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.

Specializes in Cardiac Telemetry, ED.
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.

This patient is not a drug seeker.

And yes, obviously we prioritize. However, the drug seeker is selfish and does not care about anyone else. They will monopolize your time, and if you try to prioritize someone sicker, they will manipulate you into paying attention to them. This is why, when I see that one of them is up for discharge, I prioritize getting them out of there. They can no longer be a time suck if they are gone. The problem is when they turn what should be a quick and easy discharge into a time consuming ordeal.

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virgo, do the docs give these drug-seekers the pain meds that they demand upon discharge?

what does a pt do if they are refused?

do you guys have to get security to escort them out?

i'm just wondering, because in in-patient hospice, these folks get whatever they want...

leslie

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Specializes in Acute Care Cardiac, Education, Prof Practice.

I would venture to say the nurse in question may never have had a real drug seeker. Three Lortab a day does not a seeker make...but Demerol Q2, Phenergan "anytime I can get it", Zofran and a sandwich + a host of anti-psychotics and cigarettes in the bathroom complete with dewey eyes when discussing friends from rehab is different.

However I still treated her with compassion, took her for a walk outside mid med pass to help relieve her mania and worked to resolve her constipation.

Tait

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Specializes in Cardiac Telemetry, ED.

Leslie,

Some of the docs are very good at drawing the line. They will tell the patient exactly what they are willing to give, and what they are not going to do. They base what they prescribe on the workup and diagnosis. Others give the patient whatever they want. Some of them talk tough at the doctor's station, but will let the nurse be the "bad guy" before they will go in there and talk to the patient themselves. It is not consistent. Some of the frequent fliers will even ask if Doctor Soandso is on tonight, because they know they will get what they want from Doctor Soandso.

Usually they leave threatening to "come right back". I haven't seen anyone escorted out.

Regardless of whether someone's name is well known, they always get a workup appropriate for their chief complaint. You never know when there might actually be something wrong, and to dismiss their complaints because of their behavioral history would open the doctor up to liability, should a real problem be missed.

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Regardless of whether someone's name is well known, they always get a workup appropriate for their chief complaint. You never know when there might actually be something wrong, and to dismiss their complaints because of their behavioral history would open the doctor up to liability, should a real problem be missed.

of course, every single one of them need to be worked up r/t cc.

such a waste, though...

of time, money, resources, etc.

ftr, i definitely do not think the pt with tid vicodin, was med-seeking...at all.

as most of us know, hospitals can be a refuge for all types of folks.

and tencat, since we both do inpt hospice, i wanted to tell you that i have absolutely no problem with 'enabling' an addicts demands.

my only goal with them is to ensure they die, getting what they want.

really, it's just all so pitiful.

leslie

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Pain is whatever the patient says it is. Who are we to judge ? I have had drug seekers and I give them the pain meds in the prescribed paremters. Now if mr.x has RR of 10 and still requesting morphine I would hold the morphine. ( and have narcan near by)

Why? What else meets this rule? "______ is whatever the patient says it is?"

Alcohol use? What if a patient was admitted with slurred speech and alcohol on his breath but denied etoh use. what if he had other clinical s/sx of chronic alcoholism? Would you advocate for withdrawl protoclol, or go with "alcohol use is what the patient says".

How about sexual activity in a teen with signs of an STD who claims to be celibate?

The list is endless. Patients lie frequently. Why would anybody assume that a person wouldn't lie about pain? Part of the nurses job is to understand the difference between objective (signs) and subjective (symptoms) information. We do it all the time.

Addicts lie frequently to support their addiction. It is one of the defining characteristics of addiction. Of copurse drug addicts lie about drugs, just like gambling addicts lie about gambling. Choosing to believe an obvious lie is a form of enabling.

All that being said:

1. the patient mentioned in the first post doesn't really sound like a seeker. It is odd that she didn't mention chestpain to the nurse, but people are weird.

2. I regularly give narcotics to people who lie to get them. It's part of my job as an ER nurse. In fact, I have done it twice today, and am sure I'll do it again. Giving medications as ordered and believing that pain is what the patient says are two entirely different issues. The first is my job, the second would be naive.

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Specializes in Med-Surg.
This doesn't sound like a drug seeker to me.

This is what I was going to say.

There is a distinct difference between a chronic pain pt with a tolerance built up asking for pain medications and a drug seeker. I think the nurse in the op's situation needs to learn that. Sadly for the patient in pain too many nurses don't see this and judge a patient immediately.

I can spot a drug seeker. I know I'll get flamed for showing no compassion but in 18 years of med surg, I've had drug seekers suck the life out of me, diverting me from providing care to other patients with their demands and histrionics. Fortunately these have always been a very small minority of the patients I've cared for and I definitely follow the dictate "pain is what the patient says and whom am I too judge" so if one person says that to me, you will be ignored.

I'll leave it at that.

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...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!"

I thought it was nitro...?

I remember being young and in the hospital with my 3rd baby. The nurses acted surprised that I chose Ibuprofen 800mg for pain instead of Percocet (and I only took a couple of doses of Ibuprofen at that.) With my last child, though, born 6 years after the 3rd, I gladly accepted Percocet. I hope they don't think I was a doper, I didn't even take them every 4-6 hrs., I only took a couple of those.

Anyway, I know there are people who work the system, but it's hard to resent someone as pitiful as the patient I took care of. She was just wanting to feel better, I don't think she was intentionally trying to step on anyone else to get what she wanted. As a group, I do resent drug seekers, but inidividually, A lot of times I just see an empty person in a sad situation trying to numb their pain, whether it is emotional or physical.

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Specializes in ICU, telemetry, LTAC.

I have had a lot of belly fistula patients in the last year, along with some recovering from multiple traumas and it seems to me our docs really like to give them dilaudid. Like, REALLY, the patients don't always ask for it, some of them are not on it when they arrive but know it well within a short time. Some of them are also, thank goodness, on other things to work with the dilaudid, and a few respond to heat, massage, and some distraction techniques.

That being said, I haven't had any broken bones, and I certainly never had a giant hole in my belly that threatened to let my stomach acid digest me. (Fistulas are horrible.) So for the belly patients I really tend to just push what the doc ordered and keep 'em breathing. For the trauma patients I like to advocate for alternating the IV dilaudid with the lortab-type meds or even nsaids so they can have something to help the healing process as well. It's a lot of work to make sure that I follow up and sorta "schedule" the prn meds the way I think will help them, while letting them know that I'm trying to help them avoid withdrawal once the healing and rehab is done. Sometimes all that work actually works.

Then there are the few who really just want their meds and will make up wonky complaints to get me to call the doc so they can have an extra dose. One in particular comes to mind, he complained of severe testicular pain and was in LTAC for ABX for a spine infection. So I say okay, drop your britches I have to look at it. He said what?? I told him that if it hurts 10/10 it is my legal duty to make sure it isn't about to fall off and so let me do the exam. The body parts in question looked normal, no swelling, redness or monkey business. The patient was very surprised that I didn't just hand him dilaudid but did my job. I told him I would let the doc know but probably his spinal infection was having nerve complications resulting in pain there, etc. He did get a lot of pain meds.

Ok so a few months later we get the patient back and this time it's for - I kid you not - scrotal edema. This time the scrotum was the size of a football and threatening to peel all the skin off, and he had cardiac and pulmonary complications as well. Oh the irony, be careful what you complain of.

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Specializes in OB/GYN, Peds, School Nurse, DD.

Have any of you been treated like a drug seeker? I have.

About 3 years ago I herniated 2 discs--I was in so much pain I nearly passed out. Thankfully, I was treated appropriately, had weeks of PT, and I was able to avoid surgery.

Last year I herniated a disc again on a Friday night. Went to the ER. The doctor concurred that it sounded like a herniated disc. He ordered Vicodin. Well, Vicodin makes me horribly sick and I will not take it. I have had Percocet after surgeries before, so i requested Percocet. Now the back story you have to know is that I am allergic to many, many meds. And I take some meds for bipolar disorder. He looks at my chart, smirks and walks out. Next thing I know here comes the nurse with *one* percocet. Okay, one is better than none. My pain came down to a nearly tolerable level. When time to go the doctor brings me a Rx for exactly *four* Percocets. WTH?? Are you kidding me? Nope, that's all you get. Call your doctor Monday. Goodbye.:angryfire

I know that doctor thought I was drug seeking. He looked at my allergies,my psych history, coupled with my request for a specific drug and totally blew me off. I am so not drug seeking. The only meds I take are for cholesteral and a mood disorder. I don't even take Advil! I really felt abused and all I could think is "I hope some day YOU suffer with a herniated disc; see how you like them apples!":madface:

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What gets me is when patients become addicted because of their interaction with the healthcare system (on our unit we give out IV morphine and Ativan like candy on Halloween) and then the nurses turn critical when the patients get addicted and start asking for meds.

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I agree... I think there are people who genuinely are seeking pain relief. I also believe we create drug seekers with our western approaches to medicine. I have back pain... I see a chiro and do stretches and try to be aware of my body. No, I wouldn't expect someone with severe kyphosis to do this. We need to shift the thinking of people. As I administered 600mg Seroquel last night to a patient on many other sedating meds it is insane, she needs the dilaudid pca on top of everything else. How can that much medicine work as intended? How long can her kidneys and liver take it? Yea... we can make some people look like drug seekers for sure.

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