Drug seekers

SmilingBluEyes · Oct 12, 2015

I sure hope when/if the time comes, I don't get the passive-aggressive treatment a few here are all about.

Sheesh.

SleeepyRN · Oct 13, 2015

Ahhh I can see where you are coming from with strictly drug seekers. But as the thread has led in multiple directions, I was not aware you were speaking of, for example, the pt who comes to to the ED doing everything to get narcs.
So I can understand doing that to beligerent patients who truly ARE drug seeking. Nope, you have to wait. I have other patients with real needs to attend to first.

I want to clarify that I ONLY make a patient wait if there is a higher priority at the time, or if I am smack dab in the middle of something. Judgment aside on the true drug seekers. I give them their meds, internally annoyed at beligerence, but I use prioritization first.

SleeepyRN · Oct 13, 2015

I sure hope when/if the time comes, I don't get the passive-aggressive treatment a few here are all about.
Sheesh.

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.

Whispera, MSN, RN · Oct 13, 2015

It strikes me as sad that it seems more people in intense pain, and needing medication for it, are seen as addicts rather than people who just need medication to help them. Why are some so quick to jump to the conclusion that a person is an addict, with all the negative connotations that come with that label?

TheGooch · Oct 13, 2015

It strikes me as sad that it seems more people in intense pain, and needing medication for it, are seen as addicts rather than people who just need medication to help them. Why are some so quick to jump to the conclusion that a person is an addict, with all the negative connotations that come with that label?

That's why I'm using MMJ. I don't have to worry about self righteous judgmental people(like the OP) any more at the ER when I have a flare up of my lower back pain.

Getting approved to use it was one the best things I've done lately.

TheGooch · Oct 13, 2015

I'll never forget the time I ended up in the ED with terrible pelvic and back pain. I couldn't walk and I had no idea what was wrong with me. The first time they treated me like dirt and sent me home with nothing in an ambulance, even though I never even asked for pain meds. When they got me home I could not get out of the ambulance so they brought me back to the hospital where the nurses, including the charge nurse, ridiculed me and made me feel like an inconvenience. Several years later it happened again after a long time of mysterious pain. I went to the ED again straight from work because I could not stand. They gave me Dialudid and I had an MRI which came back negative. Immediately the tone changed and I was treated like absolute dirt. I will never forget that feeling of utter shame, even though again I never asked for any pain meds. I was disgusted and told the nurse in charge how I was made to feel. Months later I was diagnosed with Stage 4 endometriosis with deep infiltrating disease that I needed 3 surgeries for. I still need narcotics and I still work full time. Someone's pain is NOT your decision. Someone's addiction is NOT your concern. Do your job, act like a professional and be an advocate for the patient and try to have some compassion about what people have to go through. I hope it never happens to you so you never get to experience it first hand. Since then I have made it a point of never leaving my patients in pain for any length of time. I make it a priority to give patients their pain meds and if I see someone procrastinating for no good reason I'll give them hell. I do not want to see what happened to me happen to anyone else.

I wish I could "like" this a bazillion times!!!!!!!!!!!!!!!

Guest219794 · Oct 13, 2015

Always a divisive subject.

There will always be posters who respond the the old "pain is what the patient says it is" quote, which is absolutely ridiculous.

While there is some truth to the sentiment, it is a gross oversimplification.

Nothing is "what the patient says it is".

I don't mean that patients lie all the time about everything. What I mean is that we are expected to use judgement as nurses.

If your 400 lb pt claims to be gaining weight despite claiming to eat only lettuce, you might be suspicious. You might be more suspicious when you see Big Mac wrappers in his bag.

When a person with a history as an alcoholic comes in to the ER with ataxia and slurred speech, but has only had 2 beers, we don't just do a CT, we generally do a breathalyzer.

Turns out that alcoholics sometimes lie, and alcohol use is not, "what the patient says it is".

The list of things that are not "what the patient says it is" is endless. And given that a drug abuser will lie to loved ones to get drugs, I think it is reasonable to assume that they might lie to a medical professional for the same reason.

And sure, I suppose it is theoretically possible that a person has a history that includes:

Multiple pain complaints with no objective findings.
Allergies to multiple unrelated non-narcotic pain relievers.
An inability to tolerate mild narcotics like codeine and hydrocodone, but no problem with oxycodone or dilaudid.

I suppose that anything is possible, but that doesn't negate my judgement.

So, to answer the OP from my perspective in the ER-

I advocate for the best treatment for all my patients based on my nursing judgement. This includes patients with complaints of pain. I apply judgement in that situation as I would in any situation.

My job is to advocate, then administer the medication ordered. And I do. I recognize that I am a link in terrible system that causes and perpetuates addiction and abuse. But, overall I like my job, and have learned to live with the fact that the system is flawed.

And for those of you who have had pain and felt judged and mistreated I get it, and I'll give the OP credit for getting it as well. But when a nurse vents frustration about being a part of this flawed system, chances are they aren't talking about you. Chances are they are talking about somebody who meets this description:

Informational Brochures - Don't Be Scammed By A Drug Abuser

SmilingBluEyes · Oct 13, 2015

I am not asking anyone to suspend all judgment, but it would be nice to give a person benefit of doubt and NOT behave passive-aggressively. This ain't my first rodeo and I know there are seekers out there.

However, "punishing" them like stated in a post above is not the way to handle it. Such treatment will only inflame someone who is, by nature, belligerent anyhow. It serves no useful purpose and it's unprofessional.

RIRed · Oct 14, 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.

Give the medication the way it is ordered. Sometimes when I have a med seeker, I let them ask a second time before I give the medication. I have found that med seekers frequently go back to sleep before I bring the Med. Good luck to you. There are a lot of drug seekers out there, unfortunately.

moriahcat · Oct 14, 2015

I mistyped, I meant to type "drug-seeking." So, a person who is sitting in bed, on the phone, laughing, BP is great, HR is great, snacking on chips is truly experiencing 10/10 pain. Doesn't add up to me I guess. This particular patient has a history, based on his physician notes, of "numerable admissions complaining of vague pain, then becoming angry demanding IV Dilaudid." He is a non-compliant in his medication regime for diabetes, does not take his HIV meds, etc. This admission was for chest pain. All markers were negative, etc. Not only was he getting Dilaudid, he was getting Percocet along with it. Administered together.

My father was a long-term drug addict who became infected with HIV from sharing needles. He preferred uppers, so usually didn't use emergency facilities for getting high.

That being said, remember that HIV can cause all sorts of other issues, and the meds aren't easily tolerated. Many patients who are noncompliant with HIV medication are also suffering from depression or other issues related to a terminal diagnosis -- some have essentially chosen to die faster rather than slower. Depending on how long they've been sick and their current immune status, they could have many quality of life issues, including severe gastrointestinal distress that opiates may help and opiate withdrawal is certainly going to exacerbate.

You aren't going to fix a patient like my father in one stay. Dad was on methadone in his later years when he had to have a hip replacement and started rapidly developing other symptoms of degenerative joint diseases -- but he refused to have other scans that might have found the tumor sucking calcium out of his bones, until the high calcium itself caused an admission. The tumor had metastasized and one was already quite large. That's not an uncommon end for average 17-year diagnosed patient. It's amazing he lived that long, given his lack of compliance. But as his kid, I saw a little more to see why he was such a frustration to his doctors.

If you have the ability to notify a unit social worker about such a patient, finding an advocate to help them get care outside the ER and hospital to address their health without taking up resources and getting them better quality of life would be my suggestion.

But remember, this patient is terminal. Is addiction his biggest problem?

Farawyn · Oct 14, 2015

That's why I'm using MMJ. I don't have to worry about self righteous judgmental people(like the OP) any more at the ER when I have a flare up of my lower back pain.
Getting approved to use it was one the best things I've done lately.

MMJ = Meanmaryjean?

Thessaly36 · Oct 14, 2015

Well first I avoid this conflict by staying in my own bubble and do go with the "if it's ordered and they say they have pain the they get it" philosophy. A drug seeking patient on the hospital drugs and times in most cases isn't really getting a huge high off of what we're giving them because they are likely on drugs as well at home and I'm certain they aren't taking those as directed or they wouldn't be at ED a week after they filled their oxy Rx (at my hospital at least they don't Rx crazy amounts). Only when I see signs that a pt is starting to get in the clouds am I concerned and in that case I have never had an issue with the dr lowering the dose or increasing the time between doses. My second thought on these situations is that I (and also you trust me) will never ever ever ever get a person to stop abusing narcotics by any policy or means that might target seekers when dealing with healthcare environments. All kicking them out, or whatever other solutions I have heard offered in that vein to address the problem, will do is cause them to try more desperate means of obtaining the drugs be that pharmacy robbery or just plain old hitting the corner dealer for something way more dangerous than what we have. This is the perfect opportunity, however, to "crack the door" of change. I always have a small talk or make repeated but brief mention of their medical history showing a lot of pain Rx, or their hx of drug abuse, whatever fits their situation and then make sure to bring up a few things. That there is a such thing as physical addiction to these drugs so even if a person isn't "a junkie" they would still need help to stop using the drugs. I find that gives people an out because being a junkie that likes to get high is shameful in our society but if you have a physical addiction and you're not trying to get high it's just about your pain that's an acceptable thing to get treatment for so they feel safe telling their families ect they need help for that reason but not the other and of course I give them resources for pain Managment specialists and rehabs. Depending on the individual I may just leave the drug addict pamphlets after mentioning it to them or talking in depth. And finally there are some patients that I have been straight out with "hey I can tell you have a problem and while you are here I will continue to give you these medications as ordered but I would like you to think seriously about making a change." And I leave paper work and make sure they know if they ever want help they can always come back and ask for me and I will go out of my way to do what I can to get them into a program that will work for them. finally if I hav a patient that I think might become hostile if I approach them about their addiction I always frame it as a policy that the hospital has to speak with all patients that have been given pain killers about addiction and treatment and I try to give them as much info as I think I can. Bottom line it's safer for them to be trying to get high under your watchful eye than on the street, where I assure you 1000% they will go if they can get service at a hospital, and this gives you the opportunity to plant the seed of recovery with them.