Drug seekers

[russianbear]

I'm sure this has been posted before and I would appreciate any links to good threads on the topic. I am a new nurse and struggle with giving strong opiates like Dilaudid, etc to people who are clearly pain seeking. I feel dirty. Yesterday I had a gentleman who was ordered 1mg Q6. He was a clock watcher. As soon as that six hours was up, he was on the light. The reason he was getting this is because during the previous shift he threw such a fit yelling, screaming etc to have it the physician ordered it. Looking through his history, this is his pattern. Usually in the ER he yells and screams and demands IV Dilaudid. In this country there are a lot of people addicted to opiates because they are often over prescribed and these types of things feeds into that. As a nurse, one of our responsibilities is to encourage health and I feel more like I am contributing to a societal problem than helping a patient in situations such as this.

I don't want this to be a "pain is what the patient says it is" argument. I am talking about the rare instances where someone is clearly a drug-seeker.

[heron, ASN, RN]

See what I mean about sucking the oxygen out of the room?

We've heard from posters who are living with chronic severe pain. They've been pretty clear about how it feels to have their pain - the lived reality of it - misdiagnosed as a manipulative trick.

Anger, depression, suicidal ideation and, yes, an extremely high risk of active addiction, all on top of the abject failure to relieve the pain even a little. I think that focusing so narrowly on addiction becomes dangerous if it causes us to ignore the presenting problem: the urgent need for pain relief.

It seems a bit like treating a serious infection with just a cooling blanket to bring down the fever.

[Been there,done that, ASN, RN]

I'm a nurse with a bad back. With the help of different docs - ortho, neuro, pain management - I used conservitive medical management for years. Then...I hit the point where the pain was getting worse and worse -- and when I finally developed foot drop, I admitted that I was at a point where that surgery I'd been avoiding for 20 years was necessary.

I'd been on fentanyl patches at home - but they were no longer helping - and got admitted for intractable pain. In the hospital, I was on what - to me, anyway - were huge doses of IV dilaudid. I was conformable and functioning. It was several days before there was an opening in the OR schedule, so I used that time to prepare my students' assignments & set up my office so my assistant could manage while I was out.

As one of the NP's noted, my back was split open in the OR. And while I'd planned for post op care with my docs (who ordered a PCA pump for me post op) and the Pain Service NP --- I thought I had covered all the bases.

I didn't count on one of the ICU nurses - who I had never met - and who admitted she didn't know me - deciding that I was 'drug-seeking'. I have no idea where that came from or what she saw that gave her that idea.....but there it was.

And apparently, she convinced the ICU intensivist that I was a major drug seeker. He cancelled my PCA and ordered 1 mg of dilaudid IV every 4 hours. That was a fraction of the dose I was on preop. No surprise - I was asking for pain meds all the time. In addition, while my docs had clearly told me they wanted me to stand at the bedside that first night- she refused to let me do that - actually yelled at me.

And the final horror: my repeated requests for pain meds led to her taking my call light away - and closing the sliding glass door to my ICU room.

So - I now know what it feels like to be a supposed 'drug seeker' - and what it feels like to hit a pain level of 10 --- and have no relief for over 9 hours - and to feel abandoned by my nurse.

I'm not saying your patient isn't inappropriately drug seeking - you were there and you assessed him. But, I can tell you that not all patients that repeatedly ask for pain meds are inappropriately drug seeking. When my PCA was reordered at 7:30 -- and the pain nurse had it on by 7:45 ----and gave me several boluses, until my pain level was below a 4....then I stopped asking for pain meds.

I did ask to speak to the unit's director tho.....and discussed with her what I went through over the night shift in the Surgical ICU - truly one of the most horrible nights of my life.

What a horror story! Really sorry this happened to you.

Is it too late to file a complaint? Nurse Ratched is still out there, abusing other people.

P.S. that looks like your real name, you really want to be anonymous here.

[Horseshoe, BSN, RN]

Omg. How incredibly horrific. I have no words. I wouldn't typically admit this on here, but I guess I will.

I've been suicidal in the past from my chronic pain. I get no pain medication. The only treatment my urologist will do for my interstitial cystitis is weekly bladder installations of steroids. I did one round of 8 weeks, and it brought my daily usual pain (when not in a 3 month flare) from a 7 to a tolerable 5. That's it. The treatments cost thousands of dollars. I had to borrow a grand from my parents for one round of tx just to be able to function somewhat like a normal person in the world. But I only did the treatments once. It's way too expensive.

After graduating nursing school, I quit my first job after only 3 months. I would come home every night in tears curling up in the bed, not sleeping bc of the pain, and then getting up for work the next day, smiling to my patients, nobody none the wiser.

Finally, I was just SO incredibly depressed, I literally walked off the job and didn't work for almost a year. I laid in bed day and night, didn't leave the house, didn't eat, just wishing I was never born. Months when I had a flare, my pain was an 8. Day after day, week after week. I shut everyone out of my life except my husband, because unlike well known chronic pain conditions, people just don't understand.

I broke down in tears at my urologist's office, literally crying to my clinical nurse specialist telling her I wished I wasn't alive. I WAS begging for SOMETHING. The Dr. ordered one week's worth of flexeril for muscle spasms of the bladder. Does NOTHING for the intense pain of acidic urine eating through the bladder, creating bleeding ulcers.

I've had to accept this as my reality. I only work part time because of it, but I'm NOT letting this keep me from living my life anymore. I HATE HATE HATE people judging the amount of pain anyone is in. I hate those memes where it shows a pt smiling and a cat with bubble over its head saying no dilaudid for you. HATE it.

With known drug seekers, yes, I'm human. Certain people, their beligerence irritates me. But I'm not withholding meds. They might have to wait if someone else takes priority, but beligerence or not, I'm not withholding meds or punishing anybody.

That sounds so awful. I've had a history of painful UTIs, so I have a hint of what you must feel, but I cannot imagine living with that and worse constantly. I think if I were in your shoes, I'd rather have the bladder removed, get a urostomy, and be done with it.

I'm sorry you have not found relief for this problem and I hope you can find a solution soon.

[odaat]

You know what really sucks? Being a bonafide addict with chronic pain. I became an opiate addict after taking them for my legit pain and when I could no longer get it prescribed I started getting it by other means. But being a true addict I understand that I was trying to treat the emotional pain of a ****** childhood just as much as I was treating my physical pain.

So now, I just stay clean and live with the pain. Like a previous poster, some days I almost just don't want to live because I know I will never get any relief. It's either live with the pain as best I can or die an addict. I fear ever having any horrible acute pain because I'm pretty sure at least 90% of health care providers will not give me any pain relief after I admit to having been an addict.

Somedays I can't help feeling like if I had only been treated appropriately i.e. not have been prescribed heavy duty narcs and then be abruptly cut off from them maybe things would have been different for me addiction wise. Then again, maybe not.

I will say too though that emotional pain can be just as if not worse than physical pain. I live with severe anxiety and PTSD. Before the board of nursing had the right to call the shots on my medical care, I had a prescription of xanax for years. I would only take it when I had an acute PTSD episode, as in I have flashbacks so bad that it literally feels like I am being raped again as a child. Xanax would stop that horror show in it's tracks, it was the only reason I ever took it, and a months prescription would last me months and months and months. Now though, I'm an addict and am no longer allowed the medication I used for YEARS with no problem. So guess what happens to me now when the ole PTSD flares up? I unimaginably suffer horrors nobody should ever experience even once let alone over and over and over. It takes months to get back on my feet emotionally from it. But I'm an addict...addicts deserve to suffer right?

[NanaPoo]

I'm a nurse with a bad back. With the help of different docs - ortho, neuro, pain management - I used conservitive medical management for years. Then...I hit the point where the pain was getting worse and worse -- and when I finally developed foot drop, I admitted that I was at a point where that surgery I'd been avoiding for 20 years was necessary.

I'd been on fentanyl patches at home - but they were no longer helping - and got admitted for intractable pain. In the hospital, I was on what - to me, anyway - were huge doses of IV dilaudid. I was conformable and functioning. It was several days before there was an opening in the OR schedule, so I used that time to prepare my students' assignments & set up my office so my assistant could manage while I was out.

As one of the NP's noted, my back was split open in the OR. And while I'd planned for post op care with my docs (who ordered a PCA pump for me post op) and the Pain Service NP --- I thought I had covered all the bases.

I didn't count on one of the ICU nurses - who I had never met - and who admitted she didn't know me - deciding that I was 'drug-seeking'. I have no idea where that came from or what she saw that gave her that idea.....but there it was.

And apparently, she convinced the ICU intensivist that I was a major drug seeker. He cancelled my PCA and ordered 1 mg of dilaudid IV every 4 hours. That was a fraction of the dose I was on preop. No surprise - I was asking for pain meds all the time. In addition, while my docs had clearly told me they wanted me to stand at the bedside that first night- she refused to let me do that - actually yelled at me.

And the final horror: my repeated requests for pain meds led to her taking my call light away - and closing the sliding glass door to my ICU room.

So - I now know what it feels like to be a supposed 'drug seeker' - and what it feels like to hit a pain level of 10 --- and have no relief for over 9 hours - and to feel abandoned by my nurse.

I'm not saying your patient isn't inappropriately drug seeking - you were there and you assessed him. But, I can tell you that not all patients that repeatedly ask for pain meds are inappropriately drug seeking. When my PCA was reordered at 7:30 -- and the pain nurse had it on by 7:45 ----and gave me several boluses, until my pain level was below a 4....then I stopped asking for pain meds.

I did ask to speak to the unit's director tho.....and discussed with her what I went through over the night shift in the Surgical ICU - truly one of the most horrible nights of my life.

THIS is why we can't judge our patients based on our preconceived notions of opiates and our stereotypes of those who use them. This "nurse" abused her power, she judged you without even knowing you, and she is, in my opinion, an absolute monster. She has no right to have humans in her care or watch. It's frightening.

It is horrible to have to depend on someone else when you're in pain. When you're hospitalized, you can't just go to the medicine cabinet and get what you need for your migraine or whatever pain that you're having. You are 100% dependent on that nurse to have compassion. He/she is responsible to administer what has been ordered in a safe manner and to advocate for you should you need something else if that doesn't work. But to take it away because SHE/HE thinks you shouldn't have it. NO.

[heron, ASN, RN]

I agree that the ICU nurse definitely flirted with malpractice in her failure to assess her patient. You'd think she'd know better as a critical care nurse. But I think calling her a monster is a tad over the top.

[NanaPoo]

I agree that the ICU nurse definitely flirted with malpractice in her failure to assess her patient. You'd think she'd know better as a critical care nurse. But I think calling her a monster is a tad over the top.

Nope, I stick with monster. Taking a call light away and closing you in your room?? Monster.

[nursingnotes7]

nothing you can do about it but give the medication and monitor your patient. i had a female sneak her own narcotics into the hospital and shoot up in bed. respirations at 8-9 BP dipped from normal value to mid 80s off 1mg of diluadid.

what did the MD do? increase her doses and shorten the time-frame on each of her "pain" meds. also, the veteran nurses refused to care for the patient because they were afraid she would kill herself on their watch. i'm not sure how she got narcotics in TWICE. so they assigned the patient to me... a new graduate with 6 months of experience. what i found strange was whenever i have a patient of the like, my break relief/charge nurse NEVER medicates the patient and always tells them "wait, your nurses is on break."

whenever i am handed a patient who is in "pain"... i just tell them i need to leave this monitor on you and you cannot take it off. q15 minute vitals, doses away, and call it a day.

[heron, ASN, RN]

Guys, it's not a zero-sum proposition.

[SleeepyRN]

SleepyRN, I'm so sorry for your pain.

Aww, thank you Farawyn. I've learned over the years to be more positive. I can actually be happy again, even with the pain. We all have challenges in our lives. This one just happens to be mine. I'm way past the "poor me" phase.

My poor grandma has the same condition, and she tells me over and over how she wants to walk out in the street in front of a truck bc of the never ending pain. And she is on lots of narcs! But of course after so long, she has a high tolerance. And she takes them exactly as prescribed.

Recently she told me that she thinks about my Granddad's shot guns (he's passed away) and has thoughts of shooting herself. It breaks my heart hearing my grandma say these things. I would be furious if a nurse tried holding back meds, or waited a while to give her her pain meds during hospital stays!

[SleeepyRN]

Ponder this one.

My father and my brother both had huge pain issues. They both had a brain enzyme that interfered with the metabolism of opiates. At the end they both required 80 mg of morphine an hour to control their pain.

Clinicians could NOT understand this concept..both of them suffered greatly , even with me running interference.

The moral of this story is.. medicate without judgement.. you may never know the whole background.

Unimaginable. How heartbreaking

[SleeepyRN]

RubyVee, That's very insightful and helpful. Do I need to use APA format as well? Where should I put my reference list and table of contents? I did not realize I was being monitored for format. I wasn't posting for you, I was addressing OP. If you cannot read something, then don't read it. Hope those is condensed and well-packaged enough for you to read.

RubyVee was offering good advice for if you want your post to be read. Our brains aren't wired to read what seems like a never ending paragraph.

Breaking up your post into paragraphs makes it literally easier on the eyes, and easier to follow. More people will be inclined to read your post.

We value your opinions and would like to hear them. When new to a site such as this, one really needs to gauge the temperature of the group and learn that group's particular style, for lack of a better word. Be yourself of course, but mindful that there are a few different group personalities. We can really be a fun, supportive group.