Ever have an addicted patient complain about post-op pain medication?

[Munch]

I usually work on the Neurology/Neurosurgery floor(sometimes oncology) but this story takes place on the neuro floor. The other day we had a new patient come to the neuro floor after having surgery. The patient copped to being an opiate IV drug user...which okay that's fine. The patient was hooked up to a PCA(even people who are drug users get legit pain and it's cruel not to treat it). The doctors also knew this patient wasn't faking pain to seek medication. Major Neurosurgery HURTS(I know first hand). However the patient was complaining BIG time about the PCA and wanted high doses of IV push pain medication and benzos pushed every 2 hours. EVERY doctor(from Neurosurgery, Pain Service and the Floor Doctors) declined.

Okay..so I'm gonna try to cut to the chase. My new patient had a visitor come in carrying something(I had no idea what but it was small and kind of looked like one of the flat pencil cases kid take to school to carry their pens and pencils in). The visitor stayed literally for two minutes and left. Our policy is to go in and check on the patient after a visitor leaves(don't know why...every floor had this policy). So I went in to check on my patient and caught the patient IN THE ACT of injecting something into the extra IV that was put in the patients opposite hand during surgery. In addition to that, the patient had at least four already prepped syringes lined up on the table(I guess they wanted to admire what they had I don't know why they even had it out and the patient isn't allowed out of bed so the patient was too slow in hiding the "stash." The Visitor obviously prepped the syringes for my patient(what a friend).I didn't even have to ask what was going on. Longer story short the patient was taken up to psych and taken off the PCA(psych's policy and my patient was NOT happy about this). Psych has their own way of taking care of pain when these things happen..which happens more than one may think.

So my fellow posters has this ever happened to any of you? Have you ever have had a patient push substances into an IV that belongs to the hospital? What is your policy with patients that commit these acts? Usually patients go to the bathroom and do this and aren't caught until they've done it a few times(but like I said my patient couldn't get out of bed). It's also hospital policy to call the police(The doctors call the police, nurses don't). I feel bad especially if these patients aren't violent people, they just need help, but If a nurse turns a blind eye to a patient that has drugs on them...and gets caught, the nurse gets fired...and I refuse to lose my job over a patient who broke the law.

[elthia]

Yes it happens. I can't really say much more than that.

[link51411]

yep. all the time

[merner1012]

I know of specific patients that are NOT allowed to have an IV at all- per the MD! And yes, this does happen a lot I'm sure. I work in neurosurg and we had a young patient on our unit for MONTHS because a post-op crani infection, we couldn't place him without insurance and he had a long history of doing everything and anything. Turns out, since he was there for so long, they eventually made him non-monitored so he could leave and smoke, not like being monitored was going to stop him. We find out about the day before he leaves or the day that he left, that the whole time he's been going 3 blocks down to the college town pretty much every night, WITH HIS PICC, and drinking at the bars. We weren't surprised but still, these things happen. God only knows what he was doing with his PICC, but I can only imagine!

[iluvivt, BSN, RN]

Yes happens a lot..I know many a PICC and PIVs I have placed that got used for this purpose. The healthcare worked is often stuck between a rock and a hard place b/c they often need the access for treatment. We even caught a patient digging in the sharps container looking for god knows what. On 4th of July a pt went outside for fireworks..so he has hx of IVDA/drug abuse. I go in to start the IV and the room has the distinctive smell of pot..they probably were all smoking outside.

[FurBabyMom, MSN, RN]

Uh, yeah. Happened all the time. I had one last Friday who kept saying he was in pain (ACDF so yeah probably was in some pain) but the anxiety attack he staged to get his Xanax (home med that neurosurg hadn't reordered) could have done been executed without him saying he felt his throat was swelling and couldn't breathe...because stat paging anesthesiology to see a patient is a great time... And the neurosurg PA was so mad I called him about the complaints...and wouldn't come see my patient or ask me to ask the hospitalist group to see the patient. Yay...epically great night.

You'll also have the addicted patients that come in for bizarro complaints for which their pain probably isn't a 10/10... Or you get the winners who go to outlying hospitals complain of back pain and loss of movement in their lower extremities. So they get themselves flown up to a hospital like where I worked (level 1 trauma center, teaching hospital) and get a zillion tests and complain of the pain and not being able to move - except when nobody is looking the manage to get from the bed to the bathroom unassisted and if they think nobody's watching they limp around the hall. They're admitted on like the 23rd and on the 28th have an epiphany and ask their physician "if I'm walking on the 30th can I go home on the 31st" ... 1st of the month miracle I tell you.

And I had one who was admitted in ICU, peg'd trached and PICC'd who had back surgery and a million other (all of the others) problems stemming from her IV drug abuse. We found a dirty needle in her bed one night she admitted to injecting it into her veins but not even knowin what it was...so then we had to play mean cop and check her visitors for what they were bringing her...sigh

[MurseKyle]

I know this post is old but I'm going to add my two cents anyhow. So, when we have a patient who is an addict, we often times find ourselves reluctant to give them pain meds. We tend to say "Oh they're not 10/10 oh they're just drug seeking, they're an addict", etc. We are reluctant to give pain medications to patients because we do not want to be the nurse that lets the patient get high. But, who are we as healthcare providers to decide how somebody is supposed to feel? What it really comes down to is punishment. Most people will argue that statement but it's the trust whether we want to admit it or not. As a society, and even nurses, we have this subconscious urge to punish the addict. We do not want them to get high. Yes, part of it may be because we want to the battle the addiction but we also simply don't want them getting high and continuing with their drug abusing derelict ways. But remember folks, addiction is a disease! We are not God, it is not our right to say how somebody is supposed to feel.

Think about it, the hospital is the SAFEST place in the world for somebody to be under the influence of drugs! They have an army of nurses on their side! If they want a whopping dose of an pain meds and they're paying for it, the doc should order it, the nurse should give it, and the patient should be able to have it. In acute care, we are there to treat the issue that brought them to the hospital. And if they're there because they're having a slipped disc repaired or whatever, we need to treat the slipped disc. We are not addiction experts or professionals. In addition, we should not be scared to give a huge dose. Yes, on a normal person it might kill them and we would all lose our jobs but we're not talking about normal people here, we're talking about IV drug users. So if they're a heroin addict, they can handle exponentially more than you're average Joe.

Something else to think about.... people who are drug addicts are not always faking their pain. Very commonly, after prolonged drug abuse, a person's pain threshold becomes significantly lower. So a little bump that might make a normal person wince, may be incredibly painful for an addict. So when they say they're a 10, they're a 10. We are not to pass judgement.

[MurseKyle]

However, bringing street drugs into the hospital is unsafe and illegal and should not be tolerated. Didn't want my last post to sound like I support visitors bringing in drugs and the patient injecting them through their PICC! Haha!

[Ruby Vee, BSN]

Happens frequently. I've gotten patients from the ER whose friends shot them up before the ambulance picked them up because "He wasn't gonna get the GOOD stuff in the hospital." Pills are pretty common, too. And once, a good sized baggie full of marijuana. The charge nurse (not me, thank the deity!) called the police on that one. I don't think the patient would have gotten away with smoking pot in the hospital. (Although decades ago, back when there were ash trays in all the nurses stations, we encouraged our oncology patients to smoke pot to help them with the nausea. And when we smelled the distinctive odor coming from our patient rooms, we'd just silently close the doors and check on them later.)

I think I would have confiscated the syringes and immediately turfed the whole affair to management. Even in the middle of the night. There is no way I'd want to be in the middle of the deluge of fecal material that making decisions about calling or not calling the police could engender. Management gets paid to make those decisions/ I don't. In the absence of a written policy about what to do in the event that you find syringes in your patient's possession (and yes, some institutions do have those policies, so check yours now, before you're in the situation, which isn't all that uncommon), I'd want management calling the shots.

[KelRN215, BSN, RN]

I work in pediatrics so, by and large, I don't encounter this issue but I remember when I was an aide working with adults having a patient who went home with a PICC line for IV antibiotics. She came back in with problems with the line and it was discovered that she was using it to shoot heroin (and likely not heparinizing it properly afterwards hence the issues). After that, the hospital refused to discharge her with the PICC in place and she had to stay inpatient for the duration of her IV antibiotic course. A current co-worker recalls working at an inner city ER and having patients who would present and then elope as soon as they had an IV in them.