IV Dilaudid problem patients!!!!!!!!!!!

Nurses General Nursing

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Recently i have been noticing a great amount of IV dilaudid addict patients. Nurses what in your opinion we should do? Giving the pain medication for post-op and other acute pain issues, i understand very well that we have to manage pt's pain. But the frequent flyer to our hospitals just bacause they are addicts in my opinion is encouraging these pt's and making a dilaudid/morphine society out there. Yesterday, i refused to participate in this with one of our MD's and demanded that this particular pt be sent to rehab for narcotic problem. Most of these pt's have pyschological issues to begin with. I refuse to be manipulated with this pt group and support there addiction in name of pain and medicine!!!!!!!!!!!!!!!!!!!

Specializes in Hospice.
Sorry eriksoln; I appreciate what you have to say but I strongly disagree with what he had to say regarding sometimes in life being right is useless. Good god if i follow that quote I would lose all self-respect for myself. But regarding what you said being cattering to these pt's and many doc's and nurses do just THAT because its easy-- give them there dilaudid they will shut up for hr and two and the whole process starts all over again. I wonder what they do outside the hospital setting obviously they are doing illegal drugs to support there addiction so in a way we professionals are encouraging these drug dealers to sell more whatever they are selling. Do you see how just giving in to them eventually now or in future can affect us or our childern. I am a non-judgemental nurse and a great one at that but Yes i don't care about my job they can fire me if they want but I will not back down in making pt's and some docs realize that they have this addiction!!!!!!!! I was not worried for all these years but it seems like now more and more people are flying frequently to our hospitals just to get high!!!! Meantime my pt's who are acutely having problems are ignored because i am too goddamn busy making my freaking addict pt's HIGH!!! OHHHHHHHHHHHHHHHHHHHHHHHH I AM SO MAD:angryfire

Mina123 ... from my own experience, I can tell you that if you frame the issue as a power struggle to keep the addict from getting stoned, you will lose. In addition ... pain and addiction are two very different problems ... which one are you treating?

I'm truly not trying to minimize your frustration ... but getting into a confrontation over with-holding opioids from those you have decided are substance abusers is a set-up for you and those patients you may be misjudging. I personally found al-anon very useful in sorting things out for myself, but that's just me.

Treating pain in an active substance abuser is enormously tricky and requires a team approach. Sounds like you've been left twisting in the wind.

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Specializes in Critical Care.
Sorry eriksoln; I appreciate what you have to say but I strongly disagree with what he had to say regarding sometimes in life being right is useless. Good god if i follow that quote I would lose all self-respect for myself. But regarding what you said being cattering to these pt's and many doc's and nurses do just THAT because its easy-- give them there dilaudid they will shut up for hr and two and the whole process starts all over again. I wonder what they do outside the hospital setting obviously they are doing illegal drugs to support there addiction so in a way we professionals are encouraging these drug dealers to sell more whatever they are selling. Do you see how just giving in to them eventually now or in future can affect us or our childern. I am a non-judgemental nurse and a great one at that but Yes i don't care about my job they can fire me if they want but I will not back down in making pt's and some docs realize that they have this addiction!!!!!!!! I was not worried for all these years but it seems like now more and more people are flying frequently to our hospitals just to get high!!!! Meantime my pt's who are acutely having problems are ignored because i am too goddamn busy making my freaking addict pt's HIGH!!! OHHHHHHHHHHHHHHHHHHHHHHHH I AM SO MAD:angryfire

You can make prescribers aware of what you perceive as addiction but you ultimately have to realise that patients who have addictive propensities have a higher tolerance for pain meds. And for some of them, not all, it really is about treating the pain.

I can understand your frustration about those who are truly seeking to get high and those who seem to enable them. Unfortunately, how are you able to accurately determine whether or not they are actually experiencing pain? It's based upon your perception. And while we hate to hear it, the first rule of pain management is that if the patient says he has pain, he has pain and we are required to render treatment.

With today's acuity of patients, it's hard when you have to deal with this type of patient. You have people who truly need your help and you want to give it but you have to deal with someone with an issue like this. It is very frustrating because it's evident the drug seeker isn't looking to change. But our role in their care remains important. We are not going to change them...one of my surgeons has expressed many times it's not his responsibility to cure a drug addict but to treat his medical problem. While I"m not that insensitive, I do see his point. You said you won't back down in making sure some docs realize that their patient has this addiction...but what do you hope to accomplish? You don't think the doc is aware of the patient's actions? All that is happening in this situation is that you are working yourself up. You're going to have to figure out a way to deal with such patients because they are a part of our practice. You can refer them to addiction specialists, social workers, what not but ultimately you can't make the patient change. I hope you are able to work this out for yourself...I sense your stress and dearly wish I could take it away for you. Best of luck to you.

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Specializes in M/S, Travel Nursing, Pulmonary.
You can make prescribers aware of what you perceive as addiction but you ultimately have to realise that patients who have addictive propensities have a higher tolerance for pain meds. And for some of them, not all, it really is about treating the pain.

I can understand your frustration about those who are truly seeking to get high and those who seem to enable them. Unfortunately, how are you able to accurately determine whether or not they are actually experiencing pain? It's based upon your perception. And while we hate to hear it, the first rule of pain management is that if the patient says he has pain, he has pain and we are required to render treatment.

With today's acuity of patients, it's hard when you have to deal with this type of patient. You have people who truly need your help and you want to give it but you have to deal with someone with an issue like this. It is very frustrating because it's evident the drug seeker isn't looking to change. But our role in their care remains important. We are not going to change them...one of my surgeons has expressed many times it's not his responsibility to cure a drug addict but to treat his medical problem. While I"m not that insensitive, I do see his point. You said you won't back down in making sure some docs realize that their patient has this addiction...but what do you hope to accomplish? You don't think the doc is aware of the patient's actions? All that is happening in this situation is that you are working yourself up. You're going to have to figure out a way to deal with such patients because they are a part of our practice. You can refer them to addiction specialists, social workers, what not but ultimately you can't make the patient change. I hope you are able to work this out for yourself...I sense your stress and dearly wish I could take it away for you. Best of luck to you.

See, thats more like my attitude about it. I dont see it as insensitive, more of a......realization of my limits/abilities. Cant make someone who doesnt want to quit quit.

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My advice is to stay within your own scope of practice and just give the pain meds....recognize that addiction is not something that can/will be addressed in the acute care setting unless you're a psych nurse. Your own scope is hard enough. I found it easier to handle when I realized that I couldn't fix an addict and it wasn't really my problem.

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Im sure some of these addicts have pain. If everyone treated all the pts who had a drug hx like this it would be a shame to see where the world goes. Hell today some people see marijuana on the chart and OMG hes a drug addict lets limit his pain med to tylenol for his pancreatitis. Sorry thats how i feel. Pretty soon no one is going to be honest on there health hx becaause of the stigma of a drug addict or poss gettting addicted. Where does it end. I fight for my pts right for pain med whether they are a drug addict or not. All you can do is relay the info to the md and allow him to prescribe.

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Specializes in private duty/home health, med/surg.

Here's a way to deal with it no matter the reason they're asking for pain meds (seeker vs. truly needing pain relief):

Dilute the Dilaudid in 10-20mg NS & pull up a chair. Sit down & administer it over 10-15 minutes. You'll be giving pain relief to those who need it while minimizing the "high" of those who are seekers.

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The frustration evident in the OP raises a question that I've asked before ... how can nurses who deal with drug-seekers get some support?

I worked for 11 years in a job I loved on a dedicated AIDS unit. In the end, I needed to leave, not because of all the death and dying, but because of the relentless addictive behaviors of my patients ... most of whom were infected due to their drug use.

Dealing with an active substance abuser is one of the hardest, most destructive to the nurse, jobs we can do. Yet, there is no venue similar to al-anon where we can sort out the effect these behaviors have on us.

Any ideas?

This is a good question. Sometimes I've felt that doctors prescribe extremely liberal pain med parameters so that they don't have to be awakened at night...I've gotten the order to give dilaudid Q30 minutes on a general floor...if the patient knows the order, my night is shot. My other eight patients are going to suffer.

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Specializes in M/S, Travel Nursing, Pulmonary.
Im sure some of these addicts have pain. If everyone treated all the pts who had a drug hx like this it would be a shame to see where the world goes. Hell today some people see marijuana on the chart and OMG hes a drug addict lets limit his pain med to tylenol for his pancreatitis. Sorry thats how i feel. Pretty soon no one is going to be honest on there health hx becaause of the stigma of a drug addict or poss gettting addicted. Where does it end. I fight for my pts right for pain med whether they are a drug addict or not. All you can do is relay the info to the md and allow him to prescribe.

Ah, there is an aspect of the problem I wasnt considering. Very true, we dont want people feeling like they cant tell us the truth.

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My dad is not honest about his alcoholism because he is afraid that the nurses will not like him. That breaks my heart because my dad is the nicest most gentle man in the world, would not ask a soul for anything...

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Specializes in Med/Surg, Home Health.

I had a patient one time who was a nurse who had lost her license r/t drug use. She was/is a frequent flyer and knew how to manipulate the doc. She was caught red-handed crushing a percocet and pushing it into her portacath. The doc was shown, he said "ah, just continue to give it to her". She then would c/o nausea and requested phenergan. She asked me "are you going to push it"? I told her that I was. I didnt understand her question at first. The other nurses had been putting it into a 25 or 50 ml bag of saline and administering it as a secondary (it would go in over a period of 15 minutes). She didnt like that. She was caught manipulating the IV pump and making it go in faster. It was more grieving to me trying to stop this situation because her antics became more desperate. Its tough handling people like this, I know. But then you have the addicts who come in and are truely in pain. It takes more pain medication to treat their pain because of the tolerance they have. So you know they are drug-abusers and they are asking for a massive amount of pain meds....its hard to distinguish between those who are in pain and those who are wanting a "high" in these situations. I blame the docs for alot of the problem of drug-abusers. They feed into it and keep giving it.

I went to the ER for stomach pain one time (it ended up being an ulcer) and they prescribed me Lortab. When I questioned WHY they were giving me Lortab, the response was "Lortab will help with ANY pain you have". All I needed was a GI coctail. Some are too eager to prescribe it, while others are the extreme opposite and wont give it to even the worst pain sufferers. Our best bet is just to administer what is ordered, if it is a problem, then try to get a PCA ordered. We need to discuss our suspicion with the doc and chart it, then leave the decision up to the doc. Im not into nursing to rehab a person who doesnt want rehab because even if successful, they will continue to abuse once discharged and what we did was in vain. I feel the frustration too, I do.

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Specializes in CCU,ICU,ER retired.

I have been on both ends of this spectrum and I can ultimately tell you it just reeks! I am 57. I don't work anymore because I can't physically do it. I have a rare type of rhematoid arthritis. is a lot like lupus but not lupus. Not only do my bones hurt, but so does my muscles and connective tissue. Here is where it gets hinky. I am a recovering addict, have been for 23 yrs. When all else is said and done , do I deserve any pain relief for the pain I am in? I signed a contract with my Doctor for pain medication I took oxycontin40 mg BID I was addicted to it. In 2005 I had my hip replaced twice the first one the prostesis went though the back of my femur. So I had to get another one. At the time I was addicted to oxycontin. Should I have denied all pain medication because I was addicted? How can a person be denied pain meds just because they have addictions? Don't they feel pain? Who are you to be judgemental about them? As a nurse I gave what the doctor ordered and never, ever with held anything the doctor ordered.

I don't take oxycontin any more. I have just started back on Lortab, and will probably become addicted again. I still have severe pain not from my hip but the rest of my body. And, by the way, my disease didn't come from the drugs. It came honestly, genetically. I still go to Narcotics anonymous on a regular basis. The folks in my fellowship know and understand. In our fellowship we have literature about the recovering addict and pain medication. I take the meds exactly as it is ordered nothing more. and I never get high, only relief.

If you have problems about addicts getting pain meds that is YOUR problem not their's.

I am sorry if I stepped on toes with this posting ,but that is how I feel.

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Specializes in SN, LTC, REHAB, HH.

WOW, i know someone personally who is a frequent flyer to the hospitals for dilaudid, oxycontin and whatever else he can get. it's sad because i know he has a drug problem with street drugs.

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