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.

[annie.rn]

Erroneous post. I apologize.

[LadysSolo]

WKShadowRN, I am not saying you are naïve, but I am saying that a lot of posters on this thread have been attacking (politely) those of us who see manipulative addicts as manipulative addicts and judging us for not buying into their behaviors. I will help to keep people from withdrawing by providing their opioids as long as they follow the rules they have agreed to, but I never "buy" their stories. Some of the posters here like to try to get us to believe they are saints, and never get annoyed by manipulative behaviors.

[canigraduate]

I honestly get more annoyed over family members wanting sandwiches and hogging the recliners.

[calivianya, BSN, RN]

Just have to say that I often go the other way with pain management. I gave my patient pain meds all night even though he didn't ask for them last night, and I had zero qualms about it. Why? Because he has such a problem that he came in because he went unresponsive after chewing a relative's fentanyl patch and ended up on the vent for a week.

Ain't nobody got time to deal with a withdrawing patient. Let's be real - these patients don't plan to stop outside of the hospital, so it's stupid to make them detox just for the fun of it. It's like the alcoholics they put on CIWA protocol and whatnot - it's a heck of a lot kinder, and makes a heck of a lot more sense, just to give them a beer with every meal tray. It's not like they're going to stop taking the substance at home just because they missed it for a week or two in the hospital. Who suffers from the forced withdrawal anyway? Well, yes, the patient suffers, but guess what? You do too, because you have to deal with the patient's symptoms, symptoms that you may have caused as a nurse that withheld pain medicine/benzos/whatever.

Forget about the patient for a second - why exactly does anyone want to make their day/night MORE difficult than it already is?

[SmilingBluEyes]

Wanted to say, that story about the ICU nurse leaving a patient helpless, call light out of reach and shutting his door, while he was in pain, is horrific. I agree with those who say such a nurse is a "monster". How awful. And if I knew who that was, or worked with that person, I would definitely report it.

[heron, ASN, RN]

@LadySolo ... Since you see manipulative addicts so clearly as manipulative addicts, could you please describe how you differentiate them from patients with chronic severe pain?

[Farawyn]

WKShadowRN, I am not saying you are naïve, but I am saying that a lot of posters on this thread have been attacking (politely) those of us who see manipulative addicts as manipulative addicts and judging us for not buying into their behaviors. I will help to keep people from withdrawing by providing their opioids as long as they follow the rules they have agreed to, but I never "buy" their stories. Some of the posters here like to try to get us to believe they are saints, and never get annoyed by manipulative behaviors.

Politely attacking?

I would say "disagreement".

[heron, ASN, RN]

I would say challenging a deficient knowledge base, incompetent assessments and a distinctly unprofessional approach to coping with one's personal revulsion with a given patient's behaviors.

ETA: speaking of naive, consider one of the definitions of the word: "having or showing a lack of experience, judgement, or information." (dictionary.reference.com)

I would agree that some posters have shown a thoroughly naive approach to the problem of pain management.

[SmilingBluEyes]

HOW in heck, does one "politely attack" anyone else?

Wait, what was the subject again????

I will say again, nurses, doctors, and other health care providers need a lot of substance abuse education. So many misunderstandings here.

[russianbear]

I don't think people in chronic pain go to the ER frequently causing a scene yelling at staff demanding IV Dilaudid. If they do, their pain is probably poorly managed. Otherwise, that is manipulative behavior of a seeker.

[heron, ASN, RN]

Google pseudoaddiction.

So ... How do you differentiate between poorly managed pain (including withdrawal) and manipulation to get high or obtain stock to sell?

[LadysSolo]

WKShadow, I am a NP, prescriber, so if I do not follow the drug contract with the patient, I am in danger with the DEA (if I keep giving them more and more and they are not following the contract.) I am not willing to lose my DEA license because someone keeps "losing" their prescription. So yes, if they want medicated they MUST follow the rules.