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.

[ixchel]

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.

What kinds of biases? (Genuinely curious.)

[LadysSolo]

I suspect the bias is that EVERYONE is honest about their "pain" and no one is trying to game the system or obtain opiates to sell or ANYTHING other than trying to relieve their "pain." (The "pain" in quotation marks is for the dishonest opiate sellers, not the legit pain patients - yes, I had a patient selling their prescription in the parking lot of the office - drug store was downstairs and the pt was under a drug contract. But "pain" was what she said it was.......)

[Cricket183, BSN, RN]

I've been very hesitant to comment on this thread because I know I have very strong biases about this issue. I spent my entire career in oncology. In general as a specialty, we tend to be very liberal with the pain medication and understandably so. Pain is a very real issue in the cancer population and for the most part the oncologists I worked with had no issue ordering pain medication and I had no issue administering it. (As long as the patient's VS were stable.)

On a much more personal note I am a chronic pain patient and I know what it is to suffer with excruciating pain. I suffer from RSD/CRPS. It causes debilitating neuropathic pain. There have been times my pain has been so high I have vomited or passed out from sheer agony. RSD feels like someone has lit you on fire while stabbing you with a red hot dagger. There are times the areas affected are so sensitive that even the movement of air or a slight touch causes excruciating pain. There is nothing you can do to escape the pain and even high doses of opioids barely take the edge off your suffering. You will do almost anything for relief. And when you do get relief, you then live in constant fear that the pain will come back and the next time it will be worse (although you can't see how that would even be possible). If it sounds dramatic, desperate--it's because it is.

I share all of this in hopes that some of you might better understand what possibly drives some of the so called "drug seeking" behaviors (clock-watching, continuously asking for meds early, etc). It's not done to irritate you or to try and manipulate you. (Although I fully understand that there are those patients out there who ARE manipulative.) When you are in that much pain, it is all you can do to make it through to the next hour, or next minute, sometimes the next second. You literally cannot see past your pain. Social norms mean nothing and niceties get tossed aside. The rational part of your brain ceases to exist. All there is is pain.

I'm not saying this is true for every pain patient but I know for me, being in that kind of pain changed me. And being on high dose opioids also changed me. Ironically, the opioids really never helped my pain much they just made me not care about it--or much of anything else for that matter. (I now know that much of what I was experiencing was due to opioid induced hyperalgesia but at the time I had failed all other treatments and opioid therapy was the only option available to me.). Luckily for me, two years ago a new treatment option became available to me and I was able to wean off the high dose daily narcotics I was on (boy was that difficult) and I started receiving a series of IV ketamine infusions every 4-6 weeks. I still have pain but for the most part it is fairly well-controlled.

[TheGooch]

MMJ = Meanmaryjean?

[TheGooch]

After having had a kidney stone removed and a temporary stent inserted into my ureter, I was back in the ED with agonizing pain after the stent was removed.

I felt the doctor and nurses believed I was drug seeking. They gave me dilauded, but it wasn't really doing anything. I knew then that it was probably inflammation in my ureter causing the pain. I requested Toradol (non-narcotic NSAID.) Within minutes, the pain was GONE.

The look on everyone's faces when I was good with the Toradol....shock.

That's right A-holes. I wasn't drug seeking.

So it's okay for you to "delay" the medication for a patient in pain if you have other priorities.

Pot meet kettle?

[CardiacRNLA, BSN]

I feel that many of this thread have tried to act high and mighty, like making judgments towards people's lifestyle choices are NEVER a part of nursing. HELLO? We do it ALL the time. We make judgments on patient's diets, smoking habits, drinking, etc. If we used the same attitude, then just let diabetics and cardiovascular patients eat whatever they want, or allpw people to light up in their rooms. We can't change their habits. Why ask about smoking cessation? They are just going to do it anyway, right? Judgment or "bias" as is the buzzword cannot be removed from healthcare or ANY profession quite frankly.

Secondly, to those that say, people with pain present differently, I agree. However, I think that's where the definition of ACUTE care comes into play. Some conditions will NEVER have pain relief. The point is to make the pain manageable. The point of acute care is when a person's condition causes a decline so great in functioning that they require 24 hour care. If you can laugh, walk about the unit, go down for a smoke, and get up and go to work, then you do not need acute care. If you have gastroparesis, demand Dilaudid and Phenergen together but refuse to be NPO to improve your condition, eat everything in sight, I will not be apt to believe you need acute pain relief. Sorry if that is a "judgment" or a "bias."

I certainly do not believe in punishing patients by withholding medication or being rude to a patient. And I know that the drug seeker label DOES get thrown around too much. I also believe that if it is ordered and the patient is stable, I will give the medication. It just makes things easier and practical. However, I do not have to like having my time wasted by people who not only ask for pain meds, but demand snacks every 15 minutes, toiletries, want to be bathed when they can walk to the toilet. That takes valuable time away from my other patients who can't walk, are non-verbal, or cannot advocate for their wellbeing. Or I don't have to pretend these people don't exist because some pie-in-the sky people want to believe they don't exist.

Lots of nurses want to seem like they are above reproach but if they were honest, even most of the ones poo pooing the OP have had the SAME thoughts and made the same comments themselves.

[Farawyn]

You do you and I'll do me, PP. ^

M'kay?

[ixchel]

Regarding chronic pain patients having a bias that those asking for pain meds are never seeking, you are so dead wrong it's not funny. The seekers are the ones who ruin the legitimacy of pain management. They are the ones who make us have to carefully consider our words for fear judgment will get us on a "do not give opiates" list in the minds of our doctors and nurses. If anything, it's possible we're sometimes BETTER at knowing who is legit and who is not because it's a road we walk down and understand intimately.

Good grief. I'll never say I've heard it all, but I'm feeling pretty damned close.

[Cricket183, BSN, RN]

Regarding chronic pain patients having a bias that those asking for pain meds are never seeking, you are so dead wrong it's not funny. The seekers are the ones who ruin the legitimacy of pain management. They are the ones who make us have to carefully consider our words for fear judgment will get us on a "do not give opiates" list in the minds of our doctors and nurses. If anything, it's possible we're sometimes BETTER at knowing who is legit and who is not because it's a road we walk down and understand intimately.

Good grief. I'll never say I've heard it all, but I'm feeling pretty damned close.

Couldnt agree with you more and I hope my previous post did not come across that I believe that there aren't drug seekers out there. I know there are. I should have used the quote feature but I was addressing your previous question about what kind of biases those with a history of chronic pain might bring with them. (Post #176).

ETA: OK, reading the post below mine I see now what you were addressing. Sorry, been a long couple of days with very little sleep...gotta love insomnia...I'm a little on the slow side tonight. Ignore me.

[canigraduate]

Lots of nurses want to seem like they are above reproach but if they were honest, even most of the ones poo pooing the OP have had the SAME thoughts and made the same comments themselves.

Umm... No.

Maybe 10 or 15 years ago when I wasn't in healthcare and was selfish and immature.

Not as a nurse.

The attitude you are talking about is a symptom of a problem that many people have, which is seeing people as a diagnosis rather than as a person.

These same drug addicts are people, often ones who love their kids, play with dogs, and keep an eye out for their elderly neighbor.

I had a woman in withdrawals a while back who had turned to drugs after being shot by her father. Her husband and kids came in and they were a really sweet family, but the patient just couldn't deal.

It's too hard to get psychiatric help and too easy to score heroin.

This poor woman was pooping herself, had the junkie aches, and her pain/anxiety was through the roof, but she took the time to proudly show me pictures of her family.

It took TWO DAYS for us to get the hospitalists to take her seriously and get her meds to hold her until she could be transferred to a rehab.

TWO DAYS of agony for this patient. All they wanted me to give her was two percocet q4 and 0.5mg of Ativan BID. No immodium, no NSAIDS, no nothing.

I was really ashamed of my hospital that day.

[sissiesmama, ASN, RN]

Push it real good! -Salt-n-Peppa

Hahahahahaha! Deserves the "post of the day" award!

Anne, RNC

[SleeepyRN]

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.

This, I believe, is the very root of the problem.

I can completely understand someone using a substance to cope with certain issues/events. I'm not saying it's mentally and emotionally healthy, I just can sympathize.

Then they try to stop, but too late. Your body is hooked.