Frequent Flyers in the ED

Uptoherern, RN · Mar 3, 2004

March 3, 2004

sorry...........wasn't sure how to "paste" just the small article below. Just thought it was interesting, and wonder how it will work. :rolleyes: scroll down for the article................

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Anti-drug strategy focuses on prescriptions

Hope Yen

Associated Press

Mar. 2, 2004 12:00 AM

WASHINGTON - The Bush administration is pushing for stronger state monitoring of prescription-drug use in a crackdown on the escalating abuse of sedatives, pain relievers and stimulants.

Under the strategy announced Monday, the government will pay states to help develop monitoring systems to track patients' drug use. The programs would flag cases indicating a pattern of abuse, such as "doctor shopping," where a patient gets prescriptions for drugs from multiple physicians.

Federal officials also plan to seek out pharmacies that sell controlled substances illegally over the Internet, which will entail deploying modern Web-crawler technology to search out those peddling prescription drugs online.

The goal, say federal health officials: Reduce illegal drug use by 10 percent in two years and by 25 percent in five years.

"The non-medical use of prescription drugs has become an increasingly widespread and serious problem in this country, one that calls for immediate action," John Walters, director of the White House Office of National Drug Control Policy, said at a news conference.

Prescription medicine now ranks second, behind marijuana, among drugs most abused by adults and young people, according to a report by the drug control office. Meanwhile, emergency-room visits resulting from abuse of narcotic pain relievers have jumped 163 percent since 1995, it said.

The plan would dedicate about $10 million in federal money to augment prescription monitoring programs.

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luvallbabies · Mar 3, 2004

tom, didn't mean to "flame" you in the other thread. Can't find the other thread. but it was along these same lines. What I meant before, and what I'll say again, is that I don't like wasting time on these people. They take up space that could be used for someone who is really sick. Kind of the same as the drunks. We have a policy now that if someone comes in etoh, they have to be placed on a monitor. ! Right now 12 of the 32 metro hospitals are on diversion. 2 others would be, but were opened by ems to "take their turn". How silly that we should have to have er space taken up by the theatrical drug seekers. Maybe wishful thinking....maybe wearing rose colored glasses, but if they no longer receive the narcs from my facility, why come there.?
too bad we have snoring (smellyfoot) drunks on monitors "sleeping it off" and the drug seekers getting their CT's (or whatever was appropo to their complaint) when the possible heart attack from down the block has to be diverted to a hospital 20 minutes away.

you are the type of person that makes me afraid to go to the er for my migraines,, have you ever had a headache so bad that you wished your head would jsut explode to relive the pressure? last feb 2003 i had to go twice in one wk , the local clinic never called me back and i just couldn't stand it anymore,, i have 4 kids and was stuck in bed w/ no lights ~no noise~ and my puke bucket, i finally went in to the er and they gave me a shot of demerol, i think,, anyway it was a narcotic,, it still didn't take my headaache away ,, the next day i still had it , it was a sat so i had to go back to the er,, so yes i guess that looks bad , and yes if i go to the er i am going for medicine, it doesn't have to be a narcotic,, i'll take whatever works, this time they put fluids in me and an iv of something that wasn't narcotic and it worked,, i wish i knew what it was so if i need to ever go back i can ask for it by name., not every migraine sufferer is a narcotic drug seeker,, a drug seeker yes but for the high ,,no,,i can think of better things to do w/ my time than sit in the er

RNin92 · Mar 4, 2004

you are the type of person that makes me afraid to go to the er for my migraines,, have you ever had a headache so bad that you wished your head would jsut explode to relive the pressure? last feb 2003 i had to go twice in one wk , the local clinic never called me back and i just couldn't stand it anymore,, i have 4 kids and was stuck in bed w/ no lights ~no noise~ and my puke bucket, i finally went in to the er and they gave me a shot of demerol, i think,, anyway it was a narcotic,, it still didn't take my headaache away ,, the next day i still had it , it was a sat so i had to go back to the er,, so yes i guess that looks bad , and yes if i go to the er i am going for medicine, it doesn't have to be a narcotic,, i'll take whatever works, this time they put fluids in me and an iv of something that wasn't narcotic and it worked,, i wish i knew what it was so if i need to ever go back i can ask for it by name., not every migraine sufferer is a narcotic drug seeker,, a drug seeker yes but for the high ,,no,,i can think of better things to do w/ my time than sit in the er

The problem is not the people who are truly in need. I do not doubt for one second the horrific pain some people are living with every day.

The problem is the ER is not the answer. In your case...why DIDN'T your doc/clinic call back??? Why didn't they prescribe a migraine targeting drug like Zomig or Maxalt for those bad ones? Narcotics are not only NOT the answer...they just nake everything more complicated. Not even the seeker problem (which IS an OMG problem) but in your case you were at risk for a rebound HA from the narcotic.Not to mention nausea...which is always soooo fun with a migraine I'm sure!

The drug seekers are the ones who clog up the entire system. They are the ones who are "allergic" to ALL anti-inflammatories, NSAIDS, and the only thing that ever works is that "D drug"...pushed really fast!! And you look at their Rx they take and see 12 different docs prescribing every narcotic known to man.

They are the ones keeping you waiting in a noisy crowded ED waiting room with a migraine that is out of control.

luvallbabies · Mar 4, 2004

The problem is not the people who are truly in need. I do not doubt for one second the horrific pain some people are living with every day.
The problem is the ER is not the answer. In your case...why DIDN'T your doc/clinic call back??? Why didn't they prescribe a migraine targeting drug like Zomig or Maxalt for those bad ones? Narcotics are not only NOT the answer...they just nake everything more complicated. Not even the seeker problem (which IS an OMG problem) but in your case you were at risk for a rebound HA from the narcotic.Not to mention nausea...which is always soooo fun with a migraine I'm sure!
The drug seekers are the ones who clog up the entire system. They are the ones who are "allergic" to ALL anti-inflammatories, NSAIDS, and the only thing that ever works is that "D drug"...pushed really fast!! And you look at their Rx they take and see 12 different docs prescribing every narcotic known to man.
They are the ones keeping you waiting in a noisy crowded ED waiting room with a migraine that is out of control.

i have been perscribed ultram and broke out in hives, i am not sure if that is an nsaid so if i tell you that would i be labeled a seeker?? i am just so afraid of being stereo typed , the clinic here in town sucks,, your appt can be for 1 oclock and you will still be in the waiting room at three,, i am suprised they still have pts that go to them, i do have imitex now that i inject myself and have not had any problems,, plus it works great ,, i had been perscribed vicodin before but w/ the nasau sp? i get from my migraine, the vicodin usually ends up in the toilet and if it doesn't i am sleepy with a migraine, its a no win with that med,, i have seen a pt once when i was in the er w/ my child and she was actually arguing w/ the dr about what she wanted for pain , i was embarressed for her, and once at my ob's i over heard the nurses talking about a druggie that just called in for a refill of something,, so when i need medical help,~some sort of med~, i am really reluctant to go to the er unless its so bad i would rather die than try to stick it out, so on top of wishing my head would just expole off i also have to worry about what might be being said behind my back, i guess its certain people screw it up for the rest

Uptoherern, RN · Mar 4, 2004

boy, alot of people just don't get it. I AM NOT talking about people who have legitimate pain, people who don't use the er as a clinic. I am talking about people like the one our er doc got a letter about a couple of weeks ago. I'd never in my entire life seen a letter from an insurance company written to all docs that this patient had seen. It was 4 pages long. All different docs, different locales, different scips (sometimes 3 or 4 a day). Insurance co. was notifying all docs that had written rx's for this guy about the abuse. Does he need help? Yes! Either to address chronic pain px or narcotic dependence. Does he need help in the ER? NO! He needs one resource, one primary doc who knows what's going on to help him with whatever px he has. This is not an emergency px, it is a chronic px.

z's playa · Mar 4, 2004

The problem is not the people who are truly in need. I do not doubt for one second the horrific pain some people are living with every day.
The problem is the ER is not the answer. In your case...why DIDN'T your doc/clinic call back??? Why didn't they prescribe a migraine targeting drug like Zomig or Maxalt for those bad ones? Narcotics are not only NOT the answer...they just nake everything more complicated. Not even the seeker problem (which IS an OMG problem) but in your case you were at risk for a rebound HA from the narcotic.Not to mention nausea...which is always soooo fun with a migraine I'm sure!
The drug seekers are the ones who clog up the entire system. They are the ones who are "allergic" to ALL anti-inflammatories, NSAIDS, and the only thing that ever works is that "D drug"...pushed really fast!! And you look at their Rx they take and see 12 different docs prescribing every narcotic known to man.
They are the ones keeping you waiting in a noisy crowded ED waiting room with a migraine that is out of control.

RNIN92; This brings us back to the bane of an RN's existance and the all too popular question that we as migraineurs like to know......how do you know who the "real" ones are? :uhoh21: I for one take all the meds that stop my migraines 95% of the time. If it doesn't work, I go to the ER with a letter from my PCP that says I MAY need narcotics. I've been 3 times in one year. Narcotics are usually a last resort for experienced migraineurs. We HATE going to the ER and walking the Green Mile to cubes unless its absolutely necessary. On the otherhand yes if I see that a person has been doctor shopping, I think I would suggest a psych. consult. CAtherine

teeituptom, BSN, RN · Mar 4, 2004

I had one ask if we had a menu last noc

right

luvallbabies · Mar 4, 2004

I had one ask if we had a menu last noc
right

w/ a migrine food would be the last thing on my mind,,

z's playa · Mar 4, 2004

Food with migraine? Gross. Menu? Surreal.

Marie_LPN, RN, LPN, RN · Mar 4, 2004

Any meds that i take when i have a migraine, i have to take with food first or i'll get an upset stomach (basically forcing myself to eat). So when someone has a migraine, asking for a bite to eat isn't too strange to me.

z's playa · Mar 4, 2004

Any meds that i take when i have a migraine, i have to take with food first or i'll get an upset stomach (basically forcing myself to eat). So when someone has a migraine, asking for a bite to eat isn't too strange to me.

Just wondering if you are able to drink milk. Thats what I do with meds that upset my stomach. I know there are people who react differently to migraines. I wish I could function during one. :)

veetach · Mar 4, 2004

you are the type of person that makes me afraid to go to the er for my migraines,, have you ever had a headache so bad that you wished your head would jsut explode to relive the pressure? last feb 2003 i had to go twice in one wk , the local clinic never called me back and i just couldn't stand it anymore,, i have 4 kids and was stuck in bed w/ no lights ~no noise~ and my puke bucket, i finally went in to the er and they gave me a shot of demerol, i think,, anyway it was a narcotic,, it still didn't take my headaache away ,, the next day i still had it , it was a sat so i had to go back to the er,, so yes i guess that looks bad , and yes if i go to the er i am going for medicine, it doesn't have to be a narcotic,, i'll take whatever works, this time they put fluids in me and an iv of something that wasn't narcotic and it worked,, i wish i knew what it was so if i need to ever go back i can ask for it by name., not every migraine sufferer is a narcotic drug seeker,, a drug seeker yes but for the high ,,no,,i can think of better things to do w/ my time than sit in the er

In defense of ErDiane, I think I can safely say that we, as a group of nurses in the ED, definately dont think every person with a headache is a drug seeker. I know I have seen those come in with what they term as a migraine, and after the CT find out that there is a brain tumor present. And suddenly their life is turned upside down. In most ED's you have your frequent flyers who come in on the weekends, wearing sunglasses, drinking a mountain dew, laughing with their friends complaining of a migraine. When asked their pain level it is most generally a 10 on a 0-10 scale.

These people are of very low priority on my triage scale, they are the ones who sit in the waiting room watching TV and joking and laughing with everyone, and they get their narcs and then go home :rolleyes: its tough to give up rooms to them when there are really sick people or children waiting to be seen.

Once you see these morons over and over and over so that you know them on a first name basis, and you know their drug of choice, you cant help but form an opinion on the validity of their complaint.

On the other hand, true migraine sufferers are definately a priority, and receive the quickest attention possible. Can we tell the difference between the two different types of patients?? yes we can.