What do the drug seekers coming into your ER ask for most? In our ER it seems to be Vicodin or oxycontin.
What is their usual complaint? In our ER it usually is back pain with pain radiating down the leg. Sometimes they will limp.
Do you have ANY ER Doctors with the Balls to order a non Narcotic? We do. Its cut down on our repeat offenders! Can lead to some very entertaining and loud discussions behind those pt curtains....
Ever have a repeat offender that went really bad? We did. Came in as an overdose after a year of weekly visit for refills of Vicodin for uncontrolable back pain and spasms. Died. Found out later his main income was reselling his pills to those in the area and online. Family sued the Dr and facility for allowing him to become addicted..... and won.
What a depressing thread. On one hand you have these poor souls who suffer from chronic pain. They truly suffer, so we help them... we give them medicine, opioids, to take away their pain. And it works, and they are so grateful. But the pain comes back, and so they come back, so we can make it better again. Before long, they're addicted. And now, to make matters worse - we don't believe their pain even exists. They are drug seekers. Addicts. Frequent flyers. Where we once listened empathetically, now we roll our eyes with contempt.
It's just sad.
I don't pretend to have all the answers. Certainly there are many people who are purely drug seekers visiting the ERs across the country in search of a fix. Thank goodness it's not my job to decide, I just couldn't do it. I've read research articles about the lived experience of those who experience chronic pain and the most important thing to them is feeling that others believed their pain. And so, I do... every time. The nifty part is I don't lose sleep over it, it's what I was trained to do.
In a perfect world, we would not continue to treat people with chronic pain in an acute fashion, but that's for another thread.
Please do not take this the wrong way but you need to learn the difference between addiction and habitation/dependency. And there is a difference. And one of the problems is the incorrect use of the word addiction or addict. Sorry but it is a very sore spot with me.
Please do not take this the wrong way but you need to learn the difference between addiction and habitation/dependency. And there is a difference. And one of the problems is the incorrect use of the word addiction or addict. Sorry but it is a very sore spot with me.
Grannynurse :balloons:
Please explain the differences between addiction and habitation/dependency.
Specializes in ER, ICU, Infusion, peds, informatics.
please explain the differences between addiction and habitation/dependency.
thanks!
in short, addiction is a psychological as well as a physical need for the drug/substance, which causes "drug seeking" behaviors.
habituation/dependency, however, occurs when someone is using something, say lortab, for some "legitamate" reason; lets say post op knee replacement.
if that person takes the lortab every day, they are going to become habituated to it: their body is used to the lortab, and suddenly stopping the med will cause withdrawl symptoms. however, there is no psychological need for the drug. most people can handle the habituation by slowly tapering the dose, and they are fine. for many, this occurs naturally, since as time goes on the pain is less and they don't need to take as many pain pills each day.
this is pretty simplistic; there is more to it than that, and i'm sure someone will come along and expand on this explanation. but those are the basics.
Please explain the differences between addiction and habitation/dependency.
Thanks!
Well, I can't explain it from the inside out, since I never found my drug of choice despite months of field research in the 60s. The best description of what an addict is feeling is in a book called "Postcards from the Edge" by Carrie Fisher. The interior monologue is toward the beginning of the book and is harrowing reading for anyone who has ever been close to a substance abuser.
Basically, dependence is a state where people will have physical symptoms if a drug is withdrawn suddenly. People can be said to be dependent on a variety of non psychoactive medications like insulin and the glucocorticoids. Patients with chronic pain will eventually become dependent upon opioid medications. However, most will not become addicted. When the drugs are withdrawn suddenly, the pain patient will have physical symptoms. There won't be a craving for the drug, one of the hallmarks of addiction.
The addicted person, however, will feel the cravings constantly. Even when satisfied, s/he will continue to crave more of the drug. Addiction can best be summarized by the AA motto, "One is too many and a thousand isn't enough." No matter how much drug is available, an addicted person will continue to use more of it, chasing a high that is always just out of reach. Opioid addicts call this "chasing the dragon." The behavior is compulsive, the dosages escalate quickly, and simply detoxing the person and turning him loose without other treatment will do nothing toward curing the addiction.
The dependent person will rarely increase dosages without physician approval, even when s/he is in significant pain. There is no craving for the drug itself, although aversion to pain may produce classic drug seeking behavior.
There was a study of pain patients in Boston in the late 70s and early 80s that followed 10,800 patients who had been given opioid drugs for various conditions. There were four new addictions among these patients. That is an amazing statistic, and one that tells me that perhaps the NIH should be studying patients who don't get addicted to these drugs as well as patients who do. Only then can we begin to understand what the real differences between dependence and addiction are at the level of brain chemistry and probably genetics.
:angryfire 
momking
4 Posts
Gees!
And the beat goes on. Celeste, I pray for total recovery in all areas of your life.
We can get WAY out of balance.
Nursing is about nurturing.
We all love you. Glad you are going strong.
You excel,you now have wisdom & experience, & I hope you get power, vindication, justice, & a new nurse consultancy out of all this.
With plenty of money & materials to do EXACTLY WHAT YOU WANT TO DO. Now & FOREVER. GOD BLESS you in your patience, suffering, & perseverence.
Love always & all ways, momking