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.

[heron, ASN, RN]

I'm not offended, more like frustrated that nurses seem to think that being abused by drug seekers gives them immunity from accountability for their failure to recognize or care professionally for patients with chronic pain issues.

Interestingly, I find that nurses who think that normal vs, clock-watching and talking to their friends are foolproof indicators of recreational drug seeking are also newer nurses.

Often, they've been working just long enough to think they've seen it all but not long enough to realize that nobody really does.

FWIW, the OP was by a nurse who felt that a patient who insisted on dilaudid 1mg q6h was "drug seeking". (Maybe it was 2mg, I don't remember)

The ICU nurse who "advocated" for discontinuing a pca was a post from a chronic pain sufferer describing how she was labeled and treated as a junkie.

And we wonder why people in chronic pain start acting badly ...

[Angelicpurl]

Want to know why we use "smart" PCA pumps that read barcode? Because of patients like my aunt who had terminal cancer.

She suffered for over a week in uncontrolled pain. A doctor refused to change her med or increase dose. She was on PCA continously 10 mg/hr and 10 mg every 6 minutes. Ok...so a nurse misprogrammed the pump. No one questioned why instead of changing the syringe EVERY 4 hours, she suddenly didn't need a change for A WEEK. All the nurses in the family, no one would listen to us. We didn't work for the hospital & had NO access to settings. Her concentration was 100 mg/ml on the pump & syringe was only 10 mg/mL. Doses & everything else was same....

[TheCaptain, ASN, BSN, RN]

I'm not sure you actually read my post, no where did I say anything about treating a patient badly or that I fail to care for my patients appropriately even though they sometimes treat us badly. I instead gave the OP a scientifically valid reason why pain should be addressed and might be much worse than it appears on the surface to an observer. Something that resonated with me and gave me a better understanding of how chronic pain patients perceived pain levels might work. I have never treated a patient with anything less than professionalism regardless of their history or bad behavior towards me. My entire reply was for the OP because I understand the frustration that can be encountered in that type of situation (although the OP was not a great example) and how we can change our thinking to understand the problem from a scientific, factual perspective and treat appropriately.

[annie.rn]

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. .

While I get your point that organs crashing will cause death much more quickly than acute pain will, I disagree that people don't die of acute pain.

The summer between my junior and senior years of nursing school I worked at a VA hospital on a med/surg unit. We had about 5 long term patients that were on our unit waiting for a bed in the on campus VA nursing home.

One such man was a very sweet, easy going patient. Never took pain meds (I shadowed the nurses when they passed meds as well as asked the nurses about it ). He woke up one day w/ excruciating back pain. Long story short, the sadistic doc would not give him anything for pain b/c the few tests he ran came back negative.

This doctor ordered normal saline injections as a placebo. When they did not work he still thought the pt.'s pain was psychosomatic.

All the pt. did was cry. He got very little sleep. He had previously been quite active but stopped getting out of bed. He wouldn't eat. He stopped painting (his favorite thing to do).

I was so astonished by the rapid decline of this patient. He would regularly scream and beg, "please kill me! I can't take this pain anymore."

He died within a week of the onset of the pain. I have never forgotten him.

Like I said, I know what you are referring to is different but I wanted to illustrate that uncontrolled pain can kill. Maybe not directly but by the torturing someone so much that they lose their will to live.

[heron, ASN, RN]

Captainc, I was responding to your invitation to stop reading your post, explaining why I was not offended, but frustrated.

Sorry if if it came across personally.

Carry on ...

[banterings]

Even if someone is a drug seeker, does that excuse NOT treating their pan and suffering OR treating them as a human being with dignity and respect?

How terrible must someone's life be that they escape it with drugs. Simply ask, are your preconceived notions and judgements helping that person out of that hole or pushing them down further?

[Ruby Vee, BSN]

Even if someone is a drug seeker, does that excuse NOT treating their pan and suffering OR treating them as a human being with dignity and respect?

How terrible must someone's life be that they escape it with drugs. Simply ask, are your preconceived notions and judgements helping that person out of that hole or pushing them down further?

Someone's life doesn't have to be terrible that they escape it with drugs.

[Ruby Vee, BSN]

I've read all the comments with interest. I'm a nurse, I've been frustrated by drug-seeking behavior and the manipulation and nurse abuse that goes along with it. I hate being the object of that manipulation and abuse. I'm also a person who has had cancer, a serious back injury and joint pain so bad I'd cry all the way home from work due to the agony of being upright and weight bearing for 12 hours. There were days I had to take a Percocet to muster the willpower to drag myself up to my top floor bedroom. Otherwise I couldn't face the pain of the steps. I don't think I ever resorted to manipulation or abuse to get pain medicine, though. My husband agrees.

At one time, my tolerance for narcotics was pretty high -- 4 mg. of Dilaudid every three hours with an additional Ativan before my PT sessions to reduce my anxiety about the coming exacerbation in pain with doing my exercises and having the PT manipulate my joints. I sincerely hope that tolerance goes away because I have fears of being seen as a seeker if I ever have to have surgery again.

This whole discussion is becoming rather silly, though, with nurses jumping in to say that just giving the narcotics makes their shift go easier and more nurses to complain that they've been mistreated by their nurse while they were genuinely in pain and others pointing out that the pain is what the patient says it is (REALLY? How trite!) and still others telling how their grandmother or auntie was in terrible pain and it wasn't getting treated. Everyone seems to believe that their anecdote is the exception and that anyone who disagrees with them is wrong.

I'm a nurse. I've treated pain. I've been in pain. Sometimes it was adequately treated and sometimes it was not. It really sucked when it was not. Some may have seen me as a drug seeker. Others may have recognized that after three orthopedic and two cancer surgeries, perhaps my pain was a bit different than the average. There are good nurses and good prescribers and there are bad nurses and bad prescribers. Some assessed ME and others just wanted to get through their shift by treating me in the average way. I get that. Hopefully I've got enough sense to recognize the difference and to be one of those who assesses the patient in front of them rather than making sweeping generalizations. Or treating the pain that the granddaughter's SO who is in nursing school thinks there is.

[WHITEHAWK007]

If someone truly is a "drug seeker" and you give them a drug they need are you not helping care for this patient? Consider an alternative to the situation, this "drug seeker" is so addicted that they begin with non life sustaining cardiac rhythms, are you happy? Will we we feel better as their nurse that we withheld something that was needed? We all have bias' as nurses and it is important to remember this and recognize and search other employment if we consistently encounter these moments we feel we have to betray our own values or "feel dirty". Good luck, you will figure it out.

[canigraduate]

I just think it's crazy that our profession prides itself on being compassionate to rapists, murderers, gangsters, and whatever human filth comes through the door, but let an addict come in...

[Tex.]

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.

As a chronic migraine patient, I can't like this enough.

[BostonFNP, APRN]

I had a nurse-patient issue last week that made me think of this thread.

In short this was a chronic opioid user/abuser that has been hospitalized many times, has been spoken to be me and several other providers for asking nurses to "push it fast", always wants IV benadryl with his dialudid, etc. I think we all know this kind of patient. He was admitted to the hospital via the ED where he got some dilaudid. I admitted the patient, discussed with him that we know he has an problem with narcotics (which he acknowledged), and made a plan that I would give him appropriate narcotics in the hospital to get him to a tolerable level of pain while diagnostics were run, but he would not be discharged with any narcotics. I wrote an order for 1mg dilaudid q3h and went to clinic for the day.

Five hours later at my office I get a phone call from the patient (from his room phone) irate that he did not get his medication and he was in pain and refused to go to CT without it; again we discussed the plan. I call the attending RN and ask about his ordered/scheduled dose, which was now missing x2. The RN tells me she didn't feel comfortable giving the medication; so I have her go through the vitals with me and her assessment (which were essential normal other than a pain rating of 10/10 (probably told her 100/10), for the past two checks). So I ask her why she didn't feel comfortable given the ordered med: "because he's a drug addict".

I did my best to remain calm and professional, provide education, and the nurse did give the med. As I look back on it, I get more and more upset at the situation. In my opinion, the RN did not have reasonable objections to carrying out the order, interrupted an established plan of care, delayed the patient's CT scan, and didn't report that a med was held twice. I understand her concern, but on the other hand, I didn't feel that I this case it was her concern to have as I can assumed that concern.