I've read so many articles and listened to so many podcasts dealing with the origins and consequences of the opiate addiction problem here in the US. I see the fallout almost every day that I work on my critical care unit and see the repercussions touching nearly every single demographic we work with. Opiate addiction - whether it be patients getting their fix from an ED doc, a hospitalist, a primary care or pain clinic practitioner or a street heroin dealer - is clearly an issue that stretches across the continuum of care.
None of this, I believe, is much up for debate at this point.
My question is this: in the midst of such a widespread systemic issue how much am I, as an individual nurse, helping to perpetuate the problem? How can I do my part to, if not help solve it, at least not make it worse? What's my role in all of this?
As a non-prescriber I know there's only so much I can do, but as someone who administers a whole lot of ordered pain meds I feel a certain amount of responsibility here. I obviously don't want my patients to suffer, and I've very much had the whole "pain is whatever the patient says it is, regardless of your assessment of the situation" thing drilled into me, both by nursing school instructors and by hospital administrators who don't want to hurt our patient satisfaction survey results. I try to make a concerted effort to find the balance between making my patients comfortable and using the least 'heavy-duty' option to get them there.
But when I have patients who order IV dilaudid as if they're choosing from a menu or whose pain is never less than a 10/10 while they're chilling in a recliner reading magazines I can't help but wonder if there's something I should be doing aside from just going with it. I know that for a chunk of the population, every day is filled with constant, unending pain, and these people are why I can't bring myself to challenge patient's pain ratings or under-medicate. But when approximately 5% of the world population is consuming something like 80% of its narcotics it feels equally unhelpful to pretend as if none of my patients' behaviors are coming from a place of addiction. I just feel helpless. What, if anything can/should I do as just one nurse?
That posts makes me sick from a prescriber perspective. I have just recently outed two new patients with the fingerstick blood in the urine had never seen that before a few weeks ago must be making its way around the web recently.
You can't judge a person's pain level based on whether they're sitting in a recliner watching TV, talking on the phone, laughing, eating, etc. I have had to have numerous orthopedic surgeries, including two total knee replacements on opposite sides of one year. Following those surgeries, I was prescribed Percocet. During the time of the knee surgeries, I was on Percocet following the meniscus removal and until many months following my 2nd total knee...so over a two year period. I never took more than I was prescribed. I was able to do all the things that patients do that nurses accuse of lying about their pain level. I'm also a RN and have heard many nurses being so judgmental. Life does go on, even while in pain. I suffer daily with chronic pain and am currently on no pain medication (my choice because I want it to work when I have another surgery), but I can't just crawl in a corner and let life pass me by because I hurt. Also, because I never took it more often than prescribed, I never took it if I could tolerate the pain, and I never took more than was prescribed, I never became addicted to it. So, instead of the GOVERNMENT cracking down on pain medications and leaving those who need it have a tough time getting any relief, I think it should be left up to the doctor to prescribe if they feel a patient needs it. As others said, it's not your job to judge.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
And there you have it. Nothing I see here is anything I can personally change as a nurse, practicing within my scope. It's so much bigger than that. If I wanted that role, I would be an NP with prescribing privileges or some such. I don't.
And I won't.
If you want to know about the degree of your complicity in the drug epidemic, the best people to ask are the people to whom you supply drugs. The problem is that they can't be honest with you, and still meet their needs. They are however, honest with each other- even on public forums.
This is an old collection of quotes/links. Some of the links are bad, but were good when I got them.
I heard some stories people go into the Emergency room and say something like. i have been moving big things. shoving heavy gravel and tossing it being my back and now my back in going into spasms.
and they got a small shot dose shot of demeral and a small script of vicodin.
Ive never had insurance in years... anyone got any ideas on things to ***** to doctors and possibly get a one script of vicodin? because they cant bet too hard to get right. one year...i got an infected swollen tonsil after antibiotics they gave me 25 vikes and i woulda been find with out them. i have been through all more pain than that tonsil and got by fine..
we all know it's very difficult to walk in to a doc you've never seen before and talk your way into a script for pk's... almost impossible for some people... myself included... but i have discovered an EASY, GUARANTEED way to get them...
OK, i've been reading different threads, and hearing "oh, i just left the ER with 60 dilaudid" etc etc. So, I've hit a couple spots to try and score some good drugs, and all i end up with is hydro, or codeine. I'm at a point where I'm about to not have any insurance for a little while, and I want to try one more time. (Sorry if this post ****** anyone off, but hey, I'm a junkie and I'm just trying to maintain.)
So, my question to anyone who might have some advice is: What should i tell the doc? Will fake kidney pain/stones work well if i drip some blood in my urine sample? Should i just go for bad neck/shoulder pain? My original horrible toothache story obviously isn't working. What are some good "unprovable" ailments that will get me some legit opies? Thanks in advance to any advice.
I urinated in a cup and afterwards pricked my finger and let a few droplets of blood mix with the ****... I was still expecting nothing and was expecting disappointment
That IV dilaudid every two hours is what popped my curiosity cherry about IV opiates. It was after that I tried shooting for the first time. Just a friendly warning.
Everytime dude needs $50 for this or $100 for that I keep telling him, "go get some happy pills from the hospital and flip 'em and use the money to pay your bills.
I am a DOCTOR shopper and i get narcotics from a million doctors by faking back pain and kidney stones...i just filled 20 lortab today....two days ago i got two shots of INTRAVENOUS dilaudid...what a rush!!! AND he gave me 30 extra strength 10mg percocets!!
You have to use different pharmacies that are not linked by a database. CVS and Walgreens are linked. Most grocery stores are linked. I cant find one dr to prescribe me pain meds so its not an issue anymore but in the past, my Every day DR was prescribing me and my pain management dr was prescribing me as well. I just used Walgreens with my insurance for one and Target claiming to have no insurance and paid cash. Their databases were not linked. Never use insurance if you are going to go to more than 1 place. A month of Hyd is like $22 at Target so its not like its expensive to not use insurance.
BostonFNP, APRN
2 Articles; 5,584 Posts
That posts makes me sick from a prescriber perspective. I have just recently outed two new patients with the fingerstick blood in the urine had never seen that before a few weeks ago must be making its way around the web recently.