Drug seekers

thirdborn333 · May 26, 2011

Thank you for the encouragement. People are people whether nurses or not so I wouldn't expect anything differently as far as common decency. Glad for all the helpful comments though. Very interesting to one who has not entered into the reality of the "nursing" world yet. I will be sure to press through any obstacles :) No matter how brutal I hope it to be my pleasure to work as a nurse. Thank you again.

Athena904, nothing that you said was in any way offensive or judgmental. If I were you, I wouldn't apologize to the posters that were so quick to judge you when all simply did was ask a question involving healthcare that you were unsure about. I've worked in healthcare quite a bit, not YET as a nurse; however, you will see plenty of drug seekers, and whether or not Obama's Healthcare bill will increase drug seeking behaviors or not i'm not sure. It will be your duty as the nurse to use your nursing judgment as to whether to administer the pain medication or not. I've learned in nursing school, as I'm sure you have also that the patients pain is subjective; therefore, what they say is pain you must acknowledge appropriately which could mean the difference in administering an NSAID or a narcotic as long as it is ordered and within therapeutic range!!!:yelclap:

LouisVRN, RN · May 26, 2011

"Drug seeking" patients whether they are seeking medications for legitimate pain issues or addiction issues can be some of your most difficult patients. Regardless of their reasons your job in acute care is to manage their pain to the best of your ability without compromising their other body systems. Just because they have addiction issues doesn't mean they aren't compounded by acute pain issues. Our policy is to ask the patient their acceptable pain level. This should take away the bias of people having differences in pain tolerance. For example I'm going to medicate someone who says their acceptable pain level is a 2 and they are currently at a 5 the same way I would someone who says acceptable is a 6 and is currently at a 9.

freemirini · May 26, 2011

Drug seekers have an illness as well. They need help. They, like many other patients, are often non-compliant and may also lack insight. I wonder if you might reframe how you think about those that "seek drugs" (who are in pain). They often have chronic pain - emotional, psychological, physical... They seek relief. Rehab would often be a good option for some of these folks...

I think it's often a struggle to deal with our preconceptions and prejudices...and our indignation when things are not as we think they should be. I know I struggle. I struggle every day. Here are some words for inspiration...

"One measure of civilization is how well we treat the most vulnerable members of our society."

William H. Foege, MD, mPH, Senior Fellow, Bill & Melinda Gates Foundation

"It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by

how it treats its highest citizens, but its lowest ones."

-- Nelson Mandela

"Overcoming poverty is not a task of charity, it is an act of justice. Like Slavery and Apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings. Sometimes it falls on a generation to be great. YOU can be that great generation. Let your greatness blossom."

-- Nelson Mandela

"You will achieve more in this world through acts of mercy than you will through acts of retribution."

-- Nelson Mandela

tyloo · Jun 1, 2011

drug seekers have an illness as well. they need help. they, like many other patients, are often non-compliant and may also lack insight. i wonder if you might reframe how you think about those that "seek drugs" (who are in pain). they often have chronic pain - emotional, psychological, physical... they seek relief. rehab would often be a good option for some of these folks...
i think it's often a struggle to deal with our preconceptions and prejudices...and our indignation when things are not as we think they should be. i know i struggle. i struggle every day. here are some words for inspiration...
"one measure of civilization is how well we treat the most vulnerable members of our society."
william h. foege, md, mph, senior fellow, bill & melinda gates foundation
"it is said that no one truly knows a nation until one has been inside its jails. a nation should not be judged by
how it treats its highest citizens, but its lowest ones."
-- nelson mandela
"overcoming poverty is not a task of charity, it is an act of justice. like slavery and apartheid, poverty is not natural. it is man-made and it can be overcome and eradicated by the actions of human beings. sometimes it falls on a generation to be great. you can be that great generation. let your greatness blossom."
-- nelson mandela
"you will achieve more in this world through acts of mercy than you will through acts of retribution."
-- nelson mandela

:yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah: :yeah:

very refreshing to read this!! thanks for the post!!!

nurseprnRN, BSN, RN · Jun 1, 2011

i seriously suggest that the op look up the definitions of addiction, habituation, and tolerance. also look up and take to heart work by the excellent nurse expert on pain, margo mccaffery. she will change your professional life.

many persons labeled "drug seekers" are exactly that for a darned good reason-- they have untreated or poorly treated or poorly diagnosed pain conditions. moreover, even addicts sometimes have painful conditions that require compassionate care and pain relief-- they are no less persons with worth and dignity. and yes, i have had horrible junkies in my care, who used their central lines for their fixes. still.

it is perfectly appropriate for some people to take dosages of opioids that would kill a horse, but they have become habituated to them, tolerant of them, and (this is the important part) functional on them, not addicted. if that last sentence doesn't make sense to you, let us know, because you really don't want to be a nurse who is ignorant on this point, even though many of us know you would have a lot of company.

heron, ASN, RN · Jun 1, 2011

i seriously suggest that the op look up the definitions of addiction, habituation, and tolerance. also look up and take to heart work by the excellent nurse expert on pain, margo mccaffery. she will change your professional life.

many persons labeled "drug seekers" are exactly that for a darned good reason-- they have untreated or poorly treated or poorly diagnosed pain conditions. moreover, even addicts sometimes have painful conditions that require compassionate care and pain relief-- they are no less persons with worth and dignity. and yes, i have had horrible junkies in my care, who used their central lines for their fixes. still.

it is perfectly appropriate for some people to take dosages of opioids that would kill a horse, but they have become habituated to them, tolerant of them, and (this is the important part) functional on them, not addicted. if that last sentence doesn't make sense to you, let us know, because you really don't want to be a nurse who is ignorant on this point, even though many of us know you would have a lot of company.

in other words, there's a big difference between tolerance and addiction.

tolerance is a physiological response to substances that requires escalating doses to produce the same effect. it is a normal phenomenon associated with a number of medications.

addiction is the compulsive use of a substance for mood alteration regardless of the negative consequences. of that use.

allnurses Guide · Jun 1, 2011

For example, we had a patient admitted to our floor with a pathological hip fracture due to metastasized lung cancer. She had visited the ER several times to seek treatment for her pain, but they assumed she just wanted narcotics and sent her home. Little did they know that she actually had a malignant cancer spreading to her bones and brain.

I've worked ER and now am doing hospice. Our last patient was a long time drug addict who was diagnosed with bladder cancer last year.

Addicts with cancer deserve pain control.

As a new nurse at 40 (13 years ago) I was very naive about nursing and medicine in general. Fortunately in my first year of work the physicians did an inservice about pain and pain meds for the nursing staff and I learned so much there. Many of the things people have already posted here are some of them.

When you come into nursing with absolutely no background besides nursing school, you are bound to have many "naive" questions. I hope you don't stop asking them.

One of the biggest hurdles to overcome with hospice patients and their families is unfortunately a result of this "EVIL DRUG SEEKERS" mentality. They have a fear of addiction and many patients will refuse to be appropriately medicated and many family members will refuse to have their loved ones medicated. It is sad.

"In the terminally ill patient's case, there is no basis for any fear about "becoming addicted" to a narcotic given for pain. Although many individuals have strong beliefs about avoiding "drugs," meaning illegal drugs such as cocaine, heroin and others, the legal use of narcotic medications for pain is totally appropriate and a welcome relief from the severe pain which plagues certain patients. Addiction is a problem for those who are not dying.

The terminally ill patient who suffers from terrible pain needs these medications to relieve that pain. Using narcotic medications for the terminally ill patient is truly compassionate and humane. It is for this purpose that such narcotic medications exist! Nobody should feel ashamed about taking such medications to ease the pain of a terminal illness, and nobody has the right to deny a patient these medications when they need them. The severity of pain some patients experience is quite mild, while others experience the most excruciating levels of pain. Modern medical science can effectively treat most pain and keep the patient comfortable".

http://www.hospicepatients.org/hospic29.html

Guest219794 · Jun 1, 2011

Thanks to EMTALA, people can already come to the ER for whatever regardless of their ability to pay. In principle I think it is good that emergency services are offered regardless of the person's insurance status or ability to pay. In practice, I see a TON of patients who should have just gone to their primary doctor instead of rushing to the ER (sometimes by ambulance) and we still treat them.
I don't see universal insurance increasing these numbers at all.

Nope. Read it.

Guest219794 · Jun 1, 2011

I am almost out of nursing school to get my ADN and be an RN. I was curious for those of you who work in a hospital/clinic setting of how often patients are only seeking admission to fuel their drug addictions. My concern is that when health care is "FREE" that they will overwhelm the system with their addictive behaviors and tax payers will foot the bill.
Would love to hear your viewpoints on this.
Thank you!

Ou of curiosity, where did you get this information?

heron, ASN, RN · Jun 1, 2011

Ou of curiosity, where did you get this information?

I believe the OP was already asked this question and has gotten the point that it ain't that simple.