Drug-Seekers

[inteRN]

Do most ER's (Im sure they do) have this overwhelming problem???

I've only been a RN for 9 mos and I'm so tired of the same people coming in with BS excuses to get their fix. Then, treat us like crap if they don't get the drug of their choice.

It's been a struggle to be compassionate, even though I put on a good front...

I guess it's a personal thing because I've struggled with a few family members who were horrible prescription drug addicts and screwed me over to get money for drugs, etc. I guess I can't help it.

Anyway, do doctors in other ER's always just give in to get them what they want or do they ever try to get them help??

We had a girl come in yesterday, (who always comes in) saying her ovarian cysts is killing her and she's allergic to everything but dilaudid. She brought her husband in too so he could get his "toothache" looked at. Of course, he got his norco script and was pressuring us to hurry up with her care so he could get it filled I guess.

I told the doc about it and he said, "yep, I know she's here for the dilaudid, but watch-- the one time out of 27 visits this year I don't do a CT of her abdomen, she'll have an appendicitis"

Its sad... the money, the time...I feel sorry for the docs! They're scared to death of losing their license b/c these patients have them by the balls! I just had to vent. Something has to be done to stop this problem and no one seems to try and help these people the right way...

[Joe B1]

I've been dealing with this problem for over 20 years in different ED's and it only seems to worsen by the year. I'm beginning to think that it's not a problem we have but a predicament we're in. The difference here is that problems can be solved, a predicament can't be solved you just have to learn to live with it.

During my career, we've gone from rarely prescribing narcotics in the ED for anything to using what I consider obscene amounts in many cases. This is good and bad. Patients that wouldn't have been given adequate pain relief before are receiving it now. On the other hand you have people on MS Contin 300mg TID, MS IR for breakthrough pain, Benzos for anxiety, and when they run out or get cut off by their MD's they end up in the ED. The ED is not the pain management clinic or the addiction recovery center.

This has also created what I refer to as the "Antiplacebo Effect" or "negative placebo effect". What I mean by this is that there is a growing belief among many people that non narcotic medications do not relieve pain, even amongst those who've never tried them.

I fear that the pendulum has swung from one extreme to the other and that we've created a monster that will come back to eat us.

Noone knows what the long term effects of large doses of narcotics will be in the majority of cases but I can guarantee you that the tolerance developed by these people will cause huge problems with getting pain relief in acute injury, illness or surgery. There's also the issue of narcotic use decreasing the threshold of pain perception in patients using them.

I don't think this is a problem that we can solve at all. As I said above, we're in a predicament and we'd better find a way to live with it. I don't think universal health care will do anything to change it and who the hell's going to pay for it anyway with our nation in decline?

I'll tell you something else. I'm not at all impressed with the effectiveness of drug addiction treatment. I see it help a few people, but not many, and it isn't widely available.

We will always have drug seekers in the ED. We will always have people in the ED's making up stories to get their narcs and benzos. We just have to deal with them one at a time.

I try to be nonjudgmental and compassionate, but I only have so much of that and I'm not going to spend a lot of it on the guy who's been in 6 times this month for different problems all resulting in pain.

[NurseGloria]

joe b1, you raised some important issues. i still sense victim blaming here. you are correct that universal health care won't solve the problem of drug addiction. but it will sure help.

other things that will help is for our government to keep drugs out of the country. educating our children and offering real hope will also go far toward replacing drugs with lives that are content due to meaningful work and happy families.

[Joe B1]

NurseGloria,

I don't blame the victims, but the truth is they're not all victims.

Education can help to an extent.

Prohibition has never been effective and usually results in illegal trafficking, theft, murder, abuse and imprisonment. People will always find a way to get drunk or high if they want to badly enough. They always have, and from every socioeconomic and educational level. We should funnel the money from our endless and useless "War on Drugs" predicament into problems that can be solved, in my humble opinion.

[screamin mimi]

I don't know if I'm willing to totally give up! I mean, realistically, I think you're probably right that this is a problem that won't be resolved . Increasing access to PCPs could help, maybe education could help, though I'm less hopeful there. I think getting rid of the patient as "customer" mentality and re-educating some our docs on what EMTALA actually requires might help more.

A lot of docs, many that I consider otherwise competent clinicians and good people, when asked why they're giving the 6th scrip that month for a frequent visitor, answer "it's just easier." Well, that's just not a good answer!

[Joe B1]

I'm not saying that I'm giving up, I'm saying that we need strategies for how to deal with the inevitable. I think that as long as you have people with control over access to drugs that people want, people will find ways to get them.

I'm sooo with you on the getting rid of the patient as "customer" mentality. I can also get on the train as far as educating the physicians, though the phrase "herding cats" comes to mind.

[BrnEyedGirl, BSN, MSN, RN, APRN]

rn-cardiac,

you are assuming that some of your patients are "allowed to go from place to place with multiple c/o pain just to get a script for your fix!" how do you know who those patients are?

i think this is where you might misunderstand the op,.....and maybe why you felt that we, as er nurses, are labeling pt's prematurely, without knowing the whole story,..i assure you we aren't,...i know these pt's, because the ones i'm talking about will often show up in my er twice in my 12 hr shift,....usually are there more than twice in the three 12 hour shifts i work a week. there are three hospitals in my town with er's,.these pts often show up with wrist bracelets from the hospital up the street. our ems units take pts to all three hospitals and will tell us that they picked the pt up in the parking lot of another hospital. we are not talking about pts that have trouble getting into see a doc so show up in the er,...we aren't talking about the pt that had to come to the er for antibiotics because they honestly couldn't pay the office visit at urgent care. we are talking about pts who average 12-20 visits a month in the er for ha, belly pain, chest pain etc and we never find anything wrong with them. i'm not exaggerating that we really do see pts that have 200 visits a yr to the er! these are the people who are abusing the system,..are they sick,..of course,..but the er is not the place to get the help they need.

[BCgradnurse, MSN, RN, NP]

I don't work in an ED, but we see similar issues in my community health center. I work in Urgent Care as an NP and probably get 4-5 patients per day requesting opiates. I fully believe that pain needs to be treated appropriately, but I get my back up at patients who 1) continuously cancel appts. with their PCP cause they know he/she won't give them the narcotics, but come into Urgent Care demanding (and I do mean demanding!) their Percocets. 2) Chronic pain patients who won't go to a pain specialist, but come into Urgent Care whenever they are out of meds and the ER won't give them any, and 3) my favorite-those who are supposedly on maintenance opiates but their urine tox screen comes back negative for whatever drug they supposedly need every day!. I have been verbally and physically threatened by some of these patients because I won't give them opiates on their say-so. So, I guess that's made me skeptical and a little cynical. You get that way when you give a patient the benefit of the doubt, and then they're caught by security trying to sell the percocet you just prescribed for them before they're even off the property. Pain is a horrible thing and everyone should have their pain evaluated fully and respectfully. I have no issue prescribing for a patient who has been on a maintenance dose, doesn't ask for early refills, and comes to their appointments, but their PCP is not available for whatever reason, or someone who has an acute condition that needs short term pain management. Urgent Care is not for chronic pain management, but many patients try to use it as such. But sadly, there are large numbers of people out there who take advantage, and I think it's doing harm to enable these people to constantly misuse or divert narcotics. It's harmful to an individual patient and harmful to the community. Addiction has got to be one of the most miserable experiences on earth, and I have compassion for those who suffer from it. But that doesn't mean I have to perpetuate it. I offer counseling and addiction services to those I think could benefit, but it's up to them.

[Blue Crab Lover]

I don't know where Nurse Gloria works but I can assure you, ER nurses have serious BS radar. Yes there are some people who tell you a detailed story for diagnosis purpose but when they are in the ER 4 times a week and making rounds to all the hospitals in the city, something is up. Oh, did I mention the 10 allergies. I haven't even been on that many meds to have 10 allergies.

[Blue Crab Lover]

All of us in the profession know that nurses and doctors are some of the biggest abusers out there.

[newtelenurse]

Wow...we just had this conversation over the weekend. We nurses we have something ...You know that little voice...the one that tells you something is just not right. The one that has you check pt. history a little closer. Check the BP a little sooner. Listen to the pt. and have your hairs stand up when they say "I just don't feel right". That feeling we get when we just know something is up...WELL that holds true for the BS as well. I am in acute care and trust me the seekers are there. When they come in with a bag of pills and 4 bottles of BP pills 1 percocet and 1 vicodin and 2 are empty and 4 are full...makes you say hmmm. It is an EXPENSIVE habit these folks have for YOU and ME. They are not paying for the drugs they seek or the tests that come back negative time and time again. Tax payers are. Which makes the hospital make cuts. Which decreases my salary and increases my insurance premium. So YES I take it personal. Do I take care of them YEP they are my pt. and I am a GOOD nurse. Do they get the extra pillow fluffing HELL NO! Do I give them the pain medicine they are ordered. YES. When I ask for a number of pain from 0-10...and I chart 10..do I believe it?? HELL NO!!! What is the answer????I don't know..but to the original poster...I understand where you are coming from and you can vent to me any time!!!

[fungez]

inteRN, I feel your pain.

Not every addict is a druggie. I've known some addicts - those who are physically habituated coupled with the mental craving for the drug - who despite their problems still manage to act half-way decent. Addicts are sick. Druggies are selfish. Druggies are jerks.

I went from oncology where you treat pain complaints seriously to the ED and now m/s where you get patients like the one I had today. The one who deliberately puked up her dilaudid so she could cook it and inject it. Or the ones who wail and cry so loudly that they disturb the other patients. They're abusive to staff and they suck all our time, energy, attention and compassion away from other other patients. They suck, period.

And to any of you druggie apologists who want to lecture me about what a judgemental meanie Nurse Ratchet I am, don't bother. I'm not going to feel bad about thinking someone who drives high, steals from family members and turns their ED into their own personal dealer are being general all-around drains on society, because they are. If you think a druggie just needs a little more love, compassion or "education" why don't you invite them into your home and let them live with you for a few weeks? Let me know how it's going when they've ripped off everything that's not nailed down.

Anyway, back to inteRN. Don't take it personally and don't let it get to you. Yeah, we're not doing them any favors when we give them their fix but ultimately it's not worth getting hypertensive over, cause they're druggies and they're not going to change until they feel like it. Good luck.

[sasha2lady]

this is the world we live in nowadays. so many people think pills can just cure it all...or a good shot of this or that. then there is the whole ...how are we gonna pay for it..nonstop chaos. plus..we live in a sue happy world too...the doc I work for is always fussing about how "i cant treat and practice real medicine anymore. its not allowed" meaning via the financial situation and seekers we often get....you'd be surprised at how many drug seekers come to our ltc facility for rehab and are long time addicts......of dilaudid, roxicodone, alcohol, and other narcs. ...usually a combo. i guess addiction knows no age or condition.