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 ER.

Two points- Thanks goodness we have this board to vent on. And other nurses who understand.

Second point- As a new ER nurse I've seen lots of frustration when we nurses have to try and explain (again) that the doc doesn't want to order more meds when someone is in pain. Even obviously hurting folks end up waiting until test results are back, because heaven forbid we start treating the symptoms before we know what it is. :(

Lots of times I've had patients/family accuse me of ignoring them when in actuality I have gone to the doc 4-5 times, just can't get a reasonable order from him. And I can't say "you are still in pain because your doc refuses to give a decent med" or "the doc doesn't think you are really hurting that bad" and I can't make the doc walk to the bedside and face up to the patient myself.

This happens AT LEAST twice in every 12 hour shift. I can see the patients feel ignored, but WTH can I do? I want to keep my job, and I also want to keep some pull with the docs so I can push for real meds for the top 10-20% of patients that are beyond coping...

No, most other nurses don't see it as a problem, but they have been working in this system longer than I have. For most it is their first ER job.

I'm not suggesting you stop telling your stories. I'm not suggesting in any way (I'm not sure how you even came to that conclusion) that you stop venting this kind of story/feeling/attitude.

I just wanted to offer a heads up, another view, because hey - that's what boards are about. It would be midnight in a perfect world if RNs were better at holding debates/colloquia on the matter but it isnt, so here are the boards. Sorry if I disrupted your party

The first few pages of posts do not offer a lot of variation in terms of different stories and theories told by RNs about drug seekers/people in pain. Many *are very clearly* dismissive of people with addictions, many stories fail to reveal or detail any attempt on behalf of the RN or SW or whoever to follow through. They appear cold and emotionless (unless the emotion is frustration and hey, please know that I think that is a highly warranted emotion in a lot of these cases, whether dealing with users or trying to advocate for a patient in 'real' pain and getting nowhere with MD).

I dont want to get into a tit for tat situation here, ok, but I wasnt damning any one individual.I was criticizing a moral stance put forth in these narratives by RNs that I find problematic in light of our role. I brought it up because, well,I wanted to say: here's the other side of the coin.

Your stories have shown me the same thing, another side.

Specializes in O.R., Endo, Med-Surge, Mgtmt., Psyche.

Unfortunately, there are drug seekers out there and we have to deal with them. Putting aside your biases could save you a lot of problems. I took care of man post PEG Tube placement who c/o severe pain. The physician who placed the PEG would not medicate him because he had a hx of drug abuse and was labeled a drug seeker. I told the man to got the E.R. and he had a perforation, was admitted, and had to be on antibiotics.

Another instance, my friend was in excruciating pain, the only thing she could do was to roll up in a ball and close her eyes and deep breathe as she was waiting on pain meds. She heard the nurse say, "She's not hurting, she's in there sleeping."

The point being, if you have somebody come in today for pain meds and then again tomorrow, make a flag but do not be so judgemental for if you take a look at the messages posted on this board, it scares me that you may take care of my family some day and label them. If you learned anything in nursing school, you surely learned that different people react differently to pain. No wonder JCAHO has had to make such a large ordeal about Pain Management.

Okay, now that we know that all the nurses who work in the ER only want to label people with pain as drug seekers, and that many of you out there are afraid that we might someday have to take care of a family member of yours, please remember this:

It's the doc who orders the pain medication. My life would be so much easier if the physicians gave everyone what they needed or wanted. Then I would not have to have patients beg me to please just ask the doctor...for whatever. I would not have to deal with someone crying in pain that I cannot relieve. I would not have to listen to someone call me a stupid b---- because they didn't get a 'script for Lorcet.

We have patients in our ER who come in with family members (come on, can mom, dad and child all have a migraine at the same time?). We've got someone who has already had 80 visits to our ER this year for migraine (and I'm sure is hitting the other local hospitals). We have people telling us that they take no meds, but when we drug screen them they're positive for opiates, thc and cocaine.

And just take a look at how prescription drug abuse is destroying the lives of the abusers and their families.

So what can we do? Only the best we can do which is to hopefully evaluate the patients symptoms and treat appropriately. And with some kindness and caring. (And this means no narcotics sometimes, and it also means a referrel to a drug treatment center too.)

I know this is a rambling post. But, the huge increase in the number of drug seekers to the ER during my career as a nurse will most likely cause me to leave ER nursing for good in the near future (and I've been doing this for 25 years).

These stories are really interesting to me and some unbelievable, it just floors me what people will do to get some drugs.

I am constantly complaining about pain documentation, because I work L&D and for the most part it's NOT applicable.

THat doesn't mean that I don't treat pain, but it's treated in a completely different way.

Patients typically are given pain medication when they ask for it, however that can depend on a LOT OF FACTORS.

So, I have a hard time asking a patient what her pain number is, when she's 9cm on admission and how is that pain affecting you and and what would be your pain goal and would you like medicice? SORRY charlie, usually too late.

Anyway, my point was Pain has a COMPLETELY different meaning in MY job.

I admire you ED nurses for what you have to go through!

I am so glad to have all these opinions and posts! It is very interesting to see so many views on this topic.

Please don't get me wrong, I have seen my share of drug seekers, and users in my career as a nurse, (10+ years), and have STRONG opinions on how to treat these certain individuals. ( And, I have ALOT of ED experience )

What has happened to me, and I think alot of nurses, in general, is we see so many of these patient, we start ASSESSING for drug seeking behaviors! (I don't remember that it is in the ED triage form.) And it seems to happen in the ED more than any other place because that is the "usual" place we find the users/abusers. I find the behaviors as humorous as can be, and as much as the next nurse, and love sharing the stories... Rx reading MOFINE 100 lbs everyday... it is REALLY funny.:rotfl:

I just don't want us to be OVERLY assessing for drug seeking behaviors. Because we see it EVERYDAY, and if the patients are in true pain, we tend to under medicate... does that make any sense?

In my earlier post, I had just been in a situation, where the ED had seen my sister two days in a row, (with clinically the wrond dx, and not enough testing). And someone had maybe misdiagnosed her as a drug seeker, seeing her 2 days in a row, complaining of pain. The ED conservatively treated her! When in all actualitiy, the pain WAS unbearable! As she acted outrageously! Screaming, crying.... as her bowel perforated. And it is different when it is your family. I know.. But it has just taught me to at least give the benefit of the doubt to the patient at first, at least for one dose.....:)

Specializes in ER.

Last night I got a call to the ER from a guy asking if we could treat his leg pain, I say "Sure." He asks if we could see him and NOT notify his PMD, I say that's up to him , and why wouldn't he want his doc to know? Because the doc doesn't like him going to the Er for pain meds. And why would that be? Because his doc thinks he takes too much. Hmmmm, so what's the med for- cellulitis in his leg....and how much exactly are you on? Morphine 600mg every day!

Probably not going to get ANYTHING from us without a call to your doc, buddy.

Several years ago I had a male come in for something to calm him down as his parents had been in an mva, dad was dead and mother critical in a hospital in Pa. MD ordered inj valium, yes he did have a driver. While waiting the 20 mins he asked for directions to a hospital 20 mins away "so he could go tell his aunt who was hospitalized there". I smelled a skunk. After he left called the other hospital and said that he may be coming. I also called area hospitals and found that he had been to the one closest to his home, 45 mins away, and got drugs; then the hospital 30 mins away, and got drugs; then the hospital across town, and also got drugs, prior to coming to mine. All of this just travel time between visits. Yes he did go to the last hospital after leaving me, and did not get any drugs :)

I talked to the ED MD and the police were called, he was arrested, indited by the grand jury after my testimony, and served one year in Maine state prison. Also there had been no accident and the state police had talked to the "dead" father just a few days before grand jury. There was no trial, he plead guilty, and the DA said he would make no deals as he had RN/MD's to testify. The charge was getting drugs by deception. After getting out he was back to the same thing, same hospitals. Died shortly after getting out of prison from a mva with lots of pill bottles in his car. (Also I had been warned to watch out for him as he was not a nice guy and may be after me. I did not live in the town of the hospital.) Yea reap what you sow. :nono:

Court isn't always a fun place to spend your time, but very necessary at times. If we take a stand and it is know, perhaps it will help. There are programs to help people with drug problems, and I support those that kick their habits, but not those who are just law breakers and liers. :angryfire

Gotta love the ones who call "incognito" first to see who the doc on is.

We had a few that did this all the time. Knew em' by voice. So I would answer, "That would be Dr. so-n-so. (always give the name of the doc that would NEVER give em anything...and they knew it) Anything else I can do for you "Joe"?

Click....buzzzz....

Specializes in ER, PACU.

This was the best..Sat night there was a 20-something year old patient admitted to psych for taking a few too many Xanax's..sleepy at first, but otherwise OK. Its now 6 hours after getting 2 tubes of activated charcol. This man was up, walking to bathroom, going outside to smoke (with a security escort) getting himself something to eat, ect. No problems. I see him sitting on the side of the bed, and then I hear him yelling for the nurse. He then gets up from the ground and is now sitting in the chair next to his bed. He says "Nurse, I just fell out of the bed and now my back hurts". I was like "Nice try throwing yourself out of the bed, you were up all night walking around with no problem and now you fall?" "But nurse, my back hurts so bad. I think I need pain medication". He got Tylenol. After getting Tylenol and Motrin, the doctor finally just asks him what he wants. Morphine. Go figure! She laughed in his face! Patient in the bed next to him calls me over and whispers to me that she saw him throw himself out of the bed.

Specializes in Med-Surg, Geriatric, Behavioral Health.

My last drug seeker story involved "one of our own"...an RN who was released because of taking opiates (liquid) from patient PCA pumps. They asked her for a urine, which she declined to give. When she was released from the hospital, she would often be found "visiting" patients (while wearing a nurse's uniform)...making "her" rounds sorta speak, until one day she nearly hit one of our security guards in the parking lot with her car as she was trying to flee...(the car was stopped...iv tubing/supplies and syringes were found in the car). Sad...very sad.

Looking back, nurses were able to piece backward her behaviors that should have raised flags earlier.

1. She spent beaucoup amounts of time medicating her patients for pain

2. She would case other nurses' patients for need for pain medication and PCA machine refills

3. Getting very upset with doctors over the phone for not prescribing pain medication for her patients

4. Requesting to come in to work extra, coming in to work, but requesting to leave to go home after working part of her shift

5. Having her co-nurse carry most of the patient load

6. Going out for frequent smoke breaks...way too frequent

Yes folks, it happens to our own too.

Opiates...the worst drug addiction out there.

Pt. "X" comes in c/o migraine headache and back pain. Pt. really does have back problems and has had to have rods placed due to scoliosis. However, the pt. states that her headache is just "unbearable" and she has had it for 1 week with no relief. What the pt. forgot is that she has a stamp on her hand from the dance club she attended Saturday night. Pretty bad migraine headache there:)

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