Drug seeking patients

[Art_Vandelay]

The patient had a history of drug seeking behavior, but he also had a cardiac history and was taking cardiac meds.

So, one day he presents to me with c/o chest pain on the left side of his chest that is not radiating anywhere. Vitals are taken and all are WNL. He says he has had heart attacks before, but none felt like this and he "wasn't sure" so he "wanted to tell" me. He has no other symptoms. Assessment is normal. My gut tells me over and over he is lying. I give him ordered PO narcs and call the doctor and ask for a callback. He has no nitro ordered. The doctor doesn't call me back right away and the patient presents to me again, stating "it's radiating to my neck now." I call 911. The paramedics arrive and assess him and --what a shock!-- their assessment findings are all WNL. And voila!, his pain is not radiating to his neck anymore. Oh, and he is not sure about his pain location now, it might be in his ribs. "I told you I wasn't sure." Meanwhile, the paramedics are looking at me like, "Why did you call us? This patient is perfectly fine." Nevertheless, by this point I had talked to the doc and received the order to send the patient to the ER. I am still so irritated about it. I knew the patient was lying from the start, but I didn't trust myself. And here I am looking like the fool. It makes me so resentful toward these types of patients!!!!!! Just wondering how other nurses would have handled the situation...

Oh, and by the way, the patient came back that day with EKG and labs normal. Gasp!

[autumnmom]

When I worked in LTC every time we called 911 the paramedics would act like we were idiots for calling them. They felt like if someone wasn't coding we were wasting their time. If in doubt send them out and if MD says send, well they have no reason to question it.

[Whispera, MSN, RN]

Someone who is addicted to pain killers will have pain most of us never dreamed was possible, when they can't get their painkillers. The same is true for those who are addicted to drugs that are anxiolytic. They have emotional and physical pain without their drugs. Who's to say their pain is less valid than someone else's?

I hate the words "drug-seeking," even though I accept that it happens. I wish I could wave a magic wand and change the negative attitudes about people who seek drugs to a more overall one of calling them "help-seeking." I don't believe most drug-seekers want to keep on their current path. They're just glued into it. I bet most of them would bless the day they could stop seeking.

[usalsfyre]

Dealing with addictive behaviors in a textbook is very different from facing it over and over again on the job.

The exasperated, angry and cynical posts I read about "drug seekers" are a normal response to being manipulated. It's easy to get pulled into the contest over whether the junky gets his fix.

The misuse of EMS is a big part of the problem, as is management's delusion that pt. satisfaction scores has anything to do with quality of care.

There are some places taking measures to curb the use of EDs to feed drug habits: pharmacy data bases to spot prescription abuse, strict narc policies, billing or even filing criminal charges for misuse of ambulance services.

I fully believe that there needs to be a forum similar to al-anon for nurses dealing with drug abusers - we're the ones taking it on the chin day after day. Ignoring the damage done by this is setting us up for precisely the kind of polarization we see over and over in these threads.

It is not our pts' job to take care of our feelings ... and that's what power struggles over whether a pt is "really" in pain is really about, IMHO.

I deal with these patients daily, this is far from a textbook answer from me. At one point in my career I would get upset and angry over drug seeking behavior. As I matured, I realized, "why do I care?". A core of my job is to help relieve pain and suffering. Narcotic pain medication is cheap. I'd rather see someone "drug seek" than rob a convenience store to obtain meds illegally.

[SammiJoRNBSN]

I currently work at a county run facility which serves many of the underserved population. I have learned that no matter what personal prejudices I may have regarding people and their lack of caring about their health, I still give meds as ordered whether or not they are "faking it". I have learned that with most of these folks, I treat them as if I would treat anyone else, educate them and attempt several interventions which I feel would be suitable for them. Nevertheless, I almost always end up giving the meds because the other interventions "don't work". In the case of cardiac or respiratory...I don't even mess with that...at my facility, that's a trip to the ER. Of course the paramedics look at you as if you are stupid, just let it roll off your back.

[heron, ASN, RN]

Both of these posts remind me of something I first read over 35 years ago.

Each of us must make up our minds as to priorities.

If we decide that relief of pain is the prioriy, then we need to accept the fact that some junkies will get over. We can minimize that with good critical thinking and institutional support, but some will inevitably slip through. Best not to get your ego invested in controlling a pts addiction.

What makes it difficult is that the priority often needs to change, depending on the setting and context. Working in a substance abuse treatment setting, for instance, or caring for a hospice patient who is also an addict ... nope, nothing simple about it.

[leslie :-D]

or caring for a hospice patient who is also an addict ... nope, nothing simple about it.

i'm sorry, but for the life of me, i am not going to worry about my hospice pt being an addict...

unless s/he indicates otherwise.

it's a drain of precious time and if i can set goals for my pt, and the pt is receptive...

that is my focus.

of course it's not as simplistic as that, but it's certainly not one of my bigger challenges in hospice.

leslie

[heron, ASN, RN]

i'm sorry, but for the life of me, i am not going to worry about my hospice pt being an addict...

unless s/he indicates otherwise.

it's a drain of precious time and if i can set goals for my pt, and the pt is receptive...

that is my focus.

of course it's not as simplistic as that, but it's certainly not one of my bigger challenges in hospice.

leslie

So true ... as far as hospice is concerned, I was thinking more of dealing with all the behaviors addicts learn. These, along with behaviors of people in the pts life, certainly affect our approach to caring for them.

[Fribblet]

I think most nurses ultimately don't care THAT much about medicating drug seeing patients. Most of us understand, at least intellectually, that opiate withdrawal is an awful, awful, experience.

The problem, I'd wager, that most nurses have with drug seeking patients (at least this is my problem with them) is the absolute time-suck they become. The whine, they cry, they're manipulative, they engage in staff-splitting, they're on the call bell every 3 minutes. They take away time from patients that are actually having a medical emergency.

I'll medicate you if I have an order, but only after all my other patients who have immediate needs are tended to.

[tinahawa]

In nursing school we learn that pain is what the patient states it is. That I agree with, because we are not mind readers, we do not know how severe that patients pain is and how they cope with their pain, so it is not up to us to decide if they need medications or not. What the problem really is, is when you get patients with a history of durg seeking behaviors, those are the ones that nurses really need to watch out for becasue I don't think that it is our job to feed those addictions and if there is any way to put a stop to it I think nurses should try.

[Fribblet]

In nursing school we learn that pain is what the patient states it is. That I agree with, because we are not mind readers, we do not know how severe that patients pain is and how they cope with their pain, so it is not up to us to decide if they need medications or not. What the problem really is, is when you get patients with a history of durg seeking behaviors, those are the ones that nurses really need to watch out for becasue I don't think that it is our job to feed those addictions and if there is any way to put a stop to it I think nurses should try.

You're not going to fix their problem in a 12 hour shift. One hospital stay is not going to fix them either.

Rehab and outpatient treatment often fails as well.

If the med is ordered, I give it, after an assessment of the patient's condition, obviously. However, I prioritize my care. If a patient who comes the ER with a complaint of vague abdominal pain for the 4th time this week with a negative CT scan and labs and vitals are all WNL, administering the med is not at the top of my to do list. They'll get it eventually.

[leslie :-D]

In nursing school we learn that pain is what the patient states it is.

.

in nsg school, you'll learn a lot of things...that just don't apply to the real world.

i believe all nsg schools should preface their introduction with, "what you're about to learn, only applies in an ideal world".

heron- yes, i hear you.

i'm with these pts much more than home hospice care.

i know when they're playing me, i know when they've reached their limit...

most times. it works out very well.

leslie

[Up2nogood RN, RN]

I think most nurses ultimately don't care THAT much about medicating drug seeing patients. Most of us understand, at least intellectually, that opiate withdrawal is an awful, awful, experience.

The problem, I'd wager, that most nurses have with drug seeking patients (at least this is my problem with them) is the absolute time-suck they become. The whine, they cry, they're manipulative, they engage in staff-splitting, they're on the call bell every 3 minutes. They take away time from patients that are actually having a medical emergency.

I'll medicate you if I have an order, but only after all my other patients who have immediate needs are tended to.

So true about the manipulative behaviors! Just ask for pain meds and skip the whiny far-fetched story already.