Drug Diversion

surfnbeagle · Sep 18, 2010

We have the medications dispensed in small amounts, eg: 3 or 4 day supply. It is very difficult to deal with this.

debblynn13 · Sep 20, 2010

We have used a Duragesic patch and brought in one patch at a time and had the family put the old one in a baggie for us to pick up at the next visit. It is a difficult situation.

Debblynn

ErinS, BSN, RN · Sep 22, 2010

Our whole team is updated on pt's that are diverting. We set firm boundaries and push for facility placement as soon as possible. Fentanyl patches are a good way to go, as is methadone. ABH (ativan/benadryl/haldol) cream can be helpful- tastes bad and has the haldol in it that can calm drug seekers. Doesn't seem to have the high that oral benzos have. Good luck!

syckRN · Nov 8, 2010

Please understand, these patients can be sick with an illness that we can help them with. There is an evidence-based intervention specifically geared toward getting these patients to change their behaviors. It is called SBIRT. Google it if you are interested in learning more about it. The Emergency Nurses Association is pushing for us to learn how to do this, and it has been implemented all over the world, with good results.

SyckRN.

Here is an excerpt from my blog that exemplifies the kind of attitude that I used to have and that many many nurses and physicians have...

A

"At some point that last day of my second week, in a frantic haze of extended “fight or flight” adrenaline overload I “enjoyed” a singular lucid moment of absurd hilarity at the irony of my predicament.

Here I sat, guilty of having been the most

(no exaggeration, I assure you, if you have figured our who I am…you are, undoubtedly, nodding your head in agreement at this moment)

creatively sarcastic and maliciously witty critic of “drug-seekers” and “lunatics”

“and let’s face it folks…if you’ve got one of those problems….you got the other one too…am I right or am I right? …Hmmm.”.

(that was me…that was how I used to think…and I was neither alone nor even in the minority in this superiority…don’t kid yourself that you, as a nurse or doctor, do not see this EVERY DAY.)

I had also pounded the judgment gavel at nearly every OTHER stigmatized group I encountered. But let me be clear…I was a very likable oppressor. I was a politically correct oppressor. If you were African American, hispanic, asian…Catholic, Jew, GAY…etc…you were untouchable…

You see, I was CAREFULLY cruel…not STUPIDLY cruel…I rarely offended colleagues, administrators…those I needed to please. Get the difference?

On with the show!

All of this anti-empathy had been made possible by my (and so many other nurses and physicians, and youknowitsthefuckingtruthsodon’tactsoHolierthanThou) incredibly narcissistic beliefs that I was above it all. Younger, smarter, richer…and without a doubt, absolutely in control of my drinking (drugging, pill popping…whatever).

(Look mom, no DUI’s! )

Now we get to the IRONY:

The irony was, of course, this preposterous yet inherently “just” reality that I was waking up in

this place!

on this day!

in this condition!

R.E.H.A.B…

on Easter Sunday…

(Amen brother, pass the bottle).

Surely the Damned could know no worse fate than this:

I had become that which I despised.

Can you say…”hyp-o-crite?”

I would leave this place at the end of my allotted time…I would be humble, grateful…sober

But I would have so many unanswered questions…so much uncertainty…

I didn’t know what parts of me I would still be able to lay claim to when I finally stepped out of that place… wife?…mother?…would I ever be allowed to call myself a nurse again? Did I deserve to?…

And why…could somebody please tell me why…did I do this to myself? What on earth was wrong with me?

Why couldn’t I just be

NORMAL?!"

Still SyckRN

Hospice Nurse LPN, BSN, RN · Nov 9, 2010

We have a lot of patients/families of patients abusing the narcotics and benzos. They then cry and manipulate on the weekend to get more meds after they have gone through 60 pills in two days. We get the police involved and log everything but our agency still gets burned and we don't discharge these people. How does your agency deal with this pervasive problem.

We do what the others have suggested...send narcs out 2Xweek. It's a PIA (and expensive since pharmacy charges $10/delivery). They have one chance only. We had a pt a while ago who said she hurt real bad and that's why the meds were going so fast. I KNEW the PCG was diverting, but couldn't prove it. The PCG "lost" 12 ABH supp and 20cc of Roxanol. I began picking up her meds at the pharmacy 2x week and FILLING THE PILL BOX. One day the PCG called the office to say I forgot to deliver the meds. Bull! We ended up d/cing the pt, who was picked up by another hospice. Just heard through the grapevine that PCG had a MVA and was loaded with narcs prescribed for the pt. Report made to adult protection by the hospital and pt is now in the LTC and actually getting her meds.

I realize the diverters are sick people, but can't you get your fix somewhere else than mama's pain medicine?

AtlantaRN, RN · Nov 13, 2010

i had a patient who was NEVER on a bowel regimen, claiming to be taking the 120mg/ oxycontin/day......................................................................we would count and count, and count was always on......

patsysparksrnchpn · Nov 15, 2010

I like the fentanyl idea if the patient is a candidate for the patch. At our office, we have been trying to use the lock boxes that have to be set up by the nurse once or twice a week, sending out only a 3 day supply and count, count, count every visit. Sometimes it helps. The lock box will only dispense at the set times and breakthrough medication can be the problem sometimes.