Drug Seeking Patients

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How are each of you dealing with patients who are abusing prescription medications? There has been so much emphasis put on the patients right to pain control (over the past ten years or so). I understand and agree with this belief.

However, there are also many, many patients who (although not always a planned thing on their part) have become addicted to prescription pain medications.

I know clinically how we handle this (pain agreements, referrals to alternative pain control specialties such as massage therapy, psych counseling, etc), but my question to you all is: How do you personally deal with this on the patient level. We are trained as nurses not to "judge", yet I find myself growing increasingly angry at these patients who knowingly abuse there medications and then come in early for more. I feel I am being "played" when they hand me a line about losing there medications or tell me "they were stolen" or any other lame excuse.

Another question I have is: If the MD does not prescribe the medication that day and the patient goes into withdrawls, is he not liable? If he does prescribe it early to keep this from happening, are there not legal ramifications for this as well? Sounds like either way we loose and in the long run the patient does too.

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Good question Stormy ..? about the liability issue.. did you find an answer?

Drug seekers can be a problem in any practice.. Have you noticed a friday afternoon rush in an attempt to get controlled substances?

My Doctor (IM) is usually adamant that he will not become a pain managemant specailist. We do refer to pain management cliinics. And we usually try to weed out the drug seekers early in their attempts to establish in the clinic

What kind of practice do you work in?

Yes, we should not judge but neither should we allow patients to manipulate us with thier hard luck stories. I could write a book on the many excuses for early Vicodin refills.

If meds are "stolen" we ask for the police report....stops them in their tracks.

Do your pharmacies track drug controlled substance abuse? I find they can be helpful

Yes... Pain control is important and we should help patients in every way possible. Many patients have Pain that is very real.

I am inclined to use the medical model.. find out if there is a physiological cause for the pain, evaluate the problem, correct if possible.

The ultimate concern is for the patient and we try to get them all the help they need rather it be pain managament, psych, nerve blocks etc.

I will write more later. Gotta run!!

This is a good topic.much more to say. Thanks for posting it!

Darla

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IMHO, so long as there is documentation of pain management being addressed and alternatives being offered, there should be no liability. I would hope the physician uses sound judgement when handling these cases.

From the Nursing standpoint... you provide information, alternatives and lend support. You're not the one handing out the meds, so why do you feel the need to feel "played" or get "angry?"

Yes, it's frustrating. But TRUE addiction to narcotics is every bit as serious and important to treat as an MI, CVA, appendicitis or trauma... yet you don't see Nursing become half as angry with patients in these categories as you do with those of addiction.

The only "loser" is the addict and their family.

Peace:)

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Stormy, I have the same problem. I try not to judge but after a while it gets to you. You try to watch your patients to help them not become abusive and they get mad. It is a catch between a rock and a hard place. What really upsets me is when they call early and it has to be approved therefore it will take longer then usual they start complaining about me. I had this happen recently and it made me so mad. If you have any suggestions and better ideas on how to count to 10 let me know. Jill

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I have been told that pts that are addicted to perscription drugs get their drugs for free. What is wrong with our society to allow this and people with heart conditions, hypertension, diabetes, etc... have to spend hundreds of dollars a month on their perscriptions?

ESG RN

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I also am followed by the same doctor I have had for over 15 years. He came up with the solution. He put me on Pamelor, it has made me pain free without addiction. Here is a link:

http://www.cnn.com/HEALTH/library/PN/00044.html

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Specializes in Geriatrics/Oncology/Psych/College Health.
Originally posted by pepperbark

I have been told that pts that are addicted to perscription drugs get their drugs for free. What is wrong with our society to allow this and people with heart conditions, hypertension, diabetes, etc... have to spend hundreds of dollars a month on their perscriptions?

ESG RN

I'm not sure what you're talking about in regards to addicted patients getting meds for free - there are patient assistant programs through most pharmaceutical companies but only if the pt meets financial criteria and if they are prescribed the med. Medicaid patients must also meet criteria.

As far as providing "free" meds for the chronic health conditions you mentioned, I'm not sure how I feel about footing the bill for meds to treat conditions that are almost always results of years of poor lifestyle choices. Just my thoughts.

As regards the question of drug seeking patients, our office tries very hard to minimize prescribing narcotic meds as we deal with a potentially very impressionable patient population (college students) whose decision making/impulse management skills are often less than top-notch.

We also have a drug utilization review committee that meets periodically to review charts that have been flagged for unusual activity re: narcs. Occasionally patients have been sent letters advising them that we will care for their health care needs but no narcs will be prescribed by any provider in the practice.

I do understand your frustration. Hopefully if the entire practice is of a single mind about these issues, staff won't feel as tho they are being played or pitted against each other.

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Our practice has collaborated and developed a clear narcotics agreement which ALL patients sign when rec. a rx for pain meds.

One of the key components is no refill for any reason without an office visit. ie if script lost, dog ate it ect.

Thankfully all of the staff is on the same page about enforcing it.I

would be happy to get a copy to you if you will provide your office address.

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Hey Stormy,

I feel your pain!!! I work in Pacu and when a patient rolls that's been on pain meds @ home (esp. oxycontin!!!), believe you me, they scream to high heaven. It seems like we pour narcs into these patients and nothing seems to work. Their resp. rate could be 6-8, and their pain is still a "10". Why are all these patients being prescribed oxycontin tid??? I just wonder if the MDs prescribing would like to pay a vistit to Pacu after their patient has had surgery????!!!!:( :(

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Chloe,

I am also in Pacu, and see the same problems. Pain is 10/10 after 4mg of Dilaudid IVP and 30 mg of MS. THEN we EVENTUALLY find out that the pt has been on Vicodin or whatever for 3 years! I am NOT blaming the patient at all. They are sick. They may not be addicts though. They may just be tolerant and need higher doses. Haven't you had a patient who was terminally ill, who needed very high doses? Then do we call them addicts? NO, we say they are "tolerant". Well, there are all types of pain, and some people are jerks and will abuse any system, while others do not. We have to just treat em all!:)

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I wish every medical professional could go thru just one month of intractable chronic pain D/T whatever. Then maybe they would all stop being so darn judgemental. It is people like these so called professionals that make innocent honest hurting people like me suffer in silence. To all these judgemental pain free people I say BITE ME! And take a class on the difference between addiction and tolerance.

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angelbear, I couldn't agree with you more! Unless you've been experienced chronic pain, you have no idea what it's like. Just the stigma of having "chronic back pain" is awful.

The other morning I was giving report on a pt that had been in an accident 3 yrs prior resulting in chronic pain. He was on Oxycontin qday and Xanax bid (home meds). He was also getting Demerol 100mg IV q 4 hrs for his post-op pain.

When I told the oncoming nurse this, his response was "loser,

nothing but a druggie."

He had never seen the pt, and new nothing about him except the few sentences I had given in report!

I have had chronic back pain for 7 yrs! I could totally empathize with the pt.

:( Ugh,,,,,,,those comments make me sooooo mad!

Come on people!! There is a difference between addiction and tolerance.

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