Haven't even graduated and already burned out...

Specialties NP

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because I'm feeling a little disgusted by what I'm seeing in primary care; scores of young people on mega doses of hydrocodone, valium, Xanax, Percocet, you name it, they're on it. It just seems so wrong. I'm hoping to find a place where I won't be expected to write narcotic prescriptions. I know pain is what the patient says it is, but I think there is a fine line between treating pain and enabling drug addiction. Today, a woman came in calm and cool as a cucumber (hydro 10mg every 6 hours and valium 5mg twice daily), glassy eyes and all, and said she needed a shot for her "migrane" headache, and they gave it to her! Another patient later in the day wanted an increase in her Xanax which was twice a day, she couldn't even explain how or why she needed it. I actually became so sickened by this scene I excused myself for the remainder of the office visit. My preceptor said she agrees with me on how appalling it is but she has resigned herself to the fact that it's a part of today's society and there is no use in trying to change it because it isn't going to happen. I saw it in the nursing home where I rotated and in this clinic where I have done the majority of my clinicals. My next and final rotation will be in a cardiology clinic, will that be any better?

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Specializes in Emergency, MCCU, Surgical/ENT, Hep Trans.

No, you will still see it. Plus side, I've never seen cardiology Rx a controlled med!

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Wow. Please don't let the habits of one office discourage you. I have been in practice now for over a year and I think I've written maybe three Xanax prescriptions ? We just don't write for it very often and our patients don't ask. I occasionally write for narcotics but only with an acute injury and certainly not daily!

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Specializes in Nephrology, Cardiology, ER, ICU.

I work in nephrology and have many chronic pain pts. I occasionally write for narcs but refer my pts out to the pain management clinic most of the time as chronic narcotics are not the best way to treat chronic pain.

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Specializes in Step-down ICU.

I work in intermediate critical care and was JUST having this same convo with someone last night. Yesterday I took care of 3 different young men who all wanted pain meds. One was there for hypoglycemia issues, but ended up leaving AMA because he couldn't get an increase in his pain medicine for his back. That guy was 38 the other two were 17 and 25. The 17 year old is addicated to Percocet and take them every single day. He even takes his mom's Lyrica. Ended up taking 12 and came into the ED claiming he wasn't trying to hurt himself, he was just in pain. He was MAD when the doc prescribed Fioricet instead of Percocet. He and the 25 year old tested postive cocaine and benzo's. I thought it was just me, but I am seeing a lot more young people coming wanting pain medicine.

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More fabulous reasons for doing in patient peds! No drug seekers!! There is no way I could bring myself to do some of what you are talking about...

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Specializes in medical surgical.

I am doing clinicals and my MD preceptor refuses to write for narcotics. She is very intelligent and I am learning lots from her. However, in our state, the DEA is watching to see who is writing for pain meds and why. My preceptor says "not worth loosing your license over" and I totally agree with her. Also my primary care doc that I have had for years has a sign in the office that says "DO NOT ASK FOR PAIN MEDS".

I am not seeing narcotics rx'd during my clinicals. That being said, if a patient has an xray and it is seen as needed, they do offer a small amount of pain meds (15 pills at most). From what I have learned during my preceptor ship, these rx's have street value. They are being sold by the elderly to pay for food. I was actually told that the lortabs were going for $14 per pill.

I will also add that I am in a really rural area. There are no jobs and maybe this is specific to my state or county. I do not know.

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Specializes in Pediatric/Adolescent, Med-Surg.
More fabulous reasons for doing in patient peds! No drug seekers!! There is no way I could bring myself to do some of what you are talking about...

Heh, you haven't had a adolescent drug abuser or street drug user. Definitely a pediatric problem

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I am doing clinicals and my MD preceptor refuses to write for narcotics. She is very intelligent and I am learning lots from her. However, in our state, the DEA is watching to see who is writing for pain meds and why. My preceptor says "not worth loosing your license over" and I totally agree with her. Also my primary care doc that I have had for years has a sign in the office that says "DO NOT ASK FOR PAIN MEDS".

I am not seeing narcotics rx'd during my clinicals. That being said, if a patient has an xray and it is seen as needed, they do offer a small amount of pain meds (15 pills at most). From what I have learned during my preceptor ship, these rx's have street value. They are being sold by the elderly to pay for food. I was actually told that the lortabs were going for $14 per pill.

I will also add that I am in a really rural area. There are no jobs and maybe this is specific to my state or county. I do not know.

I was thinking about having my own clinic and a sign to let people know: NO NARCOTICS PRESCRIBED HERE. That should eliminate a lot of trash and game-playing. Unfortunately, it's big business, but I want no part of it.

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Specializes in allergy and asthma, urgent care.

I work in Primary Care in a community health center. Narcotics are a huge problem in this particular city. I wont rx controlled substances just based on a patient's request. I request medical records from previous providers. Chronic pain patients are sent to a pain specialist. I rx vistaril and clonidine for anxiety and refer the patients for therapy. Anyone that does get a controlled substance rx has to sign a contract and is subjected to random drug tests. I also look up these patients on our state databse to look for multiple rx for multiple providers and other red flags. It takes extra time, but at least I have a better idea of who is legit and who isn't. I don't want to contribute to an already major problem and I don't want to risk my license. Some situations do require narcotic treatment and I'll rx if I think it's necessary. I don't want to have a blanket "no narcotics" policy, but I'm very stingy on the few occasions I will rx them, and I will not rx Oxycontin...never..no way. I've seen too many people who were given oxycontin for a legitimate reason turn into addicts, and end up using heroin.

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Specializes in Pediatrics, Med-Surg.

I feel your pain and as BC grad I also work in a health care center where many people come in for pain, I try my hardest not to prescribe narcotics, and if I have to prescribe i give a very limited supply and refer to pain management, let them deal with it,they have a better idea of what is needed. You will have to be firm and many patients will curse you out if they don't get what they want but truth of the matter it's your license. For anxiety I may also give BusPar, I don't write for Oxycontin no matter what, the most I'll write for is Percocet and even then I'm stingy. I have a pt who has MS and keeps coming for percocet and motrin, I told her this month that I will not give her any more meds and that I'm sending her to pain management to better manage her because it is very likely that Percocet is not the best medication for her and I also write for like 40 pills even if its every 6 hours to at least attempt to keep some control. I'm sorry you feel burned out but its a reality that we have to deal with, don't let the drug seekers turn you off from those who really are having pain and need some help, also remember that many psych issues may manifest as physical symptoms so you have to do a thorough history to try and weed out what's going on.

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