge where they are coming from. To come into a hospital and manipulate and undergo tests with serious health consequences like radiation from CT scans and X-rays shows that these people are really sick. I feel like this behavior needs to be addressed, by MDs saying no to giving narcotics and by adequate follow-up. I worked with one ER doc who was very strict with this, if he discovered a drug seeker/manipulator he would call it out and refuse to prescribe anything narcotic. One person made a huge scene, but too bad. We got security to escort the person out.

WKShadowNP, DNP, APRN · May 25, 2017

Mi Vida loca, I have grown fonder and fonder of you because so many of your posts echo my own perspective . This one mirrors mine so closely that I felt compelled to do more than simply like your post.

Keep on rockin' it!

allnurses Guide · May 26, 2017

I just want to point out not all ER's have social workers and not all that do have them around the clock. I'll leave it at that because I am not going to get involved in a debate about addicts.

Oh but I absolutely will. Just because a person is in the ED seeking medication for pain relief doesn't make them an addict and can we please stop throwing the word addict around like it's a dirty subject. Most of the time this subject comes up the strongest voices seem to be those who have never experienced chronic unremitting pain. True addicts don't go to the ER and wait 6 hours for a fix when they know they can one on the corner in about 20 minutes. Do some people abuse the system of course. Nurses who really want to be helpful should take some CEU's on Chronic pain as well as on addiction vs tolerance/dependence. Even when a true addict appears it is best to remember that addicts are not bad people they are sick people who don't know how to get well. Do we routinely rush out of the ER chronic smokers who now have lung cancer, people careless in their sex lives who now have stds, diabetics in kidney failure? We care for them equally and with compassion.

Just food for thought

Hppy

~Mi Vida Loca~RN, ASN, RN · May 26, 2017

Mi Vida loca, I have grown fonder and fonder of you because so many of your posts echo my own perspective . This one mirrors mine so closely that I felt compelled to do more than simply like your post.
Keep on rockin' it!

Thank you!! :) I enjoy your posts as well, however every time I read your signature I always think it says you're in southeast Asia lol

~Mi Vida Loca~RN, ASN, RN · May 26, 2017

Oh but I absolutely will. Just because a person is in the ED seeking medication for pain relief doesn't make them an addict and can we please stop throwing the word addict around like it's a dirty subject. Most of the time this subject comes up the strongest voices seem to be those who have never experienced chronic unremitting pain. True addicts don't go to the ER and wait 6 hours for a fix when they know they can one on the corner in about 20 minutes. Do some people abuse the system of course. Nurses who really want to be helpful should take some CEU's on Chronic pain as well as on addiction vs tolerance/dependence. Even when a true addict appears it is best to remember that addicts are not bad people they are sick people who don't know how to get well. Do we routinely rush out of the ER chronic smokers who now have lung cancer, people careless in their sex lives who now have stds, diabetics in kidney failure? We care for them equally and with compassion.
Just food for thought
Hppy

Just to clarify I only said I wasn't going to get into the debate because I have found that ESPECIALLY in our profession, it's a wasted debate and I just find myself getting so irritated and disgusted by the misinformation and judgements and uneducated responses. I live in one of the cities hit the hardest by opiate addiction and I find myself in debates constantly on the comment sections of the latest new article on what my state is doing to try and combat this. Just hoping I can knock some sense into some people backed up by facts and rationale. Based off the other posters previous posts I knew it would go no where so I refrained.

When it comes to this and the topic of mental health and suicide I get way to passionate and then irritated with the asinine responses.