Tips on how NOT to appear like a Drug seeker

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Jennifer, RN

226 Posts

Specializes in ER, telemetry.

In my ED, the doctors give pain meds like it's candy. It very frustrating when, as a nurse, you know the pt is a chronic drug seeker and the docs still give them what they want. What do you do as a nurse?

Specializes in ICU,ER.
In my ED, the doctors give pain meds like it's candy. It very frustrating when, as a nurse, you know the pt is a chronic drug seeker and the docs still give them what they want. What do you do as a nurse?

You know, things like that used to bother me too. But you know what?

It's never going to change

I just go to work and do my job and don't sweat the stuff I have no control over.

gwenith, BSN, RN

3,755 Posts

Specializes in ICU.
Having read through some of the threads regarding Drug seekers in the Emergency Department I must admit I now feel quite nervous of being misperceived in this way. I take medication which causes some urinary retention and increases my risk of Kidney stones. Hopefully this will never happen, but if it does and I need to present to the ED, what advice (on behaviour and what to say for example) can people here give me so I don't get wronly perceived as a Drug seeker. Taking into consideration I am a former Heroin addict, sensitive to NSAIDS and can't take Ibuprofen or Aspirin type medications due to asthma.

Personally I would find a 24 hour medical practice and register as a patient with them - especially if you can find one that bulk bills. That way you do NOT have to come through A&E. - You get seen faster too. Last time I had a bad case of the V&D's I turned up at the local 24 hour practice - at 0400 in the morning clutching a vomit bowl. I did NOT want to wait around in some Casualty department for hours waiting to be seen.

You might be getting a somewhat different idea of ED from the mostly American threads here - I know our hospital has an aim of treating pain within 1/2 hour of presentation.

As for being labelled a "drug seeker" - well we give the benefit of the doubt unless we can prove otherwise (i.e. patient has collected X number of scripts from Y providers over the last N period) and then the patient is put on a registry. That registry is, of course, statewide since all public hospitals are linked. So less likely to be labelled (I think - but then I have not had to present as with a pain issue to the cas department since I burnt the back off of three fingers) but once you are labelled you would find it harder to scam the system without coming up against referral for drug addiction.

Specializes in ICU, ER, HH, NICU, now FNP.

Oh but were there some sort of tracking system in the US...that sure would make save time for all the rest of us and for patients.

There is a tracking system of sorts, but not one that anyone has any access to in any timely manner.

The other day we got a few letters from insurance companies listing the Rx's that had been filled by a few of few our patients - from several doctors. Many duplicate narcotics written within a week or two of each other. That and notification from the DEA or the state is the only way you will find out. About all you can do is let the patient know they wont be getting anymore narcs, refer them for CD treatment, and set limits with them otherwise.

gwenith, BSN, RN

3,755 Posts

Specializes in ICU.
Oh but were there some sort of tracking system in the US...that sure would make save time for all the rest of us and for patients.

There is a tracking system of sorts, but not one that anyone has any access to in any timely manner.

The other day we got a few letters from insurance companies listing the Rx's that had been filled by a few of few our patients - from several doctors. Many duplicate narcotics written within a week or two of each other. That and notification from the DEA or the state is the only way you will find out. About all you can do is let the patient know they wont be getting anymore narcs, refer them for CD treatment, and set limits with them otherwise.

I think we might have hit a nail on the head!!!

A national registry IS needed to help identify those who need treatment for drug addiction - our system is nowhere near perfect and is also not that easy to access but it is there.

What I am reading again and again on these threads is frustration. Nurses do not want to be the "big bad guys" witholding needed medication but neither do we want to feed addiction or worse be virtually forced into giving overdoses/toxic levels of medication because the patient is on the tenth dose of whatever having already taken 8 doses that they obtained elsewhere.

The few ARE spoiling it for the many and I think most acknowledge that. If there was a way of deterring the real drug seekers (I.e. come to ED and you WILL be caught and referred for treatment) then you are once again freed to treat all patients as if they are genuine and without facing a personal ethical dillemma.

Specializes in ICU, ER, HH, NICU, now FNP.

I agree - but...

People will lie about who they are, fake their identities etc etc...

It wouldnt be fool proof by any means - but anything would have to be better than nothing.

It would also be nice if all the narc scrips were linked on a computer - that would help reduce forged scrips too.

babynurselsa, RN

1,129 Posts

Specializes in ER, NICU, NSY and some other stuff.

Some states have enacted pharmacy databases to track narcotic prescriptions. Oklahoma just enacted theirs this summer. When a patient fills a script at a pharmacy, the pharmasist is able to see what this patient has had filled elsewhere. We recently had a patient come into our ER and left with the desired scripts only to have the pharmasist notify this patient that she was attempting to fill them. The pcp apparently had the final say and she did not get them.

I wonder about a similar database for ER visits. Working agency I see people one night that I may have seen in another ER a few nights earlier.

Specializes in ER, ICU, L&D, OR.

Wear a suit

have insurance

be polite

be articulate

rph3664

1,714 Posts

I worked as a case manager in the level one ER for about two years and it was my job to deal with the chronic patients. Drug seekers are those who continually seek care from DIFFERENT ER's, they don't follow discharge instructions, give different names and social security numbers, shop from one ER to the next and alter prescriptions. The other ERs as well as pharmacies call around to each other.

So...given this criteria, you should have no problem. Especially if you are upfront about your problems, I don't think there would be a problem. It is not a problem for patients in pain to receive excellent care. The biggie red flags are listed above.

Good luck.

I haven't read the whole thread, but I'm a pharmacist and when I worked at a grocery store some years back, I had three patients who the local ER refused to see because of their drug-seeking behavior. The ERs in the cities around us were on to them as well.

Eventually, we called them out, got them angry with us, and they took their business elsewhere.

Specializes in ER, ICU, Infusion, peds, informatics.
i think we might have hit a nail on the head!!!

a national registry is needed to help identify those who need treatment for drug addiction - our system is nowhere near perfect and is also not that easy to access but it is there.

what i am reading again and again on these threads is frustration. nurses do not want to be the "big bad guys" witholding needed medication but neither do we want to feed addiction or worse be virtually forced into giving overdoses/toxic levels of medication because the patient is on the tenth dose of whatever having already taken 8 doses that they obtained elsewhere.

the few are spoiling it for the many and i think most acknowledge that. if there was a way of deterring the real drug seekers (i.e. come to ed and you will be caught and referred for treatment) then you are once again freed to treat all patients as if they are genuine and without facing a personal ethical dillemma.

while this sounds like a great solution to the problem, i think we would have a very difficult time implementing it in the us.

i believe that you have a national health care system in place in australia, right? and i would guess that this system has facilitated the ability to track rxs, since they are filled through the same insurance.

while we might be able to develop a system for medicaid patients, i can't see all of the insurance companies getting together and cooperating on a similar tracking system for private pay patients. plus, all the patients who are self-pay.

there would also be many people who would object on the grounds that it is a privacy violation.

it would certainly help, though. not just with drug seekers, but people who are having legitimate pain that could be taking too much tylenol due to all the scripts they have filled. who hasn't heard "well, i took two percocet that dr. x gave me, but that didn't help, so i took two davocet that dr. y gave me, and that didn't help, so i took two lortab tht dr. z gave me, and that didn't help, so now i'm here...."

kk2000

90 Posts

Specializes in Home Health, Hospice.
Someone who wasn't a drug seeker wouldn't even be concerned about this.

Had to respond here-when you know you aren't believed, and are not validated just because you are not presenting with classic pain signs and vitals, one tends to be very scared of being labelled.

I, for one, have had this experience, only to find out a few days later after having an MRI at my own expense, that I had 3 additional disc herniations after the ER doc told me that there was nothing wrong with me and to go home and take tylenol. Wouldn't even do an xray.

Please don't judge until you have been in the situation. Yes, there are drug seekers, but a person in pain is always suspect.

geniann

38 Posts

Specializes in LTC, rehab, and now office nursing.

I too know what it is like to not be believed. It is beyond frustrating- and of course we must deal with the pain. kk2000, I had almost the same situation. Then I see an ortho doc and he tells me "I know nurses know what to say to get drugs and they know how to act". I was shocked and apalled- I told him "I have NO insurance- If all I want are the pills I can buy them off the street cheaper than coming to you. I spend $200-$300 dollars to see you plus the cost of the scripts. I want a professional to help me so I get the best treatment. Yes I am in pain and I do need narcotic meds but I want them to help me- NOT rule my life! Needless to say that doc later changed his tune, but the words still hurt. Another poster said "wear a suit,have insurance and be articulate"- a drug addict can be as well dressed and well spoken as anyone and still be a DRUG ADDICT- and the doctors will see past all this- They have probably seen it ALL before- and they DON'T fall for fancy clothes or good insurance.

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