Do you ever feel like we are contributing to the creation of addicts

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Mar 15, 2014

Interesting that you should bring up this topic. I tried to educate a patient about the uses, indications, and side effects of narcotics a few months ago and was politely reassigned to another patient. Pain control is an important issue in the hospital or any healthcare facility. But the fear of lawsuits and those ever-present patient satisfaction surveys have a way of allowing nurses to only do PART of what is best for the patient, which is to administer meds. Anything else that we try to do that the patient dislikes, well, we either feed their wants and ignore their needs or face the consequences. The solution, I feel, lies in management supporting the decision of its nurses for the benefit of patient safety.

Pangea Reunited, ASN, RN · Mar 16, 2014

Yes, I believe we are. I frequently educate patients, but it never works. They only stop their Q3 dilaudid when it gets discontinued at discharge. Some of them come right back to the hospital. I don't know what happens to the rest.

Some surgeries and conditions require long term pain management, but it's sad when a two day post-op lap chole wants IV narcotics around the clock "to sleep".

BlueDevil, DNP · Mar 16, 2014

Why is a lap chole even in the hospital overnight? Here we discharge them home on ibuprofen within 2 hours. I'd never prescribe a post op lap chole a narcotic analgesic.

In response to the OP, yes I believe we as prescribers are definitely responsible and for myself, I'm doing my best to stem the tide. I cut off far more scripts than I provide. I almost never renew opioids or benzodiazepines when patients transfer to me from someone/somewhere else. I never initiate benzos, ever. I avoid narcotic pain relievers and I don't prescribe sedative/hypnotic sleeping pills. My staff are amazed when they see me give someone 10 T#2 tablets. I use ultram on occasion, but I don't typically write for more than a dozen tablets. I don't even rx any codeine cough syrups. Nor do I rx amphetamines for weight loss, and I don't treat adult ADHD at all. Nor do I prescribe those drugs for kids unless there has been a complete neuropsych eval and the patient was initiated and stabilized by behavioral health first.

The overdose on the 6:00 news isn't going to have my name on the bottle next to the body.

Consequently, all the drug seeking patients go elsewhere. I can usually predict which patients I will never see again after the first visit, lol.

Nola009 · Mar 16, 2014

Why is a lap chole even in the hospital overnight? Here we discharge them home on ibuprofen within 2 hours. I'd never prescribe a post op lap chole a narcotic analgesic.
In response to the OP, yes I believe we as prescribers are definitely responsible and for myself, I'm doing my best to stem the tide. I cut off far more scripts than I provide. I almost never renew opioids or benzodiazepines when patients transfer to me from someone/somewhere else. I never initiate benzos, ever. I avoid narcotic pain relievers and I don't prescribe sedative/hypnotic sleeping pills. My staff are amazed when they see me give someone 10 T#2 tablets. I use ultram on occasion, but I don't typically write for more than a dozen tablets. I don't even rx any codeine cough syrups. Nor do I rx amphetamines for weight loss, and I don't treat adult ADHD at all. Nor do I prescribe those drugs for kids unless there has been a complete neuropsych eval and the patient was initiated and stabilized by behavioral health first.
The overdose on the 6:00 news isn't going to have my name on the bottle next to the body.
Consequently, all the drug seeking patients go elsewhere. I can usually predict which patients I will never see again after the first visit, lol.

:yes: Thank-you for your comment. I'm glad that you eschew drug-seekers from your practice. I would like to know what we as "bedside" nurses can teach our patients regarding addiction in a way that's customer-service appropriate. I work in a SNF where many a post hip or knee replacement patients get scheduled narcs. And if they ask, our facility's doctor & NP will prescribe scheduled (q4 or 6 hrs) narcs for at least several weeks following their surgery. What will they do when they are out of our facility and back with their primary provider? Get a month's worth and then hit the needle? I'm just concerned bc there have been 8 heroin related deaths in my area within the past month and I have been told that many of those people started out on prescribed opioid analgesics.

iluvgusgus · Mar 17, 2014

I think "addiction" is different than tolerance. I have only been a RN for a little over a year, but it seems to me that people who have addictive personalities, were prone to have an addiction, or came in already with an addiction are the "drug seekers" who will bother me to death for IV dilaudid for a headache. Then there are the 80 year old ladies with hip fractures who dont call for pain meds at all, when you offer them anything for pain, insist they take something for pain, they refuse. I dont think prescribing narcotics to help alleviate pain creates addicts. I think we should give our patients the responsibility to decide if they want to continue taking narcotics or not, when they are indicated. Sometimes they are afraid of becoming addicted and refuse them from the get-go, sometimes they take them, then decide a tylenol or a motrin would work for them. Addiction is from a genetic predisposition/ early environmental influence. I dont agree with cutting people off of narcotics cold turkey when they have been on them for weeks, I think they should be weaned off because tolerance does develop and it is unpleasant to withdraw from them. I also think they should be given benzos when narcotics are cut off and then weaned off of those as well.

iluvgusgus · Mar 17, 2014

Bluedevil, I honestly wouldnt return to you either based on your policy. People want relief from their pain, not a pain nazi that will only give them tramadol. Pain is stressful to the body and wrecks havoc on it, increases blood pressure, increases blood sugar, and could even give someone a heart attack. I hate drug seekers too but if pain meds are ordered and they want it and it is due, I give it to them. I had one pt who was a frequent flier in again for "chest pain". Every 2 hours I would hear from him, asking for more pain meds. Yes, it annoyed me, however, I started to think there was something going on and so I paged the doctor relentlessly. The doctor expressed her annoyance with me, blah, blah and I continued to page her until she finally came to see the pt and ordered a CT scan of his chest. Turned out he had pericarditis and was in the hospital for 4 weeks after that on IV abx. So I dont think dismissing "drug seekers" c/o pain is smart or good practice, and purposely pushing them out the door with your spartan policies isnt too smart either because they may have a legitimate complaint.

applewhitern, BSN, RN · Mar 17, 2014

I would rather give pain medication, rather than let someone be in pain because they "might get addicted to it." I watched my son cry in pain from cancer because doctors were so reluctant to give pain meds. My daughter has severe disabling arthritis, and we literally have had to beg for pain relief for her. I also have painful arthritic flares, and since I have had a GI bleed, I am not supposed to take NSAIDS. Sometimes I do anyway, because there isn't much else I can take that isn't narcotic. To be completely honest, 600 mg of ibuprophen helps me more than anything, but then I have the fear of bleeding again. (history of diverticulitis and bleeding ulcers.) Even when doctors ordered IV pain meds, we would have nurses who would not give it as ordered, and cause delays in my son's pain management. There are more types of addictions than just pain meds. One can buy alcohol anywhere and that is alright. I think saying someone might take Norco, then progress to heroin off the street is a rather extreme example. I remember having tons of patients who became addicted to drugs during the Vietnam war. I remember having patients years ago who were addicted to valium. This is not a new thing, and no, I don't think we contribute that much to pain med addiction. If anything, I see more doctors who do not order enough, or any, pain meds for those who need it. Sorry this sounds disjointed; this is a sore subject for me.

stephonme · Mar 17, 2014

I believe that if we know what time a person is going home from a skilled rehabilitation facility that the doctor should gradually take them off the pain medication before release. When the patient first arrives every 4 hours after surgery is fine, but as the release date comes closer the time between pain medications should be increasing. They need to be weaned off the medication or close to it before they leave. By the time they leave every 8-12 hours as needed for pain. I believe it would help.

BrandonLPN, LPN · Mar 17, 2014

The OP was specifically talking about post-op patients becoming addicted. I can see how that's a legitimate concern. I agree providers need to be careful giving narcotics to patients after surgery. I have seen friends receive prescriptions for oxycontin or norco after surgeries, and have it snowball into long-term narcotic addiction.

What grinds my gears is when providers are stingy with the pain meds for patients with chronic pain. Especially in the LTC setting. Do we really need to try to wean my 70 year old nursing home resident with chronic back pain off his norco? Really?

stephonme · Mar 17, 2014

If the 70 year is clearly in pain and not abusing the pain medications that is fine but we have some that have Norco ativan and trazadone at bedtime and still asking for more. In fact this resident was chasing the dr in her wheelchair asking for more while he was on rounds. She wants to stay in a sleepy drugged state. Her family even wants this to stop.

imintrouble, BSN, RN · Mar 17, 2014

There is an unrealistic expectation, promoted by hospitals, that we can eliminate post op pain. We reinforce that expectation by offering a variety of pain meds, without the ability to do pt. teaching regarding those pain meds.