LTC Drug Addicts

Nurses General Nursing

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Has anyone else ever worked with LTC residents that were on a lot of pain medications but it was not clear why they were being given them regularely? I hope I worded that right...I'll explain...

In our LTC, we have a 67 year old woman who has had both hips replaced previously and claims that she has chronic hip pain. This woman in the past was treated with numerous narcotics and I believe she has an addiction. She is a manipulative woman; as well as being of sound mind.

These are her pain meds...

Oxycontin 40mg BID (0500 & 1730hrs)

MOS syrup 5mg PRN (which she asks for every day at 1400hrs).

Morphine 1mg s/c PRN (which she asks for everyday at 2200hrs)

She also regularly requests gravol 50mg @ 0500, 0900, 1400 & 2000hrs.

There are absolutely no non-verbal cues of her being in pain and she is so manipulative etc that she will lie and tell you all sorts of stories to get her medications. The staff are so tired of her games that they just deliver her gravol etc at the appropriate times without waiting for her to ask anymore. This woman will inspect what is in the medication cup before you leave too, just to make sure that her gravol is there.

Needless to say, this woman is complete PIA (I could go into more details but I'll save you all the trouble).

From my understanding, when the doctor would come visit her, he would just say "okay, what can I prescribe for you to help you to feel better," and would write down what she wanted.'

Why do they do this? Is it not only aiding her drug addiction?

First of all, Gizzy76, I was not offended.

Now, I never get total pain relief, even with taking the oxycodone for breakthru pain. It gets it down to a level that is more tolerable. Also my pain management MD is going to try to find a psychologist that is in my group for my insurance to try to help me deal with the pain. I do know what everyone means by not wanting to be thought of as a druggie. I cannot even tell my family what I am taking for pain because I don't want to have to listen to lectures about taking too much stuff and needing to tough it out. Even with pain meds, I have to tough it out. I cannot make them understand.

Wow...great thread. I am a total believer in treating and assessing pain. Pain is pain... I never doubt my LTC pts complaints of pain and always try to be proactive and even encourage my res to take their prns more frequently.... A situation at work makes me think....have a 43 yo chronic pancreatiis past 7 months NPO with TPN getting 100 Oxycontin BID, Dilaudid 4mg q 3 IV push, Phenergan 12.5 q 6 and Ativan q 6 prn... comes and goes on LOA frequently. Until recently coming in to get meds and leaving.... last week came back from LOA and "seemed high or intoxicated" md ordered a drug screen.. couldnt find the oxycontin but did detect Ultram. Now... I watch her swallow her pills....Where's the Oxycontin?? I still don't know what to believe with her...MD changed orders Dilaudid 2mg q 4, Duragesic patch 50mcgs and phenergan q 6... the one day she accidently got 100mg oxycontin she slept like a baby.... now I still believe she has pain...and medicate her as much as able, but what do you think of this one?

Another question for you all......Why do you think LTC res are either over or under medicated for pain?? This is such a pet peeve of mine....people will medicate for behaviors (probably caused by pain) but not for pain...

This is a great thread for discussion.

As a chronic pain patient myself, I'm working very hard to stay off pain meds for as long as possible. In order to cope with my ever-increasing arthritis pain, I find I must very carefully monitor my rest, my activity, my diet, and frankly the weather in order to maximize my energy and tolerance for the day.

I wonder if part of the problem in LTC is that it's not always feasible to try alternate pain relief activities. Some days, I need two stretch-out flat naps instead of one, some days I need two hot baths instead of one, some days I can't get out of bed without a pill. I believe that physicians and patients and often some nurses know we live and work in a world where often there's little time for anything other than a pill to provide relief.

Just a different perspective on a troubling problem...

For those that are interested in reading more opinions on "drug seeking patients", here is the link to a discussion in the past.

https://allnurses.com/forums/showthread.php?s=&threadid=7225

As for my opinion. On one hand you have to watch for polypharmacy and tolerance and on the other you cannot let someone who is in pain suffer as it is cruel for the person in pain.

Who is the only person that can judge pain?

The patient.

Not only that but nurses must learn that sometimes people have different ways of coping with pain that may not be normal. I for one try very hard to try to sleep through my pain. There may be those that say, "Oh, well she can't be having too much pain if she is sleeping". No, I don't have pain when I am sleeping, it is when I wake up that I have the pain. Call it psychosocial or whatever. I only hope that I can sleep through labor:roll

Scarlett: What dose of Duragesic did you start on? It is totally appropriate to have breakthrough while on Duragesic, but I would suggest OxyIR or MSIR; hydrocodone is more difficult to titrate to an appropriate breakthrough dose, esp. because of the tylenol component. By seeing how much breakthrough you need, your doc can adjust your Duragesic.

Specializes in Med-Surg, Tele, ER, Psych.

I went to the doc this afternoon and he took me off the Duragesic (25mcg) because I have spent the last week nauseated and with a headache. The spot where I put the patch, regardless of location, itches and leaves a square welt from the adhesive. He put me back on hydrocodone but a higher dose, and frankly, I still have pain, and nausea but now I feel drugged, which I did not feel on the patch. I don't feel like I can win!

God I hope that when I am old and in the care of someone who has the power to relieve my pain, that they believe me.

I too took no offense it is an important topic. I have sever arthritis of the spine and knees, fibro, PLMD, RLS, chronic migraines and positive lupus test though that dx is still not certain. I take hydrocodone daily, ultram, flexiril, prozac, atenolol, and temazepam at night. I worry a great deal about tolerance and dependance however the pain meds are not all that affective. The most effective has been demerol and dilaudid although the high feeling I could do with out. Dr's around here are hesitant to give these which I understand. I did here that there are dilaudid supps that take care of the pain but do not give the high effect. That would be great however I too worry about being considered a druggie. Obviously that would be a very bad thing for ones nursing career. It feels like a darned if you do and darned if you dont. Either stay and bed cause ya cant function or get relief and be called a druggie what is a pain filled gal to do.

Isnt it interesting tha we have so much 'guil;t ' associated with taking medication - that is given to us to make our life qualitative meaningful and often remian part of society both social and working

Centruires ago we aould have probably have gone to the local wise woman/ monk / doctor / etc who would tried to grind natural products to prolong our life - we would have taken these and in all reality - may have died earleir (than now)

So this is just a philosphopical question why should we feel guilty to take advantage of advances in the various feild especially science and nursing that extends our life - now that is not the real question - the question l am wandering about is - the general public will accept what they are given - and will have an improvement in their life - why as nurses do we find it so difficult to accpet medication that improves our life

BTW gizzy76 - great thread - hope you dont mind the alternative thoughts that it is provoking

Tookie

Specializes in ER.

About the LTC patient- who really cares if she is addicted at this point. If she is able to enjoy her life at this point that is the main thing. However, perhaps the manipulation is more of a problem than her needing the meds.

Another thought- perhaps she needs the interaction that frequent visits from a nurse will bring... that would be nurses feeling manipulated again, and I can understand why you would be frustrated.

I don't believe in giving so much as to render the patient unable to function, but think that you need to work with the patient to get what combination is necessary (sp) to ease the pain. Sometimes it is a hard thing to do.

Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by gizzy76

To everyone who's replied so far...I did not intend to offend. I do believe that a person's pain is their own perception and what they say it is, is what it is. I guess my biggest part of the post was wondering why doctors just accomodate these requests and not give her a pain patch then?

Also, call me crazy, but I find it hard to believe that pain comes on regularly timed intervals. She calls to the minute almost each day for her PRN's. Also, when you try to assess her pain for your charting she can't even look you in the eye, she looks away as though she is lying. All of the nurses in our facility are concerned and feel relatively the same way.

I was not doubting her pain if it came across that way.

My apologies.

It sounds as though her current regimen has her under control although it sounds a bit "inconvenient " for the staff.She knows her body and she knows what she needs and when she needs it to control her pain.I imagine that one of the reasons she won't "look you in the eye" is that she well knows the staff's attitude towards her.You said she is lucid-I am sure she has overheard remarks made by the staff and can read the body language as well....You say everyone feels the same way-imagine for a moment how that must make her feel-imagine she is your mother...or you.Imagine living with chronic pain-anticipating and dreading it-and you are dependent on others to deliver your meds in a timely manner and you well know that they don't think you are sincere....I think the staff needs some education regarding pain control.My LTC is dismal when it comes to pain control-the docs (old school) don't want to "zonk" anyone and the DON upholds them...And when we do have meds ordered they are almost always PRN-and never get admin consistently....I am no expert-but I believe that I would rather medicate a true drugseeker then deny a true pain suffer-er adequate medication.
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