Drug seekers: where's the compassion?

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We had a patient at work, age 41, female. On scheduled Lortab 10 mg three times a day. Her diagnoses included depression and chronic back pain. She clearly had the depressed affect but was very sweet and thanked me whenever I came in the room. She didn't complain of anything to me but when the doctor came in she said she was having chest pain so the doctor ordered a telemetry monitor and troponin level (both of which were normal.) Another nurse remarked that she probably said that because she thought the doctor would order more pain medicine but he didn't so HA to her.

The eye rolling and superior attitudes kind of got on my nerves. Maybe she is a drug seeker...maybe the Lortabs do something for her that make her feel better, even if it's from a buzz. Why be condescending toward her? I felt badly for her, my heart ached for her, in fact. She had the look of years of rough living and did not seem to want to go home. It was sad.

I pass out pain medications like there is no tomorrow... Who am I to judge?

Just ruminating:

As nurses, don't we have an obligation to at least attempt to keep the Pt from harm, and isn't part of that harm to themselves?

While the Pt's report of pain should get great deference from docs and nurses, we do exercise judgment in many cases, e.g. assessing suicide risk and taking adequate precautions.

Not to say that any nurse should deny pain meds, or denigrate a Pt simply because the a feels, without much if any evidence, the Pt is drug seeking.

I don't think you meant it that way, but one could infer from your post that you pass out meds w/o doing an assessment of the Pt and his pain level.

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Just ruminating:

As nurses, don't we have an obligation to at least attempt to keep the Pt from harm, and isn't part of that harm to themselves?

While the Pt's report of pain should get great deference from docs and nurses, we do exercise judgment in many cases, e.g. assessing suicide risk and taking adequate precautions.

Not to say that any nurse should deny pain meds, or denigrate a Pt simply because the a feels, without much if any evidence, the Pt is drug seeking.

I don't think you meant it that way, but one could infer from your post that you pass out meds w/o doing an assessment of the Pt and his pain level.

steffers specialty is onc.......

to the OP, frankly i think the patient's mention of CP may be more related to your observation that she seemed to not want to go home, than an expectation of increased pain med....

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Such a tough one. I work hospice, and every once in a while we get a patient who is a drug addict who has trashed his/her liver due to their habits. I have a very young man(32) with alcoholic cirrhosis who immediately dove right into the e-kit we put in the home and had a field day with the morphine and lorazepam, then wants more morphine. I kindly told him that he would not be getting more morphine, but we could put him on a scheduled medication for pain. We did go ahead and put him on scheduled lorazepam as well. For now he accepted that. He's very functional and not yet bed bound. I suppose I'll go back and his meds will either have 'disappeared' or he will have 'lost' them...sigh.

These patients drive me up the wall, but I realize that they have so many problems that I will not be able to fix. I won't let them be in pain, but it's a fine line between medicating and over-medicating to the point they need narcan (had another cirrhosis patient who did that once...) but my patients are dying, and it is my job to keep them comfortable. 99% of them I feel perfectly fine with giving whatever is necessary, but with these types it is hard to be compassionate and understanding. However, I am not a drug counselor and it is not my job to detox them...this patient I have now is just so young and he really is pretty personable and likable. It's just such a waste of such a young life.....but I will do what it takes to keep him comfortable in the time he has left.

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WOW, I didn't know there are so many nurses who believe like I do. The posts show lots of compassion, but some needed caution too.

I personally have had bad experiences as a patient in a hospital setting and can therefore empathize with my patients.

When I had my second baby I had severe pain at the site of my episiotomy. When I told my nurse her answer was, "This shouldn't hurt." She refused to give me so much as Tylenol. She told me its not good for the breastfeeding baby. I had 4 children and never had such pain there.

Another incident. The evening after I had my 3d child my feet started burning. They were warm to the touch and after a while I could not move them. It was hard for me to turn from side to side. I told the nurse and she told me its late and she can't call the doctor. I should wait until the morning. I asked for warm compression but the nurse argued she needs a doctors order and its too late to call. It was only 9-10 pm. I was up all night. The next afternoon they did a doppler ultrasound. Thank God I didn't have a DVT. But I had to stay in the hospital for a few more days.

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Specializes in Med/Surg/Tele/Onc.

If a patient asks for pain meds and if it is ordered, I usually give it. If a patient asks for meds an hour before they're due and seems to be in pain, I'll tell them that I'll try to be back in an hour, but to call if I'm not back by such and such a time - that I get busy and may loose track of time. If they seem to be more drug seeking, I'll check on them before I get it. If they're sleeping, I don't give it.

I had a new admit yesterday with pylonephritis. She was running a temp so I gave her Tylenol. She told me once that her side was killing her, but within a few minutes she was asleep. Every other time I went into the room she was snoring, sleeping very soundly. I'm sure she felt bad, but I didn't worry too much more about her pain. I never did give her any pain meds.

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Specializes in Rodeo Nursing (Neuro).

I had a run of drug seekers awhile back--every night I had one, usually a different one, who was on the call button all night for pain meds. It was frustrating. Last night I had one with chronic, severe pain who was doing her best to look like a drug seeker. Happily, census was down and I had a very light load, with other patients who appreciated being neglected. Still, it's tough. A lot of times, though, what's tough is knowing your patient really is in pain, even if sometimes it's pain of the psyche, and the tools available aren't working. For my part, I hate the feeling of being caught in the middle, knowing the patient is suffering, knowing the docs are right that more morphine isn't going to fix it. Nor does it help to see my own father dealing with chronic pain--not excruciating, usually, but depressing, because it's almost always there.

Sometimes my compassion comes in the form of kicking and cussing at the Pyxis machine, rather than a person. Sometimes it's in the form of not paging the doc sixty times a night. Sometimes it's even in the form of cutting myself some slack for being human while I count the hours to the end of the shift. But I do think about my dad when I'm pulling my hair out.

Some of the stressors of nursing don't have to be. When a patient is crying, "Oh my God, oh my God, I can't stand this..." I find it hard to accept that I need to suffer the stress of asking, "What would you rate your pain, on a scale of 1-10." Sometimes pain is what I say it is, and the example just given has to be, what, at least 6/10, right?

But some stressors are just unavoidable. So when the doc orders 0.2 of Dilaudid, Q2H, because he doesn't want to mask neuro changes, I have to keep my mind open to the possiblity that he knows what he's doing. When a patient who can't push his PCA button has no trouble with the call button, I can try to educate, but mostly I have to accept that it's gonna be a long night. Nobody held a gun to my head and made me go to nursing school. And if you're demanding 6 of morphine Q1H for your fibromyealgia, you probably aren't going to get it, but I won't blame you for trying, and I'll remind myself regularly that I used to be really brave about pain, until I actually had some. But I'll more than likely say some bad things about you in the med room. I'll try hard not to really mean most of them.

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Specializes in allergy and asthma, urgent care.

Unfortunately, in my practice anyway, the not so few drug seekers make you suspicious of everyone. It's a shame, because there are patients who are truly in pain and need relief from narcotics. I am willing to prescribe narcotics for people when there is documented evidence of injury/medical condition, and they are amenable to "following the rules" (urine drug screens, pain management contracts, etc.), or a very limited amount for an acute condition. But then you get the patient with "chronic pain" who picks up his percocet at the pharmacy downstairs and is caught on camera selling them before he is even out of the building!! Or the ones who falsify their identities to pick up someone else's prescription. I don't think we're doing people any favors by freely handing out narcotics whenever they say their pain is "bad". I think medicine, nursing, whoever has created a culture where any level of discomfort is unacceptable, and that's led to greater and greater use of addictive medications. I have compassion in the sense that it must be truly horrible to be addicted to any substance and have your life controlled by it, but that doesn't mean that I have to perpetuate this condition by freely prescribing narcotics solely based on the patient's report of pain. That is why when I have a patient that appears to be "seeking", I refuse the narcotics but give them other medication options along with information on counseling and treatment. I think it's unconscionable to do otherwise.

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Specializes in Cardiac Telemetry, ED.
We had a patient at work, age 41, female. On scheduled Lortab 10 mg three times a day. Her diagnoses included depression and chronic back pain. She clearly had the depressed affect but was very sweet and thanked me whenever I came in the room. She didn't complain of anything to me but when the doctor came in she said she was having chest pain so the doctor ordered a telemetry monitor and troponin level (both of which were normal.) Another nurse remarked that she probably said that because she thought the doctor would order more pain medicine but he didn't so HA to her.

The eye rolling and superior attitudes kind of got on my nerves. Maybe she is a drug seeker...maybe the Lortabs do something for her that make her feel better, even if it's from a buzz. Why be condescending toward her? I felt badly for her, my heart ached for her, in fact. She had the look of years of rough living and did not seem to want to go home. It was sad.

This doesn't sound like a drug seeker to me.

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This doesn't sound like a drug seeker to me.

yeah, that's what i said......virgo, ya think we are the only two who read the whole post??

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Specializes in Cardiac Telemetry, ED.

Drug seekers can be frustrating because of the amount of time and resources they divert from the person in the next room who is seriously ill or even dying. I have literally had one patient with broken bones and internal bleeding who I had to sweet talk into taking anything for pain, while in the very next room a patient whose million dollar workup was completely negative is telling me that they will only leave if the doctor gives them X amount of med A and X amount of med B, plus take home packs of each.

You look up their list of encounters and see that they've been in the ED on a monthly basis for the last six years, and they always receive the same thing no matter what their complaint, whether it is an ear ache, abdominal pain, ankle pain, or eye pain. Their workups are always negative, and they are always referred to their PCP for followup. They've even received a referral to a pain clinic, but there are no notes to indicate that they have actually made an appointment and seen a pain specialist.

Meanwhile, your nice quiet patient next door that you had to talk into taking pain meds needs a blood transfusion and is being admitted. They are the one who needs your attention, but the drug seeker is standing in the doorway to their room flagging you down as you rush past with supplies for your sick patient.

You look up and see that the drug seeker is being discharged. Hooray, you think, I can get them out of my hair so I can focus on the patient that really needs me!

You go to do the discharge, which should only take about 30 seconds of your time, and see that the doctor has not written a script for pain meds. You know why, it's because they checked and the person had a recent script for Vicodin written for them for some other malady, and if they are taking it as directed, then they should still have plenty left. But the patient says "The doctor didn't give me anything for pain?"

"No."

"Well, I'm not leaving until I get something for pain."

"Well, it says here that you can take over the counter analgesics for this type of pain."

"That stuff doesn't work. Isn't the hospital here to help people? Are you a nurse? Aren't nurses supposed to help people? Why aren't you helping me?"

"The doctor feels that Tylenol and Motrin are the most appropriate medications for your medical diagnosis. You've been discharged."

"I'm not leaving until I get something stronger."

"Like what?"

"Oh, nothing specific. I just know that Tylenol and Motrin do not work. I need something stronger, like Vic....Vico.....Vicodin, I think it's called."

"The doctor says you don't need that. It's not warranted for your medical condition."

"What do I have to do, go out of state? What's wrong with hospitals in this state? I'm not leaving until I get something for the pain!"

"I'll get the doctor."

Meanwhile, the sick patient has a room assignment, the blood is ready, and I need to go get that blood going and get the patient ready for transfer to the floor.

I've only been in the ED for a few months, and this scenario has played out on multiple occasions. Believe me, the drug seekers become obvious and being "compassionate" becomes a challenge. How compassionate is it to my sick patient that needs life saving intervention for my time to be sucked up by someone who has nothing physically wrong with them who is just trying to work the system?

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Specializes in Cardiac Telemetry, ED.

...or, reaching for the IV to remove it since the patient's been discharged with a negative workup, and all of a sudden, "Oh, my chest pain is sooooo bad! I haven't gotten anything at all for the pain since I been here! Nobody cares about my pain at all!"

"You got Toradol for your pain."

"That's not for pain, it's for gas and I have that at home. I'm a nurse, you can't fool me!"

"What is it that you need for your pain?"

"Well, morphine is what they give people for chest pain! You should know that!"

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Specializes in LTC.

One of my elderly residents has chronic pain. The md only prescribed tylenol RTC which is ineffective. I know with the elderly its best to start low and go slow, but the md wouldn't prescribe her anything thing else. When I explained that resident is still in pain he stated so what atleast she's alive enough to feel pain. I was so enraged. The point is that pain is subjective. Now if a nurse has a pt that is a drug. Seeker and other sick patients too the only thing to be done is prioritize.

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