Drug seekers

RegularNurse · Oct 16, 2015

If VS are good just give the med. What's the big deal? Most patients are only in the hospital for a few days.

SleeepyRN · Oct 16, 2015

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?

How aweful. I too teared up reading this. I am so so sorry.

**NickiLaughs, ADN, BSN, RN** · Oct 16, 2015

I let the physician choose. Ours are very good at saying, "no I'm not comfortable refilling your oxy script that you've lost 8x this year. you need to see your pcp." We have an online registry in california of all controlled med scripts. If the doc checks it when you come in for back pain and you already have oxy, ativan, flexiril and whatever else. We are unable to safely add to your regimen. My job is to call the police when people become irate.

Not saying that pain control isn't legit. But people on multiple pain meds need their pain controlled by a specialist who knows how to treat them.

jadelpn, LPN, EMT-B · Oct 16, 2015

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?

This is one of the most horrifying accounts. Makes my heart hurt.

Reminds me so much of people in our military who are sent to war as kids, to come back broken, given all sorts of stuff to survive back at home, and then due to some sort of political correctness cut off.

Personally, I have the suspicion that the reason that there is not an intense multi discipline focus on this complex issue is that is all reverts back to believing that addiction is a character defect as opposed to a disease that requires treatment. The underlying of which is pain that is untreated or treatment stops suddenly.

We are all human, and yes, there are times when nurses (myself included) feel a sense of helplessness and frustration. However, after reading your story, I am thinking my frustration should be to the patients who are forced to go into ER's and practically beg for mercy.....and rarely get it due to the political red tape.

It is ridiculous to cut off all pain/anxiety medications in the name of rehab, in the name of "doing you a favor" to have the crux of the problem--pain--still unrelenting.

In no other area of medicine is this even an issue. We encourage medication compliance. There's a level of frustration if people DON'T take their medications. If someone doesn't take their Lasix, goes into acute CHF, nurses run around to get diuretics into them pronto. If someone is not taking their blood pressure medication, they are told that it could cause a stroke....see where I am going with this?

There is so much heroin around that should someone's goal is to be high 24/7, it is quite easy to make that happen. They don't need to go to the local ER to make it happen.

morte, LPN, LVN · Oct 16, 2015

That is despicable, not to mention UNSAFE. I would have reported that all the way to the top. There is no excuse for that, and she should have been severely reprimanded.

she should have lost her lic.

morte, LPN, LVN · Oct 16, 2015

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.

that was rude, and please note several persons agreed with her, including me. i read at 95% of posts, i did not finish yours. remember the average age of nurses is around 50, our vision is not what it once was.

morte, LPN, LVN · Oct 16, 2015

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.

i don't, she maliciously got the pain med reduced. she should have been reported to the board.

Guest219794 · Oct 16, 2015

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.

I had a funny experience recently: A guy with a hx of drug abuse comes in with dental pain.

Pt: "I tried tylenol and Aleve, and nothing helped".

Me: "Wow, I am surprised you could take Aleve with your allergies to Toradol and Ibupofen- they are three very similar drugs:.

Pt: "I'm not allergic to anything, I used to say than when I was using".

Me: "I know your allergy list is made up. We all know that allergy lists are made up in the hopes of getting narcotics."

Pt: "Oh god, I don't want any narcotics. I have come way to far for that. (In with a fellow church member.) I want antibiotics- the pain should get better when the infection does."

Gave me kind of an ethical dilemma- Correct his allergy list, or leave it standing as a flag. Could help the guy in his quest to be clean, if he was to have a slip, or a moment of temptation.

As a supplier of narcotics to abusers in a system based on deception, it is unusual to have an honest conversation with an abuser. But, anybody with a computer can listen in on some very honest conversations amongst those who use us to meet their addictive/abusive needs.

In response to your OP- you asked for links that address the issue, and our role in contributing to the problem. You may be criticized here for judging and labeling drug abusers. However, in a forum dedicated to drug abusers, nobody holds much back:

Read this one through- this guys profession give him a great perspective.

Another patient experience.

In an older AN thread, I put together a collection of stuff I found on line. Getting a nurses perspective is one thing. I found getting the unfiltered information directly from the users to be hugely educational.

As a nurse, you are an integral part of the supply chain. Due to basic laws of economcs, reducing supply in one area increases demand in another. Be careful what you wish for. If we reduce our role in the supply chain, what will happen down the line? The original Washington Post article is better, but you are subject to advertisements.

BTW- the case you mentioned in your OP isn't a great example. 1mg q6 is a ridiculous order, particularly for a pt with a high tolerance. BS orders like that bug the hell out of me. If a provider believe a pt is scamming, they should grow a spine and refuse to participate. OTOH, once a decision has been made to treat the pain, the order should be something realistic and effective. If you decide to medicate a PT who just accidentally knocked his 30 mg oxys into the toilet (again), don't order 2 mg of MS. Either send him and his BS story packing, or treat him with a meaningful dose of medication. I would rather just give 2 mg Dilaudid than waste my time 20 minutes later saying. "so, on a scale of 1 to 10....."

FeleciaSmith · Oct 16, 2015

I used to be like you until I had a surgery and huuuurrrrrtttt like crazy. I used to think these folks were addicts and crazy and all that. I was immature and wrong.

It's not for you to judge a patient which it seems like you are doing just do what the order says or call the doc as to why you shouldn't.

I once had a trach patient that wanted to be suctioned till he bled seemed like... The nurses hated when his light came on because he didn't need it and he would get angry.. He dies because he needed suctioning.(!) and some nurse was being judge mental. I'm telling you this to say get out of your feelings if you know you have a clock watcher beat him to it sometimes all the power a patient has is asking for something. As a nurse the job can be good if you don't attach how YOU feel, it's not about you. I would suggest you read Leadership and Self Deception by Arbinger Institute. It's used as a training guide in some tele health jobs, it teaches you how to not fall into that trap in the first place by taking control of the interactions in a great way.

if your hospital has a pain service talk to them about how you can help patients like this.

Guest219794 · Oct 16, 2015

I used to be like you until I had a surgery and huuuurrrrrtttt like crazy. I used to think these folks were addicts and crazy and all that. I was immature and wrong.
It's not for you to judge a patient which it seems like you are doing just do what the order says or call the doc as to why you shouldn't.
I once had a trach patient that wanted to be suctioned till he bled seemed like... The nurses hated when his light came on because he didn't need it and he would get angry.. He dies because he needed suctioning.(!) and some nurse was being judge mental. I'm telling you this to say get out of your feelings if you know you have a clock watcher beat him to it sometimes all the power a patient has is asking for something. As a nurse the job can be good if you don't attach how YOU feel, it's not about you. I would suggest you read Leadership and Self Deception by Arbinger Institute. It's used as a training guide in some tele health jobs, it teaches you how to not fall into that trap in the first place by taking control of the interactions in a great way.
if your hospital has a pain service talk to them about how you can help patients like this.

Read the DEA description of a drug seeker. If that isn't you, chances are the OP wasn't talking about you, or PTs similar to you:

Common Characteristics of the Drug Abuser:

Unusual behavior in the waiting room;
Assertive personality, often demanding immediate action;
Unusual appearance - extremes of either slovenliness or being over-dressed
May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history;
Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance;
Will often request a specific controlled drug and is reluctant to try a different drug;
Generally has no interest in diagnosis - fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation;
May exaggerate medical problems and/or simulate symptoms;
May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction;
Cutaneous signs of drug abuse - skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of "pop" scars from subcutaneous injections.

Modus Operandi Often Used by the Drug-Seeking Patient Include:

Must be seen right away;
Wants an appointment toward end of office hours;
Calls or comes in after regular hours;
States he/she's traveling through town, visiting friends or relatives (not a permanent resident);
Feigns physical problems, such as abdominal or back pain, kidney stone, or migraine headache in an effort to obtain narcotic drugs;
Feigns psychological problems, such as anxiety, insomnia, fatigue or depression in an effort to obtain stimulants or depressants;
States that specific non-narcotic analgesics do not work or that he/she is allergic to them;
Contends to be a patient of a practitioner who is currently unavailable or will not give the name of a primary or reference physician;
States that a prescription has been lost or stolen and needs replacing;
Deceives the practitioner, such as by requesting refills more often than originally prescribed;
Pressures the practitioner by eliciting sympathy or guilt or by direct threats;
Utilizes a child or an elderly person when seeking methylphenidate or pain medication.

No matter what, everybody must have a line where they feel uncomfortable giving narcotics. That doesn't always mean not to give it, it just means you might feel you are doing more harm than good. I feel that way about a lot of drugs I administer.

Your line and my line might be in different places, but you must have a line.

Hypothetical- You are outside a room and hear a patient on the phone explicitly stating that he can't wait to crush and snort those oxy's he is about to score. That probably crosses your line.

My line might be in a different place. Maybe for me, the PT is laughing and giggling over the phone, till I come in- then she s curled up in a ball moaning.

There is a lot of grey in this issue. It's not a matter of heartless, judgmental not medicating patients in pain. It is about being concerned with our role in a major national health crisis.

BTW- gotta say I liked the term "judge mental" in your post. Must be an evil spell checker.

bradons · Oct 16, 2015

Drug seekers are entertaining to say the least.

Especially when the physicians give them naproxen.

imintrouble, BSN, RN · Oct 17, 2015

Read the DEA description of a drug seeker. If that isn't you, chances are the OP wasn't talking about you, or PTs similar to you:
Common Characteristics of the Drug Abuser:
Unusual behavior in the waiting room;
Assertive personality, often demanding immediate action;
Unusual appearance - extremes of either slovenliness or being over-dressed

May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history;
Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance;
Will often request a specific controlled drug and is reluctant to try a different drug;
Generally has no interest in diagnosis - fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation;
May exaggerate medical problems and/or simulate symptoms;
May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction;
Cutaneous signs of drug abuse - skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of "pop" scars from subcutaneous injections.
Modus Operandi Often Used by the Drug-Seeking Patient Include:
Must be seen right away;
Wants an appointment toward end of office hours;
Calls or comes in after regular hours;
States he/she's traveling through town, visiting friends or relatives (not a permanent resident);
Feigns physical problems, such as abdominal or back pain, kidney stone, or migraine headache in an effort to obtain narcotic drugs;
Feigns psychological problems, such as anxiety, insomnia, fatigue or depression in an effort to obtain stimulants or depressants;
States that specific non-narcotic analgesics do not work or that he/she is allergic to them;
Contends to be a patient of a practitioner who is currently unavailable or will not give the name of a primary or reference physician;
States that a prescription has been lost or stolen and needs replacing;
Deceives the practitioner, such as by requesting refills more often than originally prescribed;
Pressures the practitioner by eliciting sympathy or guilt or by direct threats;
Utilizes a child or an elderly person when seeking methylphenidate or pain medication.
No matter what, everybody must have a line where they feel uncomfortable giving narcotics. That doesn't always mean not to give it, it just means you might feel you are doing more harm than good. I feel that way about a lot of drugs I administer.
Your line and my line might be in different places, but you must have a line.
Hypothetical- You are outside a room and hear a patient on the phone explicitly stating that he can't wait to crush and snort those oxy's he is about to score. That probably crosses your line.
My line might be in a different place. Maybe for me, the PT is laughing and giggling over the phone, till I come in- then she s curled up in a ball moaning.
There is a lot of grey in this issue. It's not a matter of heartless, judgmental not medicating patients In pain. It is about being concerned with our role in a major national health crisis.
BTW- gotta say I liked the term "judge mental" in your post. Must be an evil spell checker.

A bias is a bias. I'll admit I find it hard to care for those who I think game the system for narcotics.

But those with personal histories of chronic pain also bring their biases to their jobs.