Drug Seeker Antics and Dramas

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They are an everyday event in almost every ER around the country. What is the drug of choice in your area? I've noticed around here it is Vicodin.

Our latest little treasure was an ex RN who was a daily event in our ER. She would come in complaining of backpaid and demand a shot of demerol and a script for Vicodin. Her MD's (She had many over the years) refused to see her. We kept a lot of documentation on her antics in order to confront her with her possible little problem. Well the big day came, she didn't take it real well. She stormed out of the ER, went around the building, came in thru the main lobby and straight to a pay phone. She called in a bomb threat to the ER. The police tracked her down, they could hear the hospital pages in the background. She is now in a facility.

Specializes in Nephrology, Cardiology, ER, ICU.

This is one place where ER case managers can help. One of our primary jobs was to come up with care plans (with the PCP and pt involved of course) and get on a game plan. One of the neurologists in my area has a migraine clinic and puts those pts on a solid regimen of beta-blockers and other headache abortive meds, then gives them addtl meds for break-through pain and if all else fails, they come to the ER. We are very sparing with our narcs but I always encourage the ER docs to contact this neurologist or on-call doc to ensure that we are in compliance with the care plan. This has cut down drastically the number of ER visits for this population. I do want to add to that this is only for pts having their "typical migraine pain". The education these pts get is very good and they know to come in and say that this is their "typical h/a" otherwise a CT/LP is in their future.

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Specializes in Med-Surg, Psych.

I, too, have had to go to the ER twice for a migraine. After suffering for 72 hours in acute pain, I had to go... the Dr was great, but the nurse rolled her eyes (according to my sister who was with me.) I was terribly nauseous and had been vomiting for hours. By the time I got to the ER, I was having dry heaves.

I am taking Calan as a preventative, but it does not work very well for the migraines (I get them several times a month.) Imitrex is terrible for me... it makes me feel like someone is crushing my throat. I have an Rx for Fiorinal and Compazine. Sometimes is works, sometimes not.

I realize there are people drug seeking who "use" migraines as an excuse for mediation. But, when you have a migraine for days, it is absolutely terrible.

I hope if I ever need to go to the ER again, the RN will be compassionate. If you have never experienced a true migraine, you have no idea how unbelievably painful it can be...

Michelle

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I got a call from a pharmacy one night. A pt presented to the counter with a script for "a pound of mofine" (note spelling) Of course we didn't rx this..... The pharmacist laughed all the way till the cops showed up.

Oh my gosh....unbelievable....:rotfl:

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Specializes in Emergency/Critical Care Transport.
I got a call from a pharmacy one night. A pt presented to the counter with a script for "a pound of mofine" (note spelling) Of course we didn't rx this..... The pharmacist laughed all the way till the cops showed up.

When I was working as paramedic the hospital that was our medical command facility had a clinic and pharmacy on the second floor. One day I come down with conjuntivits from my new contact lenses. I asked one of the Er docs to check my eye, he diagnosed the condition, then wrote me script for bactrim eye drops. I was going to the local pharmacy, he stops me and says, why waste time, just go upstairs. When I got there I witnessed the exact same thing. Some guy had swiped one of the ED doc's pads and had written script for "Mofine, 1 pound." Just as I entered the pharmacy, so did two city cops who kindly asked the gentlemen to come with them. Of course he didn't want to, a scuffle broke out. I ended up helping the cops hold him down while they cuffed him. In that state they frown very deeply on falsify prescriptions the guy ended up with few years out of the deal. And he never got any of his "Mofine"

But just last month I was working in the ED and answered the phone some guy tells me he's from a local pharmacy and that he has prescription for percocet but he doesn't have the DEA number of our ED doctor on file and would I give it to him! Oh yeah, like that's gonna happen! Thanks for playing and as a parting gift you get an edition of our home game!

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In the ER,I can understand you would get many drug seekers, but in Long Term Care..it's driving me crazy...My facility takes anyone to keep the beds full and I am sick of chasing patients up the street when they decide they need a fix! Mostly what I have seen is herion and crack addiction with some Xanax for good measures. Lovely isn't?

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When I was working as paramedic the hospital that was our medical command facility had a clinic and pharmacy on the second floor. One day I come down with conjuntivits from my new contact lenses. I asked one of the Er docs to check my eye, he diagnosed the condition, then wrote me script for bactrim eye drops. I was going to the local pharmacy, he stops me and says, why waste time, just go upstairs. When I got there I witnessed the exact same thing. Some guy had swiped one of the ED doc's pads and had written script for "Mofine, 1 pound." Just as I entered the pharmacy, so did two city cops who kindly asked the gentlemen to come with them. Of course he didn't want to, a scuffle broke out. I ended up helping the cops hold him down while they cuffed him. In that state they frown very deeply on falsify prescriptions the guy ended up with few years out of the deal. And he never got any of his "Mofine"

But just last month I was working in the ED and answered the phone some guy tells me he's from a local pharmacy and that he has prescription for percocet but he doesn't have the DEA number of our ED doctor on file and would I give it to him! Oh yeah, like that's gonna happen! Thanks for playing and as a parting gift you get an edition of our home game!

This same story about "mofine, 1 pound" has been going around for years. It is in an Echo Heron book. My ER doc told me it happened in med school. I've heard this story from numerous nurses through the years.

Urban myth? Old-wives-tale?

steph :)

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Of course the addicts won't care for the Stadol NS that you prescribe, but perhaps that will dissuade them from using the ED as their supplier.

Here in my little ER Stadol nasal spray is quite popular with the abusers. A pharmacotherapeutics instructor once said that anything you can put up your nose can quickly become addictive: cocaine, heroin, Afrin, Stadol nasal spray...

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This same story about "mofine, 1 pound" has been going around for years. It is in an Echo Heron book. My ER doc told me it happened in med school. I've heard this story from numerous nurses through the years.

Urban myth? Old-wives-tale?

steph :)

Steph,

Which Echo Heron book is it in? I do remember one of the books when a pt pronounced morphine, "Mopheen" (or something like that), but it didn't say it was a "pound of mopheen." Just curious, am I missing an Echo Heron book somewhere?? I tell ya, in my summer read mode, a new Echo Heron book would really hit the spot. :)

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I heard that a lot of those who try to pass phony scripts get basicly a slap on the wrist because their lawyers will put up the defense that their drug addiction drove them to it. They generally has to go to a rehab facility.

Our ER started using bright red scripts that are difficult to just make a copy of on a scanner.

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I would just like to say a few words about the agonists/antagonists that are available. I have found that they are very effective drugs. If there are migraines that won't respond to the 5-HT agonists, ergotamines, toradol, and either Talwin, Nubain, or Stadol, it is time for a head CT.

Of course the addicts won't care for the Stadol NS that you prescribe, but perhaps that will dissuade them from using the ED as their supplier.

Head CTs or not, why does no one want to except that sometimes, nothing will work. Especially around that time of the month. IF the pt comes in more than once a month ,and shows no improvement from previous # of visits...then CT. Most migraines DO respond to triptans and DHE, but there are circumstances that warrent a nod, not a rolling of the eyes. :)

PS Not saying you rolled your eyes! Just to all of us in general.

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Specializes in Inpatient Acute Rehab.

In our ER, the only narcs that a Er doc will write a script for are Lomotil and Darvocet. Even at that, they only write it for a max of 8 doses. The seekers don't even hardly come around anymore.

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Specializes in ER, ICU, L&D, OR.

Sorry there are some who are obviously so blatant, that it is being perfectly human To Roll Your Eyes At Them

While they have all these problems, RSD, FMS, Migraines, All these other chronic pain syndromes Where as some like Pain Management specialists love to make up and foster these labels because its good for there business. Yet their patients always seem to end up in the ER wanting MORE

While Physicians like ER Docs do tend to take them with a grain of salt, becaause the ER does get abused by these patients all wanting more.

Might be better if these so called Pain Management specialists would work more than routine office hours.

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