Drug Seeker Stories

Specialties Emergency Nursing Q/A

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.

These are people who get referred to rehab time and again. Paid for by the state. Most don't want to go through the trouble of rehab. It's easier not to.

It gets very, very tiring seeing the same people over and over again taking up space for people who have life threatening illnesses. We had one patient who cam in 42 times in August. For a pimple.

Okay, here's my most recent drug seeker story. I was caring for a gentleman well known to our ER who was demanding demerol for his mosquito bite. Yup. There happened to be a local police officer in the ER at the same time who said "What's he doing here? I just busted him for selling Lorcet."

Well, I can tell you have talked until I was blue in the face to many a patient with a prescription drug addiction. So far not one patient has taken me up on the offer of rehab. I always tell them, "When you're ready, let me know."

marymary, tell us about yourself and your experience. I apologize if I'm wrong, but I'm pretty sure you're not an ER nurse. And maybe not even a nurse yet either.

Specializes in 6 years of ER fun, med/surg, blah, blah.

Don't judge ED nurses, until you've been there yourself. How much better to spend your time & talents on truly ill people & helping them, instead of dealing with those cry baby drug seekers who take up valuable time & money. The ED really opens your eyes & you see a real gamit of the population. It doesn't take long to see quickly who's really sick & those who are trying to play a game with you.

I have had kidney stones since I was 7yo and Let me tell you from my experance toradol does not all ways help stone pain. I almost always have to have at least demoral for my stone pain when I get a stone that just want pass. There are also people that can not take dilaudid I happen to be one of them. I am like the person on the I chroinc pain thread, What happened to pain is what the patient says it is? I know that there are alot of people that come in to the ER seeking drugs but I hope that you don't treat all pts. with a chroinc pain problem as durg seekers. Coming form someone that has been treated that way it realy hurts when there is a true problem. :crying2: I am becoming a nurse to help pt. not treat them all as if they are drug seekers!

Specializes in 6 years of ER fun, med/surg, blah, blah.

It doesn't take long to tell drug seekers from those who are truly in paln. One tell-tale sign, are people who say that can't move an inch, but are up out of bed & outside smoking a cigarette as soon as you give them their pain meds, or cry loudly when someone is watching them, but are quiet when left alone, the list goes on & on. But it is rewarding to treat someone who's in a lot of pain & get them comfortable & these are the ones who don't like to take pain meds or any other kind of meds at all. Pain is a volatile issue in nursing, the 5th vital sign, & how to treat it properly, etc. It's can be frustrating to have to spend time with those who don't help themselves & have other issues like ETOH &/or drug abuse, or don't see their Dr's regularly, & use the ED as their fix. But treating those patiets who come in with true distress & help them, is what nursing is all about.

Specializes in Med-Surg, Tele, ER, Psych.

For some reason, this one infuriated me. I can't even remember what the CC of the week was for this person. All I know is that on the night in question, Dr. Feelgood, MS04 was in da house. The doctor started out conservative for him, and utilized his BACC Pain Protocol (Belly Ache-rs and Chronic Complainers). This is a delightful triple cocktail of Ativan 2mg, Haldol 2mg, and Benedryl 25mg, all IV so we lucky nurses have to give it in 3 separate syringes. This didn't work on the frequent flyer. She still c/o pain. So he ordered MS 5 mg, SQ to be given, then repeated cause the complaints were still rolling in.

Once she had had enough and he had discharged her, we had a problem because at this particular facility, you have to have your ride present to sign for you. And she was alone. So she called someone to leave work and come to the ED in the middle of the night to sign her out. He did and then acted like he would leave her. I insisted that he drive her home. They got into the parking lot and she walked right to her car. I was standing at the ambulance bay doors watching her. I asked what she was doing and she said she was locking her car doors. I thought, OK. But then she got in and sped off!

I called the police, who knew exactly who she was and what kind of car she drove. I guess she made it home cause they never caught her and no more ambulances ran that whole night. But boy I was mad!

Specializes in ER.

I have had that same situation where you are supposed to make sure they have a ride present after meds. I have seen them get into a taxi, drive to the end of the parking lot and get into their own car. I document that I informed the patient prior to the meds that they would need a ride or they qould be guilty of driving under the influence of narcotics, document them them getting into the taxi. Short of tying them up and throwing them into the taxi with instructions to the cab to not untie them till they get home, what do you do? What ARE our liabllities if we do all we can? At what point do people have to take responsibility for their own actions? Is this different from bar owners getting sued for allowing a patron to drink too much? Where do we draw the line?

I have read almost all of these replies and have my own story.

My sister called me on a Saturday, complaining of abdominal pain. She is not one to complain. She said she couldn't stand the pain, abdominal pain, and I pointed her to the ED. The ED gave her nothing for her tremendous pain, dx her with a UTI, and sent her home. She did a a Rx for pyridium and abx. The next day, she called me again, this time, in SEVERE pain. I took her back to the ED. She was N/V, diarrhea, and could NOT STAND UP STRAIGHT. The nurses from the ED dept recognized her, from the day before and thought she was drug-seeking. Well, a CT, that was NOT performed the day before, that I, her sister, an RN INSISTED upon, revealed free air in her abdomen. She had diverticulitis, and her bowel perforated,( she ended up with an emergency colostomy. ) At the time, the ED still would NOT address her pain, or at least it took me screaming at the desk, to get her something for the pain. That was the saddest thing I had ever seen. I know this particular ED did NOT do their job properly, but PLEASE do not think that everyone that enters the ED without perfuse bleeding, acute chest pain, or trauma does not have pain. This makes me furious! I can understand why JACHO has implemented an entire assessment of pain!

This past Thursday, she got her colostomy reversal, and the nurses on the floor were just as judgemental of her pain. She was hurting. She had an incision from her navel to her pubis area, and another to the L side (where the colostomy was). She was on a MSo4 PCA, and was not obtaining relief. The charge nurse finally came in and said, "look you have got to stay pushing that button." SHE WAS. Give thanks that I was a collague of her MD, and told him, as he changed her meds, and put her on a pain schedule that was all PO!!!!!! I have to trully wonder about those other patients who do not have someone to stand up for them........... Isn't this what NURSING is all about???????? Being an ADVOCATE for YOUR patient. I least I can go to bed knowing that I AM.:)

(This was posted in reply to someone on page 3 who questioned the experience/license of someone who wondered if an addict had received any care aside from denying him drugs..)

Firstly, I dont think she's being naive. She's being humane.

Secondly, she's not attacking anyone, she's just asking if there was followup, eg an appropriate nursing-oriented psychosocial intervention.

After reading these posts it seems to me that the only intervention going on by RNs with both real and supposed drug-seekers is judgement.

This kind of attitude - condeming, dismissive- is the thing that turns me off from ED nursing, which otherwise I think I would really enjoy.

I understand that you see true drug-seekers all the time, and it is true that they are a burden on your time and the money and time of the system. I know that over time you (and I) create interesting ways of coping with what you deal with on a daily basis, like joking about it or becoming emotionally detached from your the crazy things around us.

But it truly boggles my mind that so many nurses in the ED (and on the units) use their capacity to express empathy only when they judge someone to be deserving of it. If someone comes into the ED with septicemia from an abscess created by the use of dirty heroin-injecting technique, putting them in jail for being a junkie or a user is a thought that theoretically should never enter your mind, since law enforcement is not within our scope of practice. Caring for human beings is.

Oh, and also, if you encounter drug addicts (alcohol and otherwise) on a daily basis, please educate yourself and think seriously about how arbitrary and hypocritical our drug laws are. I know drugs ruin lives, you dont need to give me a lecture about that, but we all know that in our culture it's quietly accepted and "ok" to give children speed and housewives benzodiazepenes though it makes someone a 'bad person' if they use the same drugs or others to self-medicate their pain 'illegally'.

Some of the examples people have given could be legally considered assault (in terms of threatening to withhold meds) were the case to be that said individual was say, a young man with Crohn's truly experiencing severe pain and say, he knew what drug works best on his spasmodic pain. Sometimes pain really is what the patient says it is, let us not forget about that.

We occupy a special position as nurses; we arent concerned with power the same way MDs have been historically. As a result, we tend to cling to any form of tangible power we might have. Let's try not to lord over those we consider to be weak just because we have special information and access to that which they are trying to seek.

S

"Be the change you want to see in the world." -Gandhi

"At the ER, we(nurses,doctors) say that "we're not going to care anymore about you than you care about youself" (to the patients)."

Does that "hard line" tactic really work?

How realistic is that?

I know you have to get hard at some point, maybe with a pt you see all the time but would you treat a new "user"/"seeker" like that?

And please keep in mind that this forum is a place for VENTING frustrations which we encounter in our ERs across the globe.

No one is advocating judgemental attitudes or care any less than compassionate.

Please allow us this arena so we CAN be fresh and open minded and patient advocates.

Please don't judge me, as you accuse me of doing to my patients.

Specializes in Med-Surg, Geriatric, Behavioral Health.

I did my stint working detox. Give me 1000 alcoholics to detox over one opiate user. The alcoholics I would have to find, assess and frequently needed to encourage to take their meds to minimize their withdrawals. Many were embarrassed to relapse again and humble. The opiate users are a much different picture, however....entitled ("I made it on the ward, I want my meds now"), demanding, manipulative, arguementative, threatening to staff, attempting to make additional drug deals and connections, and god forbid if you mentioned the word "treatment"...you practically had to beat them away from the nurses desk with a broom when it came to any or all drugs they often felt entitled to. The disheartening picture in detox is alot of the counseling staff are ex-alcoholics themselves quite often (not having a "genuine" understanding of opiate addiction and how it is unlike alcoholism) or who are codependent and still working through their own issues. Often their sin here is trying to use the same global philosophy of alcoholism with opiate addiction. It is like apples and oranges; both are fruit (addiction) but light years apart (alcohol vs opiates). It just didn't work or work very well. If you treat an opiate user like an alcoholic, you've missed the boat. The drugs are different, the means to acquire the drug is different, the equipment and administration of the drug is different, they affect the body, mind and moral character entirely different, the withdrawals are different, the treatment meds are different...the approach needs to too. Unfortunately, this is not the case most of the time. It is no wonder that the relapse rate is extremely high for them. Many are not adequately treated or prepared in today's detox and outpatient settings. That is why we often see them in our ERs. Look at their rap sheets: alcoholics tend to have DUI or disorderly when they're intoxicated. Opiate users tend to have felonies when they're sober. If a CD counselor tells you addiction is addiction, it's all the same and the AA model is all they need...leave that counselor in the dust. If that counselor wants to make a case of it, have him/her personally detox and case manage opiate users for awhile and/or have him/her satisfactorily explain away, if they can, why the relapse rates are so different between the two groups with the same form of treatment modality which is often used, and why on god's earth is it still being used for both. Management, well that is a different story when it comes to opiate users. Minimal change with minimal budgetary expendature sort of says it all...ostrich heads in the sand; they are more often only concerned with Press Ganey results anyway, even if it means supporting giving drugs to opiate users to make them happy in detox to keep the scores up. Bravo to management who does not fall into this pattern. However, opiate users deserve, but often do not get, better treatment options. It is sad, but true. From a nurse perspective, you're caught in between an extremely high maintenance patient with poor outcomes from the start with treatment that often does not meet their needs in sobriety with lethargic management from above. It is frustrating. Now you know why I would rather prefer to detox 1000 alcoholics...there is often more motivation from the patient and the treatment milieu is 99% of the time developed towards them, not the opiate user.

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