Drug seekers

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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.

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.

Thanks, Horseshoe.

A UTI is a very good way of describing what it feels like. I daydream about having my bladder removed. When I was in nursing school, in my 20's, I thought I had made up my mind and decided I was getting a urostomy. Until one of my instructors, not knowing I had decided to get my bladder removed, commented on patients with urostomies and how awful they smell.

That, being so young, and newly married, made me so self conscious and I changed my mind completely about getting it done because of how she went on and on of how "nasty" it was.

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Specializes in critical care.
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.

Holy crap! 80!

I can't imagine how many prescribers they went through to find the one who was on board with titrating as high as it would take to give relief. I can't imagine the suffering they went through in the meantime.

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Some of the posts on this thread are precisely the reason why I fear ever being helpless and in pain in a hospital setting.

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I'm really sorry for your Dad.

I'd never wish that disease on anyone, for sure. Even now, when they run out of effective drugs it's just as ugly of a death as it was in the 80s. Noncompliance often makes that happen sooner rather than later. He wasn't a perfect man by a long shot, but no one is perfect.

Everyone deserves compassionate care, including addicts. But a social worker could probably help a lot with getting the patient that care outside of a hospital in the future, even if it's working the system for referrals or applying for reduced price medication.

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Not homework trolling. I work a second job to save up for grad programs. I've read all 11 pages. I've been following the thread. Just haven't had anything to add.

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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.

I think using paragraphs for long posts is a courtesy for the readers, and I didn't find her request to be unreasonable. If she was nitpicking spelling or typos, I could understand taking issue with that, but as it is, I don't understand the defensive posture.

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Specializes in ER, TRAUMA, MED-SURG.
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?

Oh I'm so sorry! I'm in tears right now after reading your post. How much longer do you have on your contract with the BON?

Anne, RNC

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Interesting discussion! Your post brought up several different issues. Addictions, pain (chronic and acute), drug resistance, and drug dependancy- just to name a few. Each of these individual issues are vast and complex topics with an array of research dedicated to them. Search any of the above, and you will find articles and research dedicated to each topic. However, the challenge is that when these things occur, they often do so as a collective. This necessitates treatments that utilize a collaborative, inter-disciplinary approach that is patient-focused. Do you have a complex pain and/or addictions service team at your facility? They are a great resource if available! Another option is your educator.

One of the first things that I would recommend is being aware of biases you may have (we all have 'em!). Go back and read your post again to see which of your statements are opinions and which are facts. For example, you mentioned that opiate consumption is essentially an epidemic in the US. What makes you say that? Is this actually an evidence-based statement? Furthermore, how will this belief affect the care you provide to your patients? Are you then reluctant to give opioids to all of your patients? To certain ones? Another statement you made stated that you wanted to promote health for your patients (essentially by not fuelling what you see to be unhealthy opioid usage). What do you consider to be healthy vs unhealthy analgesic usage? Reflect on your opinions surrounding these issues.

If you are looking for an interesting read that touches on many of these topics, I would highly recommend Gabor Mate's books. He is an expert in the field of addictions and his writing elicits compassion while furthering understanding through scientific facts. Furthermore, he describes multiple different approaches to health (i.e. harm reduction) that are a necessary and valid form of safe patient care.

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I mistyped, I meant to type "drug-seeking." So, a person who is sitting in bed, on the phone, laughing, BP is great, HR is great, snacking on chips is truly experiencing 10/10 pain. Doesn't add up to me I guess. This particular patient has a history, based on his physician notes, of "numerable admissions complaining of vague pain, then becoming angry demanding IV Dilaudid." He is a non-compliant in his medication regime for diabetes, does not take his HIV meds, etc. This admission was for chest pain. All markers were negative, etc. Not only was he getting Dilaudid, he was getting Percocet along with it. Administered together.

We all kinda "know" what's going on when it's going on, however we cannot judge a person's pain, it's their perception. People with chronic pain can often appear as if they aren't in pain.

Our MDs have to specify what pain range they want each prn given for for example

Tramadol po q4 prn mild pain (1-3)

Percocet po q4 prn moderate pain (4-6)

Morphine 2mg iv q4 prn severe pain (7-10)

This helps when explaining that I have to follow orders and give appropriately. I also try to stay on top of my patients pain before it gets too bad, less IV meds.

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Specializes in Urology, HH, med/Surg.

I think I've read most of the posts in this thread & haven't really seen this addressed-

When I did bedside nursing I did more than my share of Dilaudid pushes. And yes, quite a few were on pts that I felt were 'drug seeking'. But as has been stated- if VS were WNL & it was at the appropriate intervals- I gave it- and no matter how I felt about it I did my best not to show that to the pt. To maintain a professional & compassionate demeanor.

But what I did mind was the behaviors that accompanied some of the worst of those pts. No matter how many times you told them at what times their meds were available- they tried to get them early. They usually had other meds ordered & wanted them in between. IV Benadryl or Phenergan were giveaways. I had one ask " is there any pill I can have? Protonix? Anything?"

Or, a perpetual favorite: " if you ain't giving me Dilaudid- gimme some ice".

They call constantly for ice, jello, popsicles, etc. They call & when bell is answered- they stutter because they don't really want anything.

Or how about the ones that refuse to take their regular meds unless you give them their pain meds?

My personal favorite, the guy that had a hold of his temp dialysis cath in his chest, threatening to pull it out if I didn't bring his Dilaudid an hour early.

No, giving pain meds- no matter if I think the pt really needs it or not isn't a problem for me if the pt is not manipulative & acting like an entitled brat.

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Or the ones who tell you to "push it fast, it doesn't work if you push it slow."

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Push it real good! -Salt-n-Peppa

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