Administering pain meds to narcotic seekers

GM2RN · May 10, 2010

I am struggling with some ethical issues of administering large amounts of pain medications and muscle relaxants to pill seekers. I know we have been taught to not judge others pain. I am sure almost all nurses have experienced that patient who knows each and every med they receive and when it is available. They are on the call light constantly requesting one medication after another. Due to my personal feelings, I find it difficult to continue to administer multipule pain medications with muscle relaxants and CNS depressants. I know some people have built up a tolerance for certain medications. How do you set aside your own ethical feelings and do what the doctor and patients want. I worry about my patient coding. I have educated my patients on the effect of the medications on HR and respirations. These particular patients have already heard the lecture and continue to request what ever is available. I feel like an enabler. I have worked with nurses who say "give them what they want."

I don't understand what is unethical about this. These patients have been evaluated by a physician who has prescribed pain medication for patients who state that they have pain. As long as there is no reason to question the order for some reason, and you are evaluating for s/s that they are receiving too much medication, there's no reason that these patients should not get what they want, even if they are "seekers." You are right that we are not to judge when patients say they are in pain since we don't experience what they are feeling, and even seekers can have pain. You really need to come to terms with this for your own sake or you will wear yourself out worrying about it.

Music in My Heart · May 10, 2010

If the doc writes the order and the pharmacist posts the order then, so long as the patient is physiologically stable, then I have no authority, right, nor moral obligation to withhold the med.

The nurse who gives the med is not the enabler, the doc who writes the order is.

And so what? Withholding the narcs is not going to help the patient anymore than is denying them a nicotine fix.

Sniper RN · May 10, 2010

You can't judge their pain.

All you can do is try and help them get comfortable. That may involve giving them pain meds. No harm in that.

whichone'spink, BSN, RN · May 10, 2010

This patient has built up a physiological tolerance to opioids that he/she needs higher doses. A dose that would lower the RR of someone not used to opioids would probably not affect someone like your patient. The consequences of holding the medication are worse for someone who is physiologically dependent on opioids.

aprilgemini24 · May 10, 2010

It's not for you to judge. Whether they are a crackhead or have a high tolerance, whether they are drug seekers or have legitimate pain, you have to find a way to not think about the ethical side because that part of it is not your concern (whether it is right or wrong). If you can't get over it, move to a different area of nursing. Also, if you are truly worried about them coding, that is why we do assessments while giving the med and soon after giving it. If you are diligent with the assessments, you can catch respiratory depression and other complications of high doses of pain medicine.

BobbieJo · May 10, 2010

I guess I did not state my question very well. This particular patient I am talking about had several prn meds. Just because the doctor ordered all of these particular meds and the pharmacy has placed them on the MAR does not give us the right to give them a hand full of prn meds at one time just because they requested them right? I understand that this patient has probably built up a tolerance for these medications. Isan't it our responsibility to not overdose our patient knowing the affects of these prn meds. I am accountable and responsible for my patient even though the doctor has written numerous prn orders. So am I not liable for my patient when respirations are 8 per min due to all of the prn meds as long as I only give as ordered?

~Mi Vida Loca~RN, ASN, RN · May 10, 2010

How do you know they are drug seeking and not in real pain? Have you dealt with severe chronic pain issues?

Nursing is not a field that allows for your personal judgments to get in the way, when you start allowing it too your patients and their care will suffer. If it's not something you can do than I would suggest a new profession.

~Mi Vida Loca~RN, ASN, RN · May 10, 2010

I guess I did not state my question very well. This particular patient I am talking about had several prn meds. Just because the doctor ordered all of these particular meds and the pharmacy has placed them on the MAR does not give us the right to give them a hand full of prn meds at one time just because they requested them right? I understand that this patient has probably built up a tolerance for these medications. Isan't it our responsibility to not overdose our patient knowing the affects of these prn meds. I am accountable and responsible for my patient even though the doctor has written numerous prn orders. So am I not liable for my patient when respirations are 8 per min due to all of the prn meds as long as I only give as ordered?

If your patient is out of it and their vital signs are dangerous then obviously no you shouldn't be given them the meds in fact you need to be calling the doctor for maybe some narcan.

BUT if their vitals are stable and they are requesting their (as needed) meds and they feel they are needed and they are ordered then I don't see how you can judge that they don't need them. Sometimes when you have chronic pain your pain is back before that 4-6 hours so you are waiting right to the time to get them again, not because your pain magically came back at the exact moment.

Some meds are safe to be taken together because they work on different areas, now if you had an order for 1-2 10/350 or Norco 1-2 5/350 of Vicodin and 1-2 10/350 of percocet and they hadn't had any in the 4-6 hours and you administered all of them at once, than yes, that is not OK, they are all the same class of meds and that would be to much Tylenol.

GM2RN · May 10, 2010

I guess I did not state my question very well. This particular patient I am talking about had several prn meds. Just because the doctor ordered all of these particular meds and the pharmacy has placed them on the MAR does not give us the right to give them a hand full of prn meds at one time just because they requested them right? I understand that this patient has probably built up a tolerance for these medications. Isan't it our responsibility to not overdose our patient knowing the affects of these prn meds. I am accountable and responsible for my patient even though the doctor has written numerous prn orders. So am I not liable for my patient when respirations are 8 per min due to all of the prn meds as long as I only give as ordered?

If respirations are 8 per minute then of course you need to withold more meds if you feel they are overmedicated. But you also need to know what the rest of their vitals are, if your patient is alert and oriented or if he is lethargic and difficult to arrouse, and contact the doc if you feel the pt has had too much medication. You may also need to narc this pt. However, your original post said nothing of this. You stated that you were struggling with the ethical issues of giving pain meds to what you described as drug seekers, which is entirely different from what you now describe.

allnurses Guide · May 10, 2010

You aren't going to rehabilitate a drug addict in the short time they are with you at the hospital. Whether it is emotional or physical pain doesn't matter. They have a medication order and as long as their VS are within the scope of safe administration, your orders are to administer.

Go to the Addiction Nursing forum and read there. There are some EXCELLENT posts there about how to turn around the tendency to pre-judge these patients.

kcochrane · May 10, 2010

As others have stated, tolerence builds up to pain meds the more they are used. So you may think its a large dose...and it would be for someone like my husband that never takes any pain meds. But for someone with chronic pain or someone that abuses narcaotics, it isn't. Even those addicted have pain. They deserve to be medicated to relieve that pain. But it is possible to have too much prescribed by the MD.

I ask which prn will work best for them and try to give them that as often as they can have it. If I say I will back at 4, I'm back at 4. I continue to monitor them and make sure it isn't too much. Respirations as well as how well they are aroused from a sleep are important. If you get on a routine and monitor their responses, they probably will not be on the light as much.