Oxycontin abuse/ pain management

  1. Hello. I'm a Paramedic in North Georgia and an RN student. We have had class discussions about pain management and Oxycontin abuse. Some nurses in this area say that Doctors are now relunctant to prescribe it. Can anyone give me some information on this in your area? Thanks.
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    About rkg

    Joined: Sep '01; Posts: 2
    RN student/Paramedic


  3. by   LerRN95
    What kind of information are you looking for?

    We have alot of patients coming in our ER that are on Oxy and they have ran out. The ER doctors refuse to refill any of this medications. They give them a shot and tell them to contact their physician that precribe the medication.
  4. by   CEN35
    of all the scuttlebut on tv about it's abuse. mostly because it is so commonly prescribed. why not make an issue of all the other drugs and opiates prescribed out there that get abused?
    our er docs......prescribe only a few......usually less then 12........and thats it. if they come back in 3-4 days they get nothing.
    we did have a guy in his mid 20's.............and his physician prescribed him, like 60 somas with 3 or 4 refills? percocets, with refills, davocet with refills, and a few other things. i am talking bottles and bottles he had on him. there is a real problem!!!!

  5. by   teeituptom
    howdy yall
    As a RN with well over 20 years experience, the last 14 years in the ER.Prescription drug abuse is a serious problem that fully needs to be examined, documented, tracked.
    Yes we have a large number of patients with drug related problems. But lets face it, whether you work in a busy ER or a crowded doctors office. Its is easy to overlook the obviousness of drug addiction. It is easier to wright a prescription.rather than spend an unlimited time with a person to encourage them to realize they have a problem, and their need to deal with it. In this the medical community bears far more responsibility for this tahn they want to admit.
    Example, Pt Joe Blow has come to the ER 30 times this past year and he has always left with scripts for lortab and soma. And we know from neighboring ERs that he has been their also for the same. What do you do about this. Do the doctors in the ER as a group refuse to give him anymore meds. In which case he just hits other ERs.Then after a time off he eventually comes back. Does the ER doctor sit down at length and discuss with the patient his potential problem and how to deal with it. In a busy ER the doctor does not have time to do this, because then he is neglecting patients with possible significant pathologies presenting. Its rare when the doctors in my ER have that much spare time. Does the doctor just look at the patient and refuse to give them narcotics. This presents risks as well. You are open tp lawsuits for defamation,for refusing to treat a problem to provide pain relief measures. Or god forfid they complain to the department of health in your state, and they come out to do an investigation, because if they do, once in your doors they can look at whatever they want. And if they want they can recommend you for citations and or HICKFA violatins. I promise you , you dont want to deal with that. Do you notify neighboring ERs about this patient? I think not, that is a violation of pt confidentialty.And then you are open to further litigation.
    And to further cofuse the issue, when JACHO comes for its visit. One of the main things they are focusing on the last couple of years is pain relief and the documentation of pain control. How are you going to tell they are just a druggie. It doesnt matter how often they come to the ER, each visit they may actually be in oain, and can you deny anybody relief from pain without taking risks. That all depends on how big your balls are. Because you can surely be placing them on the chopping block.
    Even when you identify the patient as a drug abuser. Before you can decide not to give him pain relief, you have to work him up as an indivdual bases on each every visit, just to ensure the patients safety, and to protect your liability. This is a self perpetuating problem of immense proportions throughout the nation.
    The only thing that keeps coming up to me is what my old nursing instructor, once lectured on. "judge not the patient in your care, but assess appropiately and intervene correctly and caringly in the best interest of your patient"
    enough rambling from an now old nurse
    tom livingston rn texas
  6. by   rosieseattle
    I think that anybody checking into the ER has obviously an unmet need of some sort, otherwise they wouldn't be checking in. Maybe they are really in pain, maybe they are depressed. But, our job is to triage them, asses them and their needs without passing judgement.
  7. by   psnurse
    I think treating possible acute pain and making a referral back to the prescribing physician for oxycontin is appropriate.

    Ideally the prescribing physician for oxycontin would be a pain management specialist.

    I know that drug abuse is a huge problem, but I think we are sometimes overzealous in our classification of patients as drug seekers.
  8. by   shootemrn
    We like every Ed in the country have a serious problem with drug seeking patients. Alot of the problems with these patients have been posted very nicely on this thread. Our drug seekers are usally prescribed pain meds and a referal to our hospitals pain clinic. At that time the patient can be evaluated by the pain clinic and issues of abuse or real pain can be adressed. These patients are flagged in our computer system and we can stop this drug seeking behavoir in our ED with the question "What happend at the pain clinic?"
    The major downfall of this is that the drug seekers will go to other ED's and avoid ours. It is by no means a solution but an attempt to aleviate this huge problem.

    P.S. I triaged a patient last week with the chief complaint of "Medication Refill" I asked him what kind of medication he needed refilled. He told me Oxycontin. I asked are you in severe pain? He said "No...I just go into convulsions when I dont have it."
    This was all documented on the ED record and he saw a doctor and he went home very unhappy but he wasnt convulsing!

    P.S.S. We had a RX pad stolen from our department and called the local pharmacies with the script numbers. A day later the culprit was caught by policein a local pahrmacy and the scripts were recovered. He only tried to pass one script and the pharmacy faxed us the bogus prescription. It had the persons name on it and in the prescribing area it stated "MOFENE 2Lbs." swear to God!
    Last edit by shootemrn on Jan 9, '02
  9. by   sgavette
    Drug seeking behavior is a very common problem and one that will not go away. I feel that there are some doctors and also pain clinics that contribute to this problem. I have a friend that has a problem and when he would go to the pain clinic, they would give him a script to Methodone, enough for 3 months. Of course we all know that he isn't going to take the amount prescribed, so what happens when he runs out before that 3 month period is over? He goes to one of the area ED's. I feel that we really have a problem here that needs be addressed.

  10. by   NRSKarenRN

    You can always do a search here re any topic to see if previous posts on a subject. Go to the search blue box located next to allnurses logo. Check out the previous posts from the Advocacy forum from last summer.....

    FLA: More re Oxycotin-- Painkiller drug deaths up 59 percent

    FLA: More re Oxycotin-- Painkiller drug deaths up 59 percent

    Authorities recommend prescription database to deal with OxyContin Abuse

    Virginia Town's OxyContin Buyers to Be Fingerprinted