Drug Seekers

ICURN3020 · Jun 21, 2014

And, I wanted to add but couldn't edit my post because too much time has passed, this is a big "Duh". Any ED nurse is totally aware of how we "should" handle patients with substance abuse problems. You try offering a Narcotics Anonymous referral instead of a Percocet take home pack and see how well that goes over. It's nice to be idealistic, but then there is reality.

I guess this is the comment I should have quoted with my post.

It's somewhat telling that you took the time to come back and add this defensive remark to my post (which was neither directed at you or was part of your ongoing discussion/argument with other members).

Sheesh....take a vacation.

(Duh?!?, really?? How old are we?)

ICURN3020 · Jun 21, 2014

One more thing....completely off topic but I thought deserved a mention. Although this thread is under "Emergency Nursing" (which I did not even realize initially as I was browsing under "What's New"), please keep an open mind in regards to the opinions of other specialty nurses. Undoubtedly, ER nurses deal with drug-seeking patients the most. Although I suppose the OP could have wanted only ER nurse responses to this thread, I'm assuming they placed it here due to these nurses large exposure to this particular population.

As an ICU nurse, I've had patients ask me to push their dilaudid "fast", etc, and have lots of drug-seeking/abusing patient stories. My point is, it's likely that we have all, regardless of specialty, encountered this and have something constructive to add to the conversation. I get that ER nurses are a proud bunch....they should be. But so are Critical Care nurses, OR nurses, and so on. We are all on the same team!!! To imply that it is "rude" to post an opposing view in a certain area of this forum and to attack anyone with a differing opinion just because they are not "that type" of nurse is simply childish. Why not take the opportunity to educate that person on your side of things? In a non-condescending, respectful manner of course.

In this thread alone, there have been posters who state their intention was not to upset anyone, and another who shrugs it off as a possible misunderstanding, yet they are still made to feel like they have no right to state their opinion here.

And no, it's not being "idealistic" to expect that we are capable of respecting each other---it's being mature.

Anna Flaxis, BSN, RN · Jun 21, 2014

I guess this is the comment I should have quoted with my post.
It's somewhat telling that you took the time to come back and add this defensive remark to my post (which was neither directed at you or was part of your ongoing discussion/argument with other members).
Sheesh....take a vacation.
(Duh?!?, really?? How old are we?)

Oh, good, I'm glad you found my comment "telling". It was meant to be. I tire of being reminded of basic concepts that every ER nurse already knows, as if the idea of referring these patients to rehab is somehow a big revelation. It's like saying we should hold pressure on a bleeding wound or do chest compressions on a person who is pulseless- hence the "Duh".

And my comment about idealism wasn't about how we discuss these issues in an online format- it was regarding being idealistic in the clinical area, and how reality can clash with that.

ICURN3020 · Jun 21, 2014

Oh, good, I'm glad you found my comment "telling". It was meant to be. I tire of being reminded of basic concepts that every ER nurse already as if the idea of referring these patients to rehab is somehow a big revelation. It's like saying we should hold pressure on a bleeding wound or do chest compressions on a person who is pulseless- hence the "Duh".
And my comment about idealism wasn't about how we discuss these issues in an online format- it was regarding being idealistic in the clinical area, and how reality can clash with that.

I can understand the frustration that you describe when you say that you continually deal with people who suggest basic ER concepts to you as though you don't already know them.

However, my intention was not to give suggestions on how ER nurses specifically should deal with these patients. It was a very general statement meant to hopefully encourage the OP to realize that these patients need help, as their request seemed to me to be one for purely entertaining stories. I see how my intention was lost in translation and interpreted in another way, I believe based on the direction the thread took.

I just felt as if your response was somewhat belittling, made in a way that suggested I am oblivious about how to handle these issues. Especially since I specifically quoted a comment that addressed the point I was trying to support and that had nothing to do with the discussion you were having with others.

And the meaning behind your comment about idealism was not lost on me; however, I used it in a different context and hopefully the purpose in that is realized. We are all professionals and adults and should treat each other as such. Misinterpretation in this type of communication is inevitable, but instead of tearing each other down when given the opportunity, why not practice tolerance?

Have a good day! :)

Guests · Jun 21, 2014

Oh, good, I'm glad you found my comment "telling". It was meant to be. I tire of being reminded of basic concepts that every ER nurse already knows, as if the idea of referring these patients to rehab is somehow a big revelation. It's like saying we should hold pressure on a bleeding wound or do chest compressions on a person who is pulseless- hence the "Duh".

In my experience, the quickest way to destroy rapport with an IVDA is to start 'counseling' them about their addiction.

I helped out on a patient last night... long hx of IVDA and skin-popping... terrible abscess on his butt... horrible pain...

But a very respectful patient... Yeah, he wanted narcs... and no, he wasn't going to get as much as he wanted... but he knew that and didn't throw a fit... he hung in there, let me get a line (by ultrasound), and took what we could give him... and said, "I'm just hoping we can take the edge off..." Which we did...

The way I help differentiate between the drug seekers and some others is by how they behave and respond.

Anna Flaxis, BSN, RN · Jun 21, 2014

We are all professionals and adults and should treat each other as such. Misinterpretation in this type of communication is inevitable, but instead of tearing each other down when given the opportunity, why not practice tolerance?
Have a good day! :)

I think you took my comment much more seriously than I meant it.

I'm sorry if my use of the word "Duh" rubbed you the wrong way, but it is what came to mind at the time. I do not hold myself to the same level of professional conduct on an internet forum that I participate in during my time off from work as I do in the workplace. I'm okay with how I've conducted myself.

ICURN3020 · Jun 22, 2014

I think you took my comment much more seriously than I meant it.

Perhaps so....

I do not hold myself to the same level of professional conduct on an internet forum that I participate in during my time off from work as I do in the workplace.

I do and it's because I am speaking with people I do not know and who do not know me. I don't have any familiarity with them as I would a co-worker or friend.

I'm okay with how I've conducted myself.

Me too. Hopefully moving forward we have both taken something positive from this. :up:

Home Health Columnist / Guide · Jun 22, 2014

I see a ton of drug seekers in my ED and it is sad, but it is also extremely frustrating and a burden on the whole system. I don't see anything wrong with making fun or talking about these people behind their backs - we do that to plenty of other patients, it makes the job a little easier to harbor a sense of humor about certain situations.
I think the OP was curious about specific stories so I'll give him/her exactly that:
Out of the umpteen sickle cell crisis patients I've seen come through the ED so far, only ONE was actually in a sickle cell crisis. They always know exactly what they need - dilaudid. Some of them walk around, talk on their cell phones, even go outside for something to eat while their waiting. And we can't do much because "pain is what the patient says it is" - then, when the Dr (rightfully) doesn't want to order anything but oxygen, fluids and maybe one dose of morphine until we get labs back, these people absolutely flip out from threatening to sue to threatening to kill to taking their "business" to another hospital. And I'm sure they do - it's not uncommon for a drug seeker to come in with multiple other hospital bracelets on - so out of it they don't even notice.

Sickle cell disease, acute crises involve vaso-occlusive pain episodes often with tissue ischemia occurring.

Please educate yourself re Sickle Cell Crisis. Often when not in acute crisis and having increased pain, these individuals are often have anemia needing treatment. Dilaudid is the drug of choice for most patients with advanced sickle cell illness..

Guest219794 · Jun 23, 2014

I enjoy reading threads like this one.

Somehow the same old arguments remain interesting.

One of the fun things is to read a post and guess:

A- ER nurse.

B- Nurse from a different field.

C- Non nurse.

Then check the profile, or recent posts. It's surprising how cohesive the opinions of ER nurses are on certain subjects. And, often when I read an opinion and think "no way that is an ER nurse with any experience". and it almost never is.

just an observation.

lacusc93-1 · Aug 5, 2014

Hypohydromorphonemia is our favorite diagnosis.

Aggie RN, ADN · Aug 5, 2014

I think the attitude should shift from "you're wasting our time," to "how can we help a person with a drug problem."

However, how do you have that discussion in the ER?

Also, what are the odds a drug seeker even wants our help?

I have no answers, but I sure wish others would ask these questions. Then maybe we can get some resolutions that serve all equally we'll.

NurseGirl525, ASN, RN · Aug 6, 2014

I grow weary of these posts and I will tell you why, I think the drug seeker label is way over used. Anyone anymore coming to the ER with nausea and vomiting is considered a drug seeker. I had several bad years medically. I have epilepsy, fibro, and I had gastropariesis for awhile. Want to talk about vomiting where absolutely nothing helps. At my worst, I weighed 90 pounds. Normally, I'm around 150. I was constantly having seizures. I was a mess. My gastro told me no NSAIDs anymore. They had eaten a hole in my stomach. Lower scale pain meds no longer work on me. Because of damage to my liver at the time, I was allowed very small amounts of acetaminophen. But hey I'm a drug seeker? No. When I would have a seizure, off to the ED I would go for concussion checks. One time I couldn't get the after headache and vomiting to go away. Because it was my second trip to the ED in a couple days, the doc assumed I was there for drugs. No. I wanted some type of relief! So yeah, after awhile, I got crappy about it. My head hurt and I was tired of vomiting. I didn't need to be questioned. I wanted some relief and to get the heck home and back in bed. Please, stop assuming people are drug seekers. Until you walk a mile in someone else's shoes, you don't know the battles they are facing.

On a side note, when I finally got on the right meds, my world changed. But it took years of trial and error work. I haven't been to an ED in over 3 years now. Last time, I almost died from unchecked pneumonia because I didn't want to deal with the hassle and attitudes. Please give your patients compassion and understanding.