Drug seekers: where's the compassion?

[Born2BWild]

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.

[cute2]

I was treated like a drug seeker once. I ended up in ER with a migraine about 6:30 AM on a Sunday morning. I was clammy and sick. At first I could not believe they did not do something for me right away. The ER was not busy. They gave me a cold pack and an IV with something that didn't abort the migraine right away. I was only in ER once before for anything and that was another migraine years ago when I was nursing my baby and didn't take anything to prevent the headache from spiraling out of control. That time they gave me something to abort the headache pretty quick. I think it as Imitrex shot.

I could tell this second migraine incident in the ER was different. They were "suspicious" of my reason for being there. It's truly sad that I had to suffer longer because of drug seekers. I am not blaming the drug seekers but society in general for the state we are in regarding drugs.

[Virgo_RN, BSN, RN]

Have any of you been treated like a drug seeker?

Yes, I have. It didn't ruin my life.

[rngolfer53]

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....

I work in hospice, and in my experience drug seekers are quite rare at EOL.

Much more often than not, I find myself educating the families, and Pts themselves, on giving enough meds to keep the Pt comfortable.

[nursel56]

I work in hospice, and in my experience drug seekers are quite rare at EOL.

Much more often than not, I find myself educating the families, and Pts themselves, on giving enough meds to keep the Pt comfortable.

Those are the ones that make me really sad. They will writhe in pain and sweat bullets rather than risk "becoming addicted to those things". Gaahhhh!!!! My mom is being treated for cancer-- Christmas Eve I spent the night at her house. She woke up in the middle of the night and sat there all hunched up holding the side of her ribs vacillating for 3O minutes about "should I take a Tylenol or an Oxy" while the pain kept getting worse! I've told her all about getting ahead of the pain over and over- she's been guilt tripped to the max!

[nurse32]

About a year ago I went to the emergency room with severe teeth pain that was a result from a really bad infection that passed already the upper jaw. The physician assistant asked me if I will drive home because he was gonna inject me with a powerful painkiller. ( I never asked what) I refused and he prescribed vicodin.

A few days before, I went to my dentist and complained that I'm having severe teeth pain. He looked at my teeth and announced that he doesn't see anything and refused to prescribe any painkillers. The pain only intensified. I took 1000mg Tylenol and 800mg motrin an hour later when that didn't help. I watched the clock and exactly 4 hours later took another dose of tylenol. Nothing worked. That night I went to the emergency room.

My dentist refused to give me any pain meds, while in the emergency room I was offered an injection?

[BCgradnurse, MSN, RN, NP]

In my area, the ERs are notorious for giving pain meds like they're candy. I think they have a lot of pressure to move the patients through as quickly as possible, so perhaps they don't have the time to thoroughly evaluate pain. And granted, if someone appears to be in pain and presents at the ER, you want to give them something to alleviate their pain. My issue is with the "frequent flyers" who are known to be seeking, but the providers just keep giving them the drugs anyway. I also get aggravated with the docs (ortho and oral surgery come to mind), who refuse to treat a patient's post-op or post-procedure pain for more than the immediate day or two, and these patients wind up in my urgent care clinic. I've never seen them before, know nothing about what their medical conditions are, but am expected to prescribe medications cause their docs won't follow through. I don't blame the patients for this. There is absolutely a time and a place for pain killers, but I think, like antibiotics, they need to be used judiciously.

[nursel56]

I don't understand the nurses who become genuinely enraged if a drug seeker is successful in getting the doc to give them painkillers. They will often place themselves between the doctor and the patient in this dynamic which is often manifested as trying to convince the doctor NOT to give the med after he's already written for it, giving them an elaborate "heads up" about patient such-and-such, etc. I understand completely about manipulative drug-seekers, but why do some nurse's act like it's their job to decide who gets what and how much? It seems like most doctors are less emotional about the issue.

Maybe it goes to our basic instinct against dishonest behavior in the first place. We know intellectually that a drug-seeker when denied will not be (in most cases), likely to enter treatment, but will simply choose another route, another hospital, another lie. It's probably doubly frustrating to ER nurses because they don't have the time to spend counseling and making referrals when so many people treat the ER as their primary-care facility. That's why, though I don't understand the hostility some ER nurses have on a personal level, I will never play the "where is your compassion" card. Most of them would love to help drug addicts, but the structure of our healthcare delivery system itself places huge obstacles in their path, and I know all of us hope to see reform that addresses these issues and that can't be too soon! My .002 :)

[Emergency RN]

imho, we're deluding ourselves into thinking that we're actually helping these people by refusing them drugs, and often at skyrocketing and monumental health care costs.

take for example, the cost of an mi in the emergency department. how many dollars and cents does it take in terms of meds, salaries for professionals, time, and space? hold that thought for a moment; but now equate the cost of denying euphoria meds to a drug seaker; how much is it really costing that ed in terms of salaries for professionals, time, space, unnecessary tests, alternative meds, et cetera? also, how many times a day do we see these people return? my observation is that if we actively choose not to help these people with a long term sobriety solution (that is, only give them one or two pills instead, and then chase them away to the next ed, while we likely get another drug seeker in return) we've only thus created a cycle of revolving door drug seekers that then routinely needs troponins, ct scans, ekgs, nursing and medical time that could be better spent on real needs.

my suggestion is a radical one; instead of doing a plethora of needless and expensive tests that answer to their legion of faux excuses or fake presentation complaints, it would be far cheaper to allow them their high and give them a spot to sleep in the corner like the etoh drunk. while they are sleeping, they are effectively out of the circulation of demands placed on the medical system, if not in our own ed, then in someone else's. by occupying and using up their available drug seeking time through safe and observed sedation, it removes their impact on the medical system as a whole. that is, they can no longer trigger the unnecessary medical tests and expensive exams if they're snoring in a corner. by chemically warehousing the drug seeker, we can eliminate, or at least severely curtail, his or her available drug seeking time. thus if every ed decided to give sedation to drug seekers, in high enough dosage that they have to sleep through the night, we've effectively remove that class of costly time wasting ed presentation.

some may winch with horror at what i'm suggesting, and say that we should be helping these people instead. what i ask in response is; how has the system not risen to the task of genuinely helping these people get off drugs in the first place?

the primary reason? it's too expensive and nobody wants to shoulder the costs. so if that is the case, then let's at least be honest with ourselves and say so; that we, as a health care delivery system, care little about those that have become addicted. instead, we shoulder the cost of pretending to treat them. we perform ct scans even though we know that they don't need them, we give them xrays even though there is no reason, we entertain them with our salaried time, listening as they ply their elaborate (and sometimes quite knowledgeable and creative) spiel about signs or symptoms that we both already know to be non-existent. in essence, it has become a game, and a rather very costly one at that.

enough already.

again, give them the sedation that they crave, and in the meanwhile eliminate a whole class of costly time wasters from their impact on our system. imho, a few ativans or morphines is a lot cheaper than troponins and ct's. we've already lost the war on drugs, now it's time to limit our financial burden from that loss.

likewise, the ed has become the new homeless shelter and soup kitchen. the secret password that would allow you into the shelter?

chest pain (but, don't tell nobody, it's a secret...)

[Jules A, MSN]

the secret password that would allow you into the shelter?

chest pain (but, don't tell nobody, it's a secret...)

and word on the street is that my unit gives methadone, suboxone and librium which translates into "my check has run out and i'm going to harm myself if i'm not admitted now".

i don't think anyone is referring to limiting the medication a patient in hospice is receiving but for those that don't regularly work with entitled, non-terminal drug addicts with axis ii stuff take my word that it is not about a lack of compassionate nursing care.

[KinshuKiba]

I'm all for compassion; I'm all for helping and giving patients anything they need to feel better and heal. But what do you do when it's obvious that a particular patient is abusing the system? Let me give an example:

I used to work in a small town ER. We had this particular gentleman that was always (and I mean ALWAYS, 1 to 2 times a week, on average) coming in for abdominal pain. And every time he came in, he'd not just ask, but demand demerol. We'd work him up, run labs, give fluids, perform a CT, and every single thing would come back WNL. And sometimes we'd kick him out without giving anything, sometimes we'd give him something to shut him up, and sometimes we'd admit him just to give ourselves a break. His PCP was the local Dr. Feelgood, who everyone knew was just a drug dealer with a degree. She gave him Lortab, Darvocet, Percocet, Percodan, you name it. And STILL he came to us, like he was keeping an appointment. He would cry, whine, lie on the floor and refuse to move, become verbally abusive with the doctors and staff, all if he didn't get what he wanted. The worst stunt he ever pulled involved the other small ER just down the road. He went to see them for abdominal pain (of course) and they discharged him without any pain meds. He then got in his car, drove to the county line, parked just on our side of it, and called our EMS. He was transported to our ER, where, once again, he complained of abdominal pain. Two years of this, and it never varied. No one ever found anything wrong with him, and even after being told several times that perhaps his behaviour might be considered unacceptable, he continued to come to us. I have since moved, and am working in a larger ER about 100 miles away from my old job. And I still see this patient from time to time!

I think there are certainly many times that giving medication for pain is a good thing. And I think that we should always do our best to remain compassionate and impartial. But it is so hard to be that way, when something like the above takes place. You can either be a jerk and really be sick, or you can be a drug seeker and be nice about it. But to be a drug seeker and a frequent flier, and to be mean and abusive is unacceptable. And people like that don't deserve my compassion.

[Plagueis]

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.

I'm a newer LPN, and I work in LTC. In school, us students were taught the phrase, "Pain is whatever the patient says it is." Other nurses, both RNs and LPNs, have told me they were taught a similar philosophy. Forgive me if I sound dumb, but exactly what are the signs that someone is faking their pain? How can I really tell, as a somewhat inexperienced (less than a year) nurse? Isn't is subjective for the most part?

For instance, if a patient or resident is sleeping, I was taught that it doesn't mean they aren't in pain, but then I've heard nurses say that if someone can sleep, then they can't really be in pain.

I'm also recalling times when I was having severe pains (impacted teeth, menstrual cramps), and having MDs not believe me, since I wasn't screaming or crying. However, I was in pain.

[Pat_Pat RN]

to plagueis:

if someone can look at you with droopy eye-lids, a pulse of 60, rr 18, br 110/40 and says (in a droning voice, between cheetos), "this is the worst pain i've ever had, it is a 15/10." they might be lying about their pain.

here's what bothers me about the "whole" issue.

1) drug seeking drains our already taxed system, as virgo said (i think), pulling important nurse time away from *real* er patients.

2) how many drug seekers are tying up your beds while real patients, ie. lady birthing a 25 wk baby in las vegas anyone, are made to wait for hours in the waiting room.

3) are we any more than drug dealers if we give these people whatever narcotic pain medicine they want, every time they want it?

4) how many pseudo-addicts have we pushed into full blown addiction by giving narcs too much?

as someone else already said, i believe we've become a society of no pain tolerance. i stubbed my toe, give me some tylenol. i have a hang-nail, is ultram all i'm getting? suck it up people!!

a story or two...

i had a pt. last week in the er with a "laceration" to her hand. i've had paper cuts worse than this. frequently when doing mechanic work, i'll bang my knuckles and have blood running down my arm and not stop working. does it hurt? yes, what would i rate it? well, a 5/10. no, let me really think about it....more like a 2/10.

did this patient get some pain medicine? you bet'cha, lortab 7.5, #6 to go home with.

the mentality of this country is sickening. "gimme, gimme, gimme". "i'll sue you cause i want money". "this drug caused a bad outcome, i'm going to sue." no!! medicines come with warning labels, they tell you "something could go wrong". you agree to take the medicine, no one puts a gun to your head.

if you've read this far, i'm surprised, good for you.

my wife has a serious life shortening illness. sometimes it is idiopathic, sometimes it is iatragenic. no way to tell the difference. lately i've seen some commercials on tv about class action lawsuits involving at least one drug she was on before this disease showed up. we aren't going to pursue it. are we independantly wealthy? no, in fact we have a hard time making it from check to check, because she can no longer work d/t this illness could it be "their" fault? sure. could it not be? sure. who knows? god.

romans 8:28

"and we know that all things work together for good to those who love god, to those who are the called according to his purpose."

that's all i have to say about that