Drug Seeker Stories

Well I had one of those lovely drug seekers the other night. Patient said she had a kidney and was peeing prue blood. Well, I had her get a CC urine. When I went back to get her urine, I noticed her finger was bleeding and some blood spots on the sheet. And her urine was a weird pink color. So I told the doc and he had me cath her....her urine was completely clear. Of course, she tried to make up a story about how sometimes she pees blood but sometimes pees clear too. Whatever...sent her out the door...

Also had someone come in 3 times in one week who used a new name everytime. Turns out he was going to ER after ER in my city using differents names for drugs...sent him out the door and to jail.

Specializes in Emergency/Trauma/Critical Care Nursing.

Approx 1mo. ago my coworker had a patient w/hx of way too many ER visits but not enough to be on our CREDO list (credo committee of psychiatry, er attendings, social work, RN and pt advocate eval our freq fliers and write an assessment for med hx, social issues, & recommended tx plan, which can include d/c from triage if non-emergent complaint). Anyways she was in our critical care area for "gluteal pain, vomiting bright red blood, abd pain and unwitnessed syncope" pta. Her physical elxam didnt seem to correlate w/complaint and she refused any NGT or GI scope but kept asking for morphine every 30min but kept walking around the ed. well then a diff pt's family member approached the nurse and said she had just witnessed that pt grab 2 specimen tubes of blood from another nurses cart and drank it! And it was some other pt's blood too! Before nurse could confront pt she shows the rn an emesis basin filled w/blood and apple juice (swiped that from someone too after being told she was npo). MD and RN confront pt who goes nuts, threatening to harm herself if shes d/c'ed w/out pain meds. She ends up being admitted for psych eval but w/no more narcotics. Turned out that her "gluteal pain" was caused by the carpenter's nail she drove into her butt cheek to try and mimick rectal bleeding too! People never cease to amaze me w/the lengths they'll go to for dilaudid/morphine!

Specializes in Emergency/Trauma/Critical Care Nursing.

Another pt, assigned to me this time, comes in at least 10x a month for c/o sickle cell crisis. Now im well aware that a SCC is extremely painful and needs immediate tx, usually with high dose narcotics, however, 75% of the time you can objectively see their discomfort w/vitals, behavior, etc and sometimes they can hide it pretty well b/c they're used to it.Well this pt is 21y/o, hx of non compliance w/his PCP's tx plan and has a med contract w/the pain clinic so instead of asking for scripts he just comes to get IV dilaudid in the ER doesnt violate the contract, and usually walks out before discharge. On exam pt has somewhat flat affect, falls asleep easily, refuses to wear O2, BP and HR not elevated, HR 60-70bpm, resps even & 12/min. Pt denies running out of home pain meds (which he takes DAILY), but says they aren't strong enough and he needs IVP meds.I look up his med hx and see that he is prescribed 16mg PO dilaudid every 4-6hrs!!! 16mg?! He's taking almost 90mg per day if doing q4hrs! And to top it off he's also prescribed oxycontin QID and methadone TID, all by the same pain clinic MD! The kid is not even a big guy and is only 21 for pete's sake! Whats he gonna do in 10yrs? Heroin?? Pt was offered a 4mg dose of dilaudid po which he took but then said if youre not giving me any iv dilaudid i'm gonna leave and walked out. If they had even ordered him his home dose of meds while in the ED i would've flat out refused to administer that, which my coworkers agreed with. Luckily our attending agreed that it was a freakishly high dose, b/c if they wouldve ordered those meds i'd say "fine, call the hospice nurse to give that b/c im definately not!"I still am amazed he was breathing, although i did find a few incidents when he was admitted of being given narcan and holding scheduled doses of meds d/t resp depression/hypotension and that was 4mg dilaudid iv q4hrs!Scary that he's only 21 and that opiate tolerant/dependant

Specializes in Emergency Department.
..well then a diff pt's family member approached the nurse and said she had just witnessed that pt grab 2 specimen tubes of blood from another nurses cart and drank it! And it was some other pt's blood too! Before nurse could confront pt she shows the rn an emesis basin filled w/blood and apple juice (swiped that from someone too after being told she was npo). MD and RN confront pt who goes nuts, threatening to harm herself if shes d/c'ed w/out pain meds. She ends up being admitted for psych eval but w/no more narcotics. Turned out that her "gluteal pain" was caused by the carpenter's nail she drove into her butt cheek to try and mimick rectal bleeding too! People never cease to amaze me w/the lengths they'll go to for dilaudid/morphine!

Wow. Just when you think you've seen/heard it all...drinking someone else's blood? :barf01:

Specializes in Emergency/Trauma/Critical Care Nursing.

dilaudid's some good stuff i guess lol

Specializes in Emergency Department.
dilaudid's some good stuff i guess lol

Guess so...I remember my first day as a brand-new CNA in the ED. A patient told me she was "allergic to all painkillers other than 'Dulalidid.'" I didn't know what that was (or what it was supposed to be), and so I dutifully told the nurse what the patient said. She snorted and said, "Yeah...I'm sure she is..." Then the RN explained about "Dulalidid." :D

Worst one I have seen was a post heart cath pt. 2 days later after running out of pain med's pt came to the ED complaining of pain at the cath site. Cath site looked great and appeared to be healing well. First doc that saw the pt was nice and d/c'ed the pt with some po lortab. Pt returned to our ED 3 more times the same day with the same complaint all via EMS of course attempting to get more meds. So total of 4 visits to the same ED in a 24hr period for the same complaint all attempting to get more pain meds.

Sickle cell gal who comes in for her Dilaudid... 4mg, 50 of Benadryl for the itching, and 4 of zofran later, and she calls her hubby who comes down to get her.

"seizure" pt who packs a bag and has it sitting at the door waiting to go to the hospital. This one was so good at mimicing a seizure, she could ignore ammonia inhaler. We popped in a foley one time and she miraculously came out of her seizure complaining that it hurt. The next time she came in 'seizing', we grabbed a foley and told her it was going in... she hopped up and said she was better.

My mother and aunt have migraines. My ex used to get migraines, all three wanted quiet and dark when they were hurting. My ex was also a druggie and alcoholic... when he wanted pain meds, he would go to the ed and yell that he had a migraine and needed demerol. He who doth protest loudly...

Then there was the guy who was on methadone and they were tapering his dose down... He kept coming to the ed wanting us to medicate him to make the pain go away. He would say "I don't want the meds, I just want the pain to go away... But give me the meds" It's hard for me to see a 20yr old being tapered off methadone... not a heroin user... but had already gone through the morphine and dilaudid for chronic pain... This kid had 6pack abs and huge arms!!! Obviously worked out and often. No one could ever nail down where the chronic pain was or what the original injury was... or how long ago it was.

Specializes in Clinical Research, Outpt Women's Health.

I think i will just avoid dilaudid. Dang, I don't ever want to be desperate enough to drink someone else's blood. Sick!

Specializes in Emergency/Trauma/Critical Care Nursing.
sickle cell gal who comes in for her dilaudid... 4mg, 50 of benadryl for the itching, and 4 of zofran later, and she calls her hubby who comes down to get her.

then there was the guy who was on methadone and they were tapering his dose down... he kept coming to the ed wanting us to medicate him to make the pain go away. he would say "i don't want the meds, i just want the pain to go away... but give me the meds" it's hard for me to see a 20yr old being tapered off methadone... not a heroin user... but had already gone through the morphine and dilaudid for chronic pain... this kid had 6pack abs and huge arms!!! obviously worked out and often. no one could ever nail down where the chronic pain was or what the original injury was... or how long ago it was.

i agree, it is very sad and i have also encountered patients that say how much they don't want to take the medications b/c it means they have some chronic pain history to begin with, many of them cannot work, it affects their family/personal lives etc. one pt told me something that i guess i had never really thought much about, she said that by the time she was 6 or 7y/o she was already tolerant to a normal adult dose of oxycodone/oxycontin - i forget which - because her crises were so severe. i know that they try to use non-narcotic drugs first, especially w/kids but at some point, or for some people, they will most likely require the stronger narcotics, and many of them never had a chance to avoid being so tolerant to these high doses they now need as adults b/c they started so young.

as i had posted earlier, i understand how the development of drug tolerance works of course but i never imagined a person such as that 20y/o pt of mine, could still be alive, let alone be a walky, talky, functioning individual when he takes 16mg dilaudid po q4hrs, 30mg methadone bid, and multiple doses of oxycontin (don't remember the dose), yet still come to the ed b/c of his pain not being relieved (as per pt)! i mean it has to take a lot of high dose narcotics over a significant period of time to develop a tolerance like that at the age of 20, right?? while trying to look up if there was a "max or lethal dose" of dilaudid, i came across this website, and couldn't believe how many other people are on doses similar to my pt's, and even higher!

dilaudid lethal dosage? - the people's medicine community

as i've said, i don't believe all chronic pain pt's are seekers, nor do they make up the majority, but it does bother me when the one's with such "significant chronic pain" on ridiculously high doses of narcotics do things that are totally contraindicated in management/prevention of acute pain crises, i.e. the 20y/o pt i mentioned earlier smokes 1pk/day, as well as marijuana (before i get yelled at, yes it is used for chronic pain, but if your pain is d/t sickle cell, you are not doing yourself any favors by replacing more oxygen for your tissues w/smoke of any kind), comes into the ed w/a tee shirt on in the winter, refuses to wear the nasal cannula b/c it "bothers his nose", and generally never sticks around for the iv fluids if he's been given his pain meds. then there are the chronic back painers that repeatedly fail to follow through with their physical therapy b/c "they had other stuff to do" (really? what is so important when you are on disability and claim to be bed/couch bound??), ignore the doctor when they tell you "losing some weight would really lessen your pain", and refuse to take any of the anti-inflammatory portions of their treatment regimen but have no problem taking the narcotics and multiple muscle relaxers.

now granted, they don't all do that, but the ones that do are exactly who this thread is written about.

and to crunch rn, i agree! i have had dilaudid before and yes i thought it was wonderful for the whole 30seconds it took me before i was out for the next 8hrs lol, but the thought of drinking some unknown person's blood or a nail in my butt to convince a doctor that they should give me some, makes me think i just might be willing to try the motrin afterall lol. :barf01:

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Specializes in ER.

What are the best drug seeking stories that you have from being in the ER? I know there have to be some good ones out there!

Specializes in ER.
I have a lady that dislocates her shoulder to get some moderate sedation and a RX for percocet.

They should come to our ER! We don't give out Percocet after 1800 when our pharmacy closes. Our doctors don't have triplicates so the most they can get is a few Vicodin....like 10. We have a contract with a local pharmacy that they'll accept faxes.

Most of our drug seekers are either retirees or Dependents of military since we are a military hospital.

No great stories.

At my place we regularly give narcotics to known abusers who are obviously lying. Of course, it depends on which doc is working, but since it's free, and you could score, it's always worth a shot.

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