Drug rant: Legalized Dope Dealer, RN

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This week, I have officially become sick, tired, and disgusted with the drug-seeking behaviors and, in addition, the Press Ganey-brainwashed administration that condones them.

Patient comes to ED for "torso" pain (trying to be vague), straightfaced in a gown standing @ TV in room flipping through channels and going on and on on her cell phone about how someone owes her money. Seeing me, she comes over to the bed, sits down, and says "Go ahead," sticking out her arm while still talking away on her cell. I kindly explain that I need to ask questions and assess prior to pain meds, and will wait until she's finished with phone conversation. Of course, phone is hung up pronto. Upon sticking her arm out for me, multiple track marks, red infected areas that look like brown recluse bites (from dirty needle use), OK. I ask if there is IV drug use, and get a shocked-meets-almost-offended "Oh god, no. I've been in the hospital and stuck so much, they can't ever get a vein."

Long story short, friends show up (that my patient actually wants in the room), and they ask if they can talk to me. I go in the privacy room and they start going ON and ON about the patient's heroin and now pain med addiction, and that she needs help, and we need to make her get help, etc etc etc. During this, I share no info, only nodding and saying, "Ok..." Upon asking patient about contradicting info, she is again very surprised and denies ever having used heroin, as well as everything else.

So, she wants friends in room. Friends go in, and in front of me, confront her. Eventually she admits to issues, and still wants pain meds. Thankfully, goes home with an rx for Motrin. :) STILL. Gave her Dilaudid and Toradol prior to Intervention. And I've given her 10mg Dilaudid over the past 2 weeks in various visits. And we have another patient that comes in with back pain, pain is a 9/10, gets Dilaudid 2mg + Zofran 4mg IV, pain is then 8/10, gets another Dilaudid 2mg IV, pain is 6/10, and is discharged. EVERY TIME. Like 14-15 visits since 8/1/08. Other patients, same stuff. Dilaudid, dilaudid, dilaudid.

Similar patient went to administration because pain was not treated how she thought it should be... doc got chewed a new a-hole, and what good does that do? Do whatever you can to please your patient, even if it means feeding a drug addiction? I honestly HATE this. I chart like the queen b-tch, noting facial expressions, behaviors, grimace, guarding, moaning with no tears, laughing with friend in rm, watching tv and drinking mountain dew though nauseated and in severe abdominal pain, etc -- still, our docs are just as fed up but in talking about this, have literally said, "After Dr. Got-chewed-out got called in to whoever's office the other day, I'll put them in a Dilaudid coma if I have to. Whatever will make the patient happy, right?"

Since when did pain become so freaking terrible? I personally would rather be in some pain than be completely numb to my life as a whole. Me and most of the ER staff: :banghead:

Sorry, and thanks for listening! As the title says, I feel like a legalized dope dealer, and it makes me incredibly uncomfortable. Hrm!

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Specializes in Medical-Surgical.

Ah, the vague and rampant abdominal pain. It is an epidemic, and how DARE we IMPLY anyone might be drug seeking. I don't work in an ER, but it must be crazy there with this problem. dilaudid....dilaudid...dilaudid...amazing how many of the dilaudid seekers are allergic to morphine, toradol, demerol, vicodin, even tylenol, isn't it?

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I try to be understanding, but I don't have a lot of patience with patients who lay around whining for pills. I specifically have one patient in mind when I'm talking about this. She already takes enough dope to kill a horse, 20 mg. methadone plus Xanax twice a day, plus PRN Lortab and Xanax, and she asks for it like clockwork. If she isn't satisfied with the buzz she gets from that she feigns nausea to get a phenergan shot to help knock her out. It really must be hell to live like that, but it is so annoying for people who are trying to take care of her. She has kidney damage and I actually heard her wondering aloud why her kidneys were giving her trouble. Her son says if she hadn't come to the nursing home she would have OD by now. He says this has been an issue since his childhood, he would always come in from school and find her zonked out on the couch and he would have to take care of his younger siblings. It is as revolting as it is sad.

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Specializes in ob/gyn med /surg.

yes it makes me uncomfertable to , these pt's come in and get their dilauded pushes for a stomach ache and even want a pain shot before they go home .. when their egd shows gastritis or hemmroids...

i have one lady now that gets so many drugs , valium , diluded, xanax, percocet , pheregan and zofran.. and she wants them ontime .. she came up the hall and said to me " overdose me .. give me all i can have" i said no i won't ... she should have been discharged a week ago and refuses to leave , even though her benefits have run out .. she said security would have to ake her out because she isn't leaving... i hope she's gone when i get to work next week... a nightmare...

i am sure there are many patients that have become drug addicted because of the docs giving them all they want.... yet when a pt says she or he has pain .. it has to be treated... and lately i have met none allergic to diluaded

yes i feel like a RN legal drug pusher .. just like you... frustrating... grrrrrr

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Specializes in ob/gyn med /surg.
Ah, the vague and rampant abdominal pain. It is an epidemic, and how DARE we IMPLY anyone might be drug seeking. I don't work in an ER, but it must be crazy there with this problem. dilaudid....dilaudid...dilaudid...amazing how many of the dilaudid seekers are allergic to morphine, toradol, demerol, vicodin, even tylenol, isn't it?

amen to that :yeah:

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

I feel your "pain".

Here's some of the ways I deal with it...

1) I get to go home to a decent house/family after my shift

2) I only take a couple of prescription meds, which actually help me live longer (cholesterol med, GERD med)

3) I have a job and more money than any disability plan will ever pay

4) I will live longer than them

5) I have power, control and influence - after all, they come to ME for something I HAVE that they want; they have nothing I want

6) I kinda just don't care; I mean so what? I knew what this ER business was about when I started; if I hated it that much or if it caused me such stress, then I should have left this field a long time ago. Shame on those people who choose to remain in a job that causes undue amounts of stress or being upset.

7) Seven years now in the same ER and even though we use surveys and Press Gainey's; I've only gotten 3 or 4 "bad" ones, and none of them had anything to do with NOT giving pain medicines.

I think it's just part of the business and until the ENTIRE system gets back to the basics of doing Emergency care (IE: medical screening and dispo NOT full workup clinical medicine) people like these "turkeys", "toads" and "drug seekers" will continue. I choose to work "with it" and not against it.

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Specializes in tele, oncology.

The dilaudid seekers are bad enough. We once had a patient doing jumping jacks in her room while demanding Benadryl 75 mg IV plus Dilaudid 2 mg IV. Dilaudid for her 20/10 generalized, unable to qualify pain, and Benadryl b/c the dilaudid makes her itch.

What REALLY torks me off is when we get end stage cancer patients, not quite ready for hospice yet, and I have to practically pull freaking teeth to get the docs to properly manage their pain. And god forbid I ask for Ativan IV for their chemo induced nausea from anyone besides an oncologist. Yet the noncompliant ESRD patient next door is gorked out of their mind, with an alarm clock set so that they can wake up to demand their next dose of dilaudid on time. It makes me REALLY REALLY ANGRY.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Relax.

Smile.

And choose.

You can: Continue in your current spot - knowing that the "druggies" will get their fix from you and those like you. Give it to 'em and smile. Knowing that any attempt to "fix" 'em will just cause you grief" - could hurt you in any number of ways - and stress you out. Big risk and abuser of your time for ZERO reward. :(

Hmmmm.....

You could: Fight 'em at every turm, take on the doctors and get frustrated beyond words. You are seething and they are complaining and will be back for another day to "get what they came for".

I'm not trying to be offensive - but really - WHO IS IN CHARGE???

Seems a bit easy now.

I do not make enough to deal with that kind of crap. I may be busy.

I say give 'em the meds, let any judgement float out of your head and focus on the good spots in your career. IT IS JUST NOT WORTH IT - FIGHTING WITH A DRUGGIE ...makes you the victim.

Think it over.

One patient should not take up a third of my shift.

I don't make enough to leave every shift battered.

"Here is your diluadid". Have a nice day!!!

Perspective is EVERYTHING!!!

Practice SAFE!!!

;)

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

TO: NREMT-PRN.... Kudos!

I like your style.

That's kind of my "Life Mantra" - to not stress or worry about those things which I cannot change or influence; today...at this time.

However, I do continue to work "behind the scenes". I find being involved in organizations (such as ENA) helps in small steps to improve the system overall. I try to work with my RN's and my Doc's here and there (when appropriate) to educate about just "giving the drugs" - but not every one of these is a "teaching moment" -you have to pick your battles.

Finally, our hospital recently adopted a "frequent flyer" policy. If they've been in for 3 or more same c/o's within a 3 month period; they get their "medical screening" and then they MUST pay whatever their payment is (either full fare or their co-payment) before ANY FURTHER TREATMENT is rendered.

Of course, some of this is up to the MD's decision AND so that we don't miss anypeople with REAL conditions, the guidelines are fairly restrictive in who this defined population is (IE: no one over 65, normal vital signs and limited to some specific complaints: work notes, dental pain, back pain etc....)

It hasn't made a real big difference on our practice, but it is VERY NICE to know that our admin/managers thought about this and actually considered making it policy - Small steps! In the right direction!

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This is a battle no matter where you work. The difference is in admin's attitude. We have a new CEO and is 100% behind the docs when they determine that the patient is non urgent. If found to be non urgent, the patient is then asked for insurance copay or $75. up front. We do have people who pay $75 for that script for Lortab or Percocet. This is a new way of thinking for us because we have never had an admin who has the stuff to stick with the rules.

One way to stop that buzz from the drugs is to give IM injuctions. We have done that if the patient has no need for an IV.

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Specializes in Critical Care,Recovery, ED.

How easy it would be if these drugs were legalized or at least decriminalized. Society as a whole would be much better off.

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

No, I really don't think that is a plausible answer. I think that's just a "band aid" to the problem.....:down:

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