Addicts!!! NURSES How do you seperate addicts from pts. who really are in pain?!

Nurses General Nursing

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Ok let me make this short and straight to the point...

I am currently in nursing school for my BSN, and at the same time I have sickle cell disease. Basically I've been the patient plenty of times and now I will soon play the roll of a nurse (a good one at that). I am really tired of Nurses and especially Docs who think pts. with my disease are drug addicts and only want a high. We go thru serious and I mean SERIOUS pain. It is nothing to joke around with because I know exactly how it feels. I've experienced ignornant docs that try and make it seem like I am lying. This is a situation that ****** me off. I didn't ask to be born with sickle cell but i'm dealing with it just like everyone else in the world that has something they didn't ask for. Instead of nurses and docs to be on the pts. side to make things run smoother, they want to be judgemental. I really wish there was a mechine that had all of the diseases in the world which you can go into and live a life of someone else suffing for one disease or another just for a day, and maybe nurses and docs will change their nasty attitudes towards pts. in pain.

I want to thank all the nurses that have been there for me in the hospital because not everyone is like that. There were really sweet nurses who were caring and understood my situation. Again thanks too all those nurses who truely care for people.

Now I am not trying to start a riot, I just want to get peoples comments, ideas, respones, opinions etc. on either how they know a pt. is telling the truth about pain or what they think in general. Thanks in advance for all the responses:nurse:

Specializes in Med-Surg.

Better to treat a person who is not in pain for pain, than to deny a patient who is in pain treatment.

Kind of like the American justice system. Better a million guilty men go free than one innocent man be put to death.

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Specializes in Rehab, Infection, LTC.

my first husband had porphyria. although porphyria and sickle cell have nothing in common, they present basically the same (abdominal pain, neuropathies, no treatment except IVF and pain meds, pts on chronic pain meds usually).

after 14 yrs of watching how nurses and doctors treated him like a drug addict, nothing suprises me anymore.

i, too, wish that nurses could be less judgemental and treat the pt's pain for what they say it is, not what the nurse thinks it is.

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Specializes in ER, LTC, IHS.
I look for pysiologic signs such as higher bp and pulse. We also look into the pts old charts and visits. We see if they are under the care of a pcp and if they go their follow ups. Also when you see many FFs you get a sense of the real pts in need.

I guess I wasn't clear enough in my first post. I never meant to imply that I don't give the meds. As a nurse it is my job to do what the doctor orders. If pain meds are ordered then I give them regardless if I belief the pt or not. The things I listed in my first posting are issues I will bring up with the doc IF he wants my opinion. Hope that clears it up.

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I am really tired of Nurses and especially Docs who think pts. with my disease are drug addicts and only want a high.

What rationale are these nurses and doctors giving you for labeling you an addict?

Addicts of all types tend to show similar behavior patterns - recognizing those patterns is how you separate them from people who need pain relief or help with physical dependence (different from addiction). You don't even have to see an addict use their drug of choice to recognize them. My family is riddled with addicts and that experience helps me spot them.

Good luck

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Some pts. have told me they over heard the nurse say that they were drug seekers (addicts). As for me, the doc did it indirectly. He said "Your blood count is not that high, why do you need more pain meds?" That tells you right there that he was not going off subjective data, he was using my blood count as an excuse to be judgemental. I told him I was going through pain and who is he to tell me what I am feeling? I could be in school focusing on finishing my BSN, why would I want to jeapordize that? I gave that doc a piece of my mind and he walked away with a smerk on his face. He was ridiculous!!!

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The smirk on his face tells you all you need to know. His behavior is common and you can expect to get a hard time from a good number of health care professionalss when it comes to pain meds that are controlled substances. It just is the way it is. That is why you need to get with a pain management specialist. Supposedly, those professionals know how to deal with a patient's pain without resorting to giving the patient a hard time.

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Specializes in pediatrics, palliative, pain management.

Great thread! This is one of the biggest challenges of pain management, the concern about addiction. What I believe (and teach) is that addiction isn't something you can discover easily or in the immediate first few minutes. I strongly believe that drug seeking behaviour is a pattern of maladaptive behaviours that really need a lengthy (over a few days while in hospital or repeated visits in the community) by a group of people --- not just one practitioner.

I hate when people label a patient as "drug seeking" because the majority of time it is done based upon assumptions and a very cursory history/ assessment. For example I saw a post op day 4 patient who developed new onset very localized (surgical site) pain. I am thinking possible infection. I talk with the patient's nurse about the new pain. Before I can even finish expressing my concerns she informs me he has a "history" and implies that he is drug seeking. Yes this patient is a known recovering addict (clean x 2 years). I have seen him every day post op and his use of medication has been completely appropriate. This nurse was using his addict history to dismiss his pain and not even fully investigate it.

Another situation, man with severe back pain, came in for surgery (unrelated to back). Was on large opioid doses in community. We continued his opioids and sent him home on basically the same amount as pre op. I was talking with one of his nurses about his care, and how he had been on the same dose (relatively stable amount) since the 1960s. She commented "oh he really is an addict!" Really? A patient who has been on a stable dose for 50+ years, has functioned, kept a job, raised a family and had no illegal activities, had one primary physician following his pain meds is an addict?

I suspect that unfortunately many people in the health profession do not understand addiction or what actually constitutes it, yet think that they can claim to know when a patient is "drug seeking."

Only one other comment/ concern re earlier posts regarding vital sign changes --- Yes, vital signs change with acute pain, so this is useful when pain is sudden onset/ new pain , however very important to remember that chronic pain (persistant pain) does not usually present with vital sign changes. Remember that even with out increased vitals, a patient can still be in pain.

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Specializes in allergy and asthma, urgent care.

This is one of my biggest challenges as an NP in an urban community health center. Sadly, the community I work in has a huge drug problem, specifically with percocet and oxycontin. I am not as much concerned with patients seeking the narcotics for their own use, but we have plenty of patients who want them to sell on the street. We have a pharmacy in-house, and it's not unheard of to have patients trying to sell their drugs before they even leave the premises. This situation has made me very cautious about prescribing narcotics to anyone. We try to send chronic pain patients to pain management, but there are often long waits for appointments and insurance issues. I try to use NSAIDS as much as possible, particularly with new patients who we have no background on. We do a lot of urine drug screens, particularly on patients who request early refills, repeatedly miss appointments to ortho, neuro, or pain mgmt, or exhibit other unsettling behaviors. We will not prescribe narcotics to anyone whose drug screen is negative when they are supposedly taking a specific narcotic (may be selling their rx), or if the screen is positive for something illegal or for a drug we did not prescribe. It's walking a fine line...I certainly want to properly treat patients who need pain relief, but I also don't want to contribute to an already serious drug problem in the community or in an individual. To me, that is doing harm. If I have a patient with a chief complaint of severe back pain, who walks into the clinic at a fast pace while laughing on their cell phone and then asks me for "percs-the 10 ,not the 5", they won't get it. And sadly, this happens all the time. So I am a little jaded. I try to be as objective as possible, but sometimes I go with my gut. There are people who truly need narcotic pain relief and if they're consistent with seeing their provider, going to their referrals, and using their meds appropriately I'm happy to prescribe them. However,I've been burned too many times by the "pain is whatever the patient says it is" philosophy to accept strictly the patient's word as gospel.

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Better to treat a person who is not in pain for pain, than to deny a patient who is in pain treatment.

Kind of like the American justice system. Better a million guilty men go free than one innocent man be put to death.

Not the same thing, really, since the million guilty people will harm many more innocent folks. But I digress.

While I think a nurse should give prescribed meds when due, unless there are clear contraindications, there needs to be a second step if the nurse has reason to suspect drug seeking.

That is to inform the appropriate docs of the reasons for your suspicion. It does the Pt no favors to leave him/her with an untreated addiction. True, they may not want or agree to treatment, or even assessment, but if you suspected an infx, wouldn't you get an assessment ordered, since it has the potential to harm the Pt?

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Some pts. have told me they over heard the nurse say that they were drug seekers (addicts). As for me, the doc did it indirectly. He said "Your blood count is not that high, why do you need more pain meds?" That tells you right there that he was not going off subjective data, he was using my blood count as an excuse to be judgemental. I told him I was going through pain and who is he to tell me what I am feeling? I could be in school focusing on finishing my BSN, why would I want to jeapordize that? I gave that doc a piece of my mind and he walked away with a smerk on his face. He was ridiculous!!!

Could he have been asking the ? in an attempt to determine if you had a co-morbidity that was causing pain?

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Specializes in Infusion, Med/Surg/Tele, Outpatient.

Like others have said, Great thread. As a general rule if my assessment shows an indication for giving a PRN medication, I give it. Pt reports pain 5/10 dull ache head - give PRN pain medication; if MD gave options ie APAP, norco, darvocet, morphine I'll ask the pt what they'd like. If the doc has orders, its not my place to judge a subjective assessment. Ditto for nausea - pt reports nausea, give PRN antiemetic. For objective PRNs like an order for PRN catapres 0.1 mg PO q6h for SPB > 160; if the pt's SBP > 160, the docs I work with want to know why you didn't give the PRN. If I have an abnormality upon assessment, I believe its my duty to address it, whatever it is. SCC is by all accounts a horridly painful event and most docs will only order just enough narcotic to tide a pt over; any nurse who witholds meds should be taken out the back...

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Specializes in Med/Surg, ID, Oncology, Ortho.
This is one of my biggest challenges as an NP in an urban community health center. Sadly, the community I work in has a huge drug problem, specifically with percocet and oxycontin. I am not as much concerned with patients seeking the narcotics for their own use, but we have plenty of patients who want them to sell on the street. We have a pharmacy in-house, and it's not unheard of to have patients trying to sell their drugs before they even leave the premises. This situation has made me very cautious about prescribing narcotics to anyone. We try to send chronic pain patients to pain management, but there are often long waits for appointments and insurance issues. I try to use NSAIDS as much as possible, particularly with new patients who we have no background on. We do a lot of urine drug screens, particularly on patients who request early refills, repeatedly miss appointments to ortho, neuro, or pain mgmt, or exhibit other unsettling behaviors. We will not prescribe narcotics to anyone whose drug screen is negative when they are supposedly taking a specific narcotic (may be selling their rx), or if the screen is positive for something illegal or for a drug we did not prescribe. It's walking a fine line...I certainly want to properly treat patients who need pain relief, but I also don't want to contribute to an already serious drug problem in the community or in an individual. To me, that is doing harm. If I have a patient with a chief complaint of severe back pain, who walks into the clinic at a fast pace while laughing on their cell phone and then asks me for "percs-the 10 ,not the 5", they won't get it. And sadly, this happens all the time. So I am a little jaded. I try to be as objective as possible, but sometimes I go with my gut. There are people who truly need narcotic pain relief and if they're consistent with seeing their provider, going to their referrals, and using their meds appropriately I'm happy to prescribe them. However,I've been burned too many times by the "pain is whatever the patient says it is" philosophy to accept strictly the patient's word as gospel.

BC Gradnurse,

A few of your comments concern me a bit, so I would like to address them individually.

-The patient you have described walking at a fast pace into your clinic may have a chronic pain issue. Please forgive me if I am wrong, but as you know, if this was the case, their bodies acclimate to the pain to some degree and they are much more functional than those who are in acute pain. There are minimal, if any, VS changes, no text-book facial grimacing, etc.

-You said that you try to be as objective as possible. I do hope, as a nurse, that you meant subjective. It is not our position to be judge and jury, as many of us have stated in this thread. The patient's word, more often times than not, is gospel, especially when it comes to pain, as we cannot feel anyone else's pain.

-I do, however, understand your frustration because of the drug problems you have in your community, but even in suburban *gasp* and rural communities, drug abuse abounds. Perhaps we should let law enforcement do their job, and we just stick to doing ours. You are not contributing to the drug problem in your community by prescribing #90 vicoden or percocet. And you can insist upon not writing the "10's", write the "5's" and you may see that your "repeat offenders" may just not bother coming back to your clinic so that you need not worry about your own contribution to the drug problems in your community.

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