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.

Specializes in critical care.
Yes I agree that is important information to pass along in report of course. What I meant was nurses gossiping about pts or complaining about pts because they are addicts or drug seeking. I get a lot of this on my unit

Agreed!

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Yes, I see. But....

I am told to NOT take any NSAIDS....I have a history of gastritis AND I'm not supposed to take ANY blood thinners. I have Von Willebrand syndrome. Bleeding is hard to stop! So let's not aggravate my stomach, ok? Yes, Codeine makes me vomit rather violently. The "you like that picture 8 feet away?" So, you might want to move it, kind.

I'm weird. I'm one of those people that will have Dilaudid 4 mg IV, be carrying on a coherent conversation making you wonder IF you really gave me anything. But 2 Tylenol make me sleepy....

But I have chronic pain. I've got at least OA in 8 joints. I'm being evaluated for RA. My labs aren't back yet. Yes, I will be talking on the phone with a pain level of 10. Check my history. I spent 4 months with severe abdominal pain every time I drank water. I was laughed at by everyone BUT the gastroenterology specialist who looked at me, listened, & said, "I'm going to help you. I'm 99.999% sure you have gastritis. I'm pretty sure you have ulcerations. This is very dangerous given your other issues. I'm scoping you tomorrow." I woke up to a pile of meds ready for my to take at home. I hugged him at my followup appointment! I had been to the ER 4 times before & left without answers every time. I was labelled a drug seeker. If I wanted drugs, why did I decline the scripts?

I was called a drug seeker before that too. I have migraine headaches as well. No one wanted to try alternative meds. Just narcotics! I never took more 30 per year. Yeah....drug seeker. I was asking my PCP for a 30 pill script of Lortab 5 mg, so I wouldn't get busted at work if I came up positive for them. My other one was over 6 months old & the facility said I needed a newer script.

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Gooch-

What field of nursing is your specialty?

You voice some strong opinions, and it would be helpful to know the perspective.

I'm sick of the self righteousness I see here regarding this topic. Just give the damn medication as prescribed. Just because someone doesn't act the way YOU think they should while in pain doesn't negate what they are feeling. Chronic pain sufferers learn to deal with it in their own way like I have. I might be smiling and laughing but I can guarantee you that my lower back or knees hurt like hell. I've just learned how to cope with it the best way that I can.

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I'm sick of the self righteousness I see here regarding this topic. Just give the damn medication as prescribed. Just because someone doesn't act the way YOU think they should while in pain doesn't negate what they are feeling. Chronic pain sufferers learn to deal with it in their own way like I have. I might be smiling and laughing but I can guarantee you that my lower back or knees hurt like hell. I've just learned how to cope with it the best way that I can.

The overall tone of this lengthy thread has not been self righteousness.

This is a place for nurses to vent and discuss issues, which has been what is happening.

And thank god, I don't "Just give the damn medication as prescribed." as you demand. Do you think I should have given the heparin ordered for the last GI bleed because it was ordered? Should I really have given that 100 mg of fentanyl to a hip fx? What about the liter bolus to the hypertensive CHF pt with crackles? In your opinion, should I have questioned those orders? What about the nurse who gave 3 mg of epi to an anaphylaxis pt- do you think it is good that she just gave the damn medication as prescribed?

If all you have taken from this thread is that some nurses withhold narcotics because the pt doesn't act how the nurse thinks they should, then maybe you are missing something here.

The reality is that prescription drugs play a huge role in what the CDC refers to as a narcotics epidemic. And nurses play a huge role in that. Discussion and debate on this is completely appropriate. Uncritically following orders is not.

Do you think that any narcotic order to any pt should ever be questioned?

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Specializes in Hospice.

Yes, I think it's worth asking if a given narcotic order is treating pain or enabling an addiction ... or both. And, yes, "both" is more common than a lot of us want to admit.

I think it's critical to know what you're treating and why you're treating it. There's great potential for unnecessary harm if you don't get it right. There is no one-size-fits-all rule like, for instance, normal vs = no pain.

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Specializes in ER.

Just my two cents but here goes lol.

First this is going to be a sore subject for anyone who has ever sought pain relief for a legitimate complaint or chronic pain, especially if their treatment was sub par. I get that and I am in no way referencing them below except where noted.

I work in the ER. I know "pain is whatever the patient says it is" but to pretend that drug seeking does not exist is just as narrow minded as believing that a person with a drug addiction can't have a physiological cause for pain. That said, I would rather give ten addicts pain meds because they lied about their pain than leave one person suffer.

I work in emergency care, I don't work in rehab, I provide stabilization for emergent conditions, I can't cure chronic problems. I can refer, suggest, offer help but I can't make someone decide to get clean so I'm not going to try. I will be happy to assist them if they come seeking help for withdrawals or transfer to to an appropriate facility when THEY decide to get clean but until then there is little to nothing that we can do. Yes it is a drain on our resources, yes it is frustrating when there is a high probability someone is faking a complaint, filling a room and I have legitimately sick people sitting in the hallways or waiting room for hours but that isn't up to me to decide. It happens and I choose not to waste my energy worrying about it. I care about helping people that want or need my help. If my patient doesn't want to help themselves I refuse to care more about their long term well being than they do. I have my limits with all patients. Don't lie to us, we will find out. They also do not get to abuse me verbally or abuse my staff. I have had multiple patients who have become physically or verbally abusive if they did not receive the drug or amount they wanted and luckily I have a great team so when that occurs I have about 6 people in the room helping the patient decide that they either want to limit their belligerent behavior or leave.

When I worked the floor I honestly became quite jaded by our large population of IV drug abusers who shot up with dirty needles or contaminated drugs and then required 6 weeks of inpatient antibiotics to treat the infection they shot in their own veins. Most patients would go home with a PICC line and a home health nurse but you just can't send an IV drug user home with a PICC. I have caught them trying to put heroin and meth in their lines. I have had nurses physically assaulted and threatened when the Dr. decreased their pain meds. I have had to remove sharps containers from the room because they were breaking them and digging through them. I have been livid when administration was more worried about the patient being happy than keeping them alive or the staff safe. I lasted about a year and couldn't take anymore and still have an ounce of compassion left.

The turning point for me was reading a study about how narcotic use changes that brain. We all know that people build a tolerance to opioid medication. That is simply a physical fact. What I never realized is that (according to this article at least) one of the physiological changes in tolerance is that the brain adds more pain receptors. More pain receptors = more pain felt for the same stimuli. If that is correct a chronic opioid abuser can have excruciating pain from something that that a non opioid user might have only mild discomfort from due to the difference in pain receptor numbers.The effects of that chronic and severe pain have been well described in the posts above. Depression, despair, anxiety, insomnia. Basically people trying to just get high have rewired their brains so that even mild pain causes extreme discomfort (sadly it has probably also happened to a lot of legit chronic pain patients too but in a smaller way). This increased pain will last a lifetime and has to be taken into consideration when treating patients who have previously used narcotics, legitimately or not. This really changed my outlook on the self reported pain of patients and I have given up trying to estimate how much pain a given condition "should" cause. Again, kind of a vent but also my two cents...

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As discussed earlier, nurses working ER are kind of in a different category. They are in essence the clearing house for a lot of the addicted. And kudos to those that can maintain their professional detachment and treat the problem without judgment.

Most of us do not work ER and must deal with patients who have been seen and diagnosed by an MD who has prescribed pain meds, presumably with a rationale that may or may not be understood by the nurse. TALK to the MD if you have a problem with the pain med. But DON'T just take it upon yourself to withhold meds because you have decided the patient is not entitled to them (the old "nursing judgment" mantra) just because you don't like it. And no matter what, keep your judgments to yourself. It's NOT YOUR PLACE to allow personal bias (which very well may be wrong or misplaced) to affect the care you give.

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Specializes in Hospice.

And who the dickens is "pretending that drug seeking does not exist"?

Once again, captainc, did you actually read the thread?

Prime example of what we're talking about: the failure to see what's really there in favor of projecting whatever serves some obscure agenda of your own.

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It seems like a lot of people here are confusing true sufferers of chronic pain with addicts. I worked in a place where a patient went outside and injected heroin into a PICC line. Wanna tell me he was a chronic pain sufferer? There is a difference.

he may well have been...

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I've got to say I've never done it, but I totally understand why it happened.

I am thinking about one particular night a couple weeks back - one patient had a BP of 50s/20s and was a full code, the second patient had taken off her nonrebreather and was satting 62% (also a full code), and my third patient was riding the call bell for pain medication. I got an earful from that family about letting that patient be in pain once I finally made it into the room, of course, and the urge to kick the family out and take that patient's call bell away was strong.

I am quite sure if that patient came in here right now, she'd talk about that horrible ICU nurse that let her be in pain all night long, and how that nurse needed to be reported and fired.

Pain sucks, and I'm all about keeping the patient pain free, but if I have called the physician twice and they have refused to order more pain medicine, I'm at the limit of what I can do, and my other people are *actually* dying so I don't have time to sit there and do guided imagery or a massage or whatever, and we are total care so I can't delegate a CNA to do it either. Pain never killed anybody. Maybe it was so bad the person wanted to die, but they don't actually die from it. I have seen BPs in the 50s/20s kill people and O2 sats in the 60s cause people to brady down and die, too. I have never seen anybody die of acute pain.

People awake and alert enough to be asking for pain medicine are the healthiest patients on the unit. The healthiest patients on the unit don't get priority. I do the best I can, and I am definitely giving that nurse the benefit of the doubt, too, because what she did was awful but we don't know what her assignment looked like that night. We only know her (likely) healthiest patient's story.

you are totally skewing the original post. TOTALLY. the original post was about a nurse that got pain med DISCONTINUED because of her bias. pain med that was agreed upon by doctor and patient prior to surgery how dare you compare that to your situation? on the other hand, perhaps YOUR patient needed cont. drip of pain med post op as well.

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Specializes in critical care.
he may well have been...

Agreed.

I had a stroke patient who used cocaine or heroin when she ran out of her percocets and neurontin. She is known by the entire hospital and has a nickname we are all familiar with. She usually isn't admitted. She gets her percs and leaves. The stroke got her admitted though, and this was when I finally got to meet her. I expected a monster. Instead, I saw a frail person with a clearly defined cause of multiple areas of pain, and she was being under treated.

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Specializes in critical care.

People awake and alert enough to be asking for pain medicine are the healthiest patients on the unit. The healthiest patients on the unit don't get priority. I do the best I can, and I am definitely giving that nurse the benefit of the doubt, too, because what she did was awful but we don't know what her assignment looked like that night. We only know her (likely) healthiest patient's story.

The problem, though, was that she was on a PCA and the PCA was stopped. If the PCA were continued, there would not have been so many issues.

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