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.

TraumaInTheSlot said:
How "angelic" of you to be chastising your peers on this message board.

I do not mean to chastise but I am coming from the viewpoint of a chorionic pain pt., Who, in the past before I found a treatment that worked, had to go to the ER a lot, and was accused of being a drug seeker, by some nurses and docs. I don't know if they did not care to find out the truth or where just so jaded that they did not care to find out that I had gone to 11 docs in 11yrs because all they did was throw pain meds at me, and I did not want to be on narcs the rest of my life. That I is One of the reasons that I am becoming a nurse is to help others that are Truly in pain and need help.

Why do you say,ERSlave, that a sign of a drug seeker is to ask the dose? I ALWAYS did so that I could put it in my pain diary so that my doc knew EXACTLY what I was having to take to survive.

I do not mean to chastise:uhoh3: but I am coming from the veiw point of a chrionic pain pt., Who, in the past before I found a treatment that worked, had to go to the ER alot, and was acused of being a drug seeker, by some nurses and docs. I don't know if they did not care to find out the truth or where just so jaded that they did not care to find out that I had gone to 11 docs in 11yrs because all they did was throw pain meds at me, and I did not want to be on narcs the rest of my life. That I is One of the reasons that I am becoming a nurse is to help others that are Truly in pain and need help.

Why do you say,ERSlave, that a sign of a drug seeker is to ask the dose? I ALWAYS did so that I could put it in my pain diary so that my doc knew EXACTLY what I was having to take to survive.

I too ask the dose when I go in to the ER for migraine. So what? Wouldn't you want to know?To avoid asking a nurse what I'm getting like asking whats in a loot bag..I discuss treatment with the doctor first. If I go in early enough I can forgo narcs altogether and wouldn't want a hefty dose of demerol so early in the "game". Nothing like a surprise shot. (not) I also ask the dose of my Torodol since too much mixed with Maxeran gives me an adverse reaction. But I guess thats not drugseeking behaviour since it isn't a narc. :uhoh3:

My doctor gets the ER sheets sent to him so as to keep him informed prior to my visits.

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

People with chronic pain often find relief using amitriptilline, for nerve pain, which is not taken care of by narcs. A fellow nurse went to a Pain clinic offered by a British nurse who said that using narcotics is not doing it for sufferers. She tried amitriptilline & it took a couple of months but she was able to return to work. Talk to your Doc about this.

Victoriakem said:
People with chronic pain often find relief using amitriptilline, for nerve pain, which is not taken care of by narcs. A fellow nurse went to a Pain clinic offered by a British nurse who said that using narcotics is not doing it for sufferers. She tried amitriptilline & it took a couple of months but she was able to return to work. Talk to your Doc about this.

Are you directing your answer at me? (I'm too tired to go over all the posts to figure it out ) I don't have chronic pain thank gosh just migraines once in a while, but I was on amytriptaline at one point and gained 45 pounds. I've never been quite the same. It didn't really help my headaches either, so the side effects far outweighed the benefits in my case. For people with a tendency to gain weight easily, I would never recommend it. I'm a skinny person with a high metabolism and poof..it was gone.

I too tried amytriptaline when I was looking for a mirical IT WAS NOT IT! HA:rotfl: I started getting BOTOX:idea: for my chrioc debilitating migrains about 21/2 yrs ago and went from being basicly bedfast to working FT and in nursing school FT. Now I may get one med migrain in four months, and all I need is maxalt most of time. Thanks for trying to help though.

When I worked ER we thought it would be fun to put a coin operated machine in the lobby. You know the "claw" kind where you can try for a prize. In it we would have unmarked bottles. Sometimes ya get percocet ect, sometimes ya get biscodyl or other mundane med. The revenue for the hospital would just roll in, hey and talk about laughs!!

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.:)

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.:)

Thank gosh you were there. I've been in the ED on numerous occasions and usually i have my BF with me but on a few occasions he was unable to go. It really sucks when you're in pain w/ a migraine, lights hurt, you don't want to walk and you get put as FAAAAAAAAAAAR away from the nurses station as possible. It makes it hard to get anyones attention for repeats on meds or even a glass of water. I am a strong believer in pt advocacy as well. :)

(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.

+ Join the Discussion