How to deal/cope with drug seekers?

Darlene K. · Oct 18, 2005

I understand how you feel. Unfortunately, if the physician continues to write the orders, we have to give the medication. As you said, pain is subjective (it's whatever the patient says it is).

In our ER, our physicians are very proactive about not providing narcotic meds to "known" abusers. When I have a patient that has a history of frequenting the ER for these meds, I do a few things:

1) Don't insert a HL if their history is for seeking IVP meds. I draw their blood with a butterfly if labs are ordered. I have learned that once their HL is in they frequently disappear.

2) Let them know that once they are medicated they have to lie in bed with the siderails up for their safety. No going outside to smoke or leaving the room.

3) Generally, NPO status for patients in pain - just in case you need to go to surgery.

The true seekers don't like it when they are not allowed to go outside to have a smoke immediately after their IVP favorite. Sometimes they even bring a friend who will offer to push them outside in a wheelchair or wake them up when you get back with the medication (how sweet).

I certainly do not withhold pain meds from someone who is complaining of pain or if the MD has ordered a medication too be given (whether I think they are a seeker or not), as long as there are no condraindications to them having the medication. It's not up to me.

I guess for me it's a balancing act. I try to be a patient advocate for pain control, no one should have to suffer if we can help them. At the same time, it can easily p*ss me off when I feel someone is trying to play me for a fool.

Trauma Columnist · Oct 18, 2005

There has been a lot of information here about pain and patients in pain. You might do a search. Personally, I'm an ER case manager who manages our chronic pain patients. Pain is subjective - it is what the patient says it is. I do believe that as a nurse we must use solid nursing judgement along with a thorough assessment when giving ANY medication. I also deal with those patients known to sell drugs as well as those who alter prescriptions and both of these actions are illegal. However, these people can and do get involved in trauma situations, become ill or otherwise legitimately need our services. It is in these situations that a nurse must gather all the information and realize that if patients are addicted to narcotics, they are going to be very tolerant and actually require much larger doses in order to obtain pain relief. You might also do an Ovid search via your college of nursing library.

wanda06211 · Oct 18, 2005

There has been a lot of information here about pain and patients in pain. You might do a search. Personally, I'm an ER case manager who manages our chronic pain patients. Pain is subjective - it is what the patient says it is. I do believe that as a nurse we must use solid nursing judgement along with a thorough assessment when giving ANY medication. I also deal with those patients known to sell drugs as well as those who alter prescriptions and both of these actions are illegal. However, these people can and do get involved in trauma situations, become ill or otherwise legitimately need our services. It is in these situations that a nurse must gather all the information and realize that if patients are addicted to narcotics, they are going to be very tolerant and actually require much larger doses in order to obtain pain relief. You might also do an Ovid search via your college of nursing library.

I have done a few searches on drug seeking behaviors. Mostly what I was looking for was maybe like a class that is offered for health care professionals on how to deal with the situation. I could not find anything offered (if anyone knows of anything, please let me know), but what I did learn was very interesting to me. Drug seekers are categorized into basically 3 groups. #1 are the patients that sell the prescriptions in order to obtain their actual drug of choice (I've not personally had any dealing with this group that I know of yet). #2 Is the group that likes the effects of the prescription meds (these are their drugs of choice). and #3 are the patients who actually are in chronic pain and try to "stock up" because they are afraid of running out. What I tend to see are groups 2 & 3. I must admit that I am (for the most part) a little more tolerant of group 3. I understand that no one wants to be in pain, and it can be scary to think that the drugs could run out. Group 2, however, is another story all-together. I understand that people build up a tolerance for pain meds and I try not to be leery of every patient who says they're in pain. Personally, i don't care what a person has done before they are my patient, they are my patients and I care for them to the best of my ability. One of my first patients in nursing school had a history of drug abuse and had been in a major MVA. Was he addicted to drugs? Without a doubt. Was he in pain? Without a doubt. There were nurses on the floor that were discussing it in report and basically admitted to "putting him off" when he called for pain meds. I was appalled to say the least. I mean, here is this poor guy with multiple fractures, lacerations and bruises having to wait on his pain meds. But then there are the ones like I had last week that reported constant pain 10/10 and nothing helped---which was just hard for me to believe when I had to physically SHAKE her awake (every time) to give her scheduled meds. Yes, I gave her pain meds when she called, but I did chart the situation exactly as it happened and discussed it with her doctor. I know when it comes to pain, I can niether prove nor disprove what someone tells me. If they have pain meds available and call me for them, unless they fall asleep before I get there, I give the meds (but I refuse to wake someone up to give them pain meds). Anyway,Sorry so long and rambling. I guess I just still needed to vent a little.

Wanda

Daytonite, BSN, RN · Oct 19, 2005

The way I've always dealt with this is to give the pain medication if the doctor has ordered it, the patient is asking for it and the time is OK to give it. End of story. I found that I have to keep my judgment out of the situation or it will tait my interactions with the patient. So, I just act as if no one is a chronic drug abuser. As another poster said, pain is a subjective experience. Hard core addicts can get their fixes out on the street for way less money than what it costs them in terms of time and money spent to be in the hospital to get legal drugs. That means the ones deliberately seeking drugs at a hospital are in the throws of coping with pain (perhaps) or some other psychological problems (perhaps). At least that is how I rationalize it.

hipab4hands · Oct 19, 2005

The way I've always dealt with this is to give the pain medication if the doctor has ordered it, the patient is asking for it and the time is OK to give it. End of story. I found that I have to keep my judgment out of the situation or it will tait my interactions with the patient. So, I just act as if no one is a chronic drug abuser. As another poster said, pain is a subjective experience. Hard core addicts can get their fixes out on the street for way less money than what it costs them in terms of time and money spent to be in the hospital to get legal drugs. That means the ones deliberately seeking drugs at a hospital are in the throws of coping with pain (perhaps) or some other psychological problems (perhaps). At least that is how I rationalize it.

It can be very difficult to deal with these folks. I had one the other day, who gave 3 different stories, on why he was out of meds, when he had just picked up a script 2 days ago.

I didn't make any comments, but just asked what version, he wanted put on to his medical chart. He became very surprised and wanted to know why I was asking. I informed him that I had to document why he needed an early refill on his meds and pointed out that he had given me several versions on how he had run out of med.

The patient told me he didn't want anything put into his chart and that he was going to go to an ER instead. (sorry, for those of you, who had to deal with him).

I also knew that he had been removed by security from the ER the other day, so I know they were not going to give him another script either.

Daytonite, BSN, RN · Oct 20, 2005

It can be very difficult to deal with these folks. I had one the other day, who gave 3 different stories, on why he was out of meds, when he had just picked up a script 2 days ago. . .The patient told me he didn't want anything put into his chart and that he was going to go to an ER instead. (sorry, for those of you, who had to deal with him).
I also knew that he had been removed by security from the ER the other day, so I know they were not going to give him another script either,

To me, this is a very sad set of circumstances and I think it is more prevalent than thought. This is not a hard core addict, but someone struggling with the beginings of addiction or perhaps stuck in the throws of shaking off a begining addiction after something landed them on pain killers in the first place. I worked many years ago on a unit that reserved four beds for their beginning substance abuse detox program. The program has grown into a world famous institution for the treatment of this problem. All of us were put through training on the treatment of substance abuse and detoxing. These kind of patients are much more prevalent than the hard core addicts out on the street for many different reasons. But, no one starts on pain medications and stays on them for no reason at all. There are usually some medical circumstance that starts them out on that journey. Back pain, burn injuries and a host of other kinds of injuries are often involved. There are also the middle class crack addicts involved also whose cross tolerance leads them to doctor's offices seeking prescriptions for pain killers to help them deal with their crack addiction. They become very skilled at manipulating the medical system. What are the doctors to do? Anyway, I try not to judge because, god forbid, it could be one of my relatives or a friend who could end up in the same situation. We never know what kind of hell any patient has gone through with their pain unless the person is willing to tell the truthful story and we take the time to listen. But, you are still left with the problem of physical addiction which can lead to some very serious reactions if a drug is withdrawn cold turkey. I guess I tend to be more forgiving of these people since I have been suffering with back pain for the last few years. While I never got to the level of narcotics for my pain I did manage to permanently damage my kidneys by taking huge amounts that were supposed to be safe levels of Motrin for my pain. It's a very difficult and long road to go off a medication that helps one's pain and find alternative therapies to treat it. Many people who find themselves in an addictive type cycle really feel a lot of shame about admitting their problem--denial is a big part of the problem and puts them in a situation where they are isolated from telling people the truth about it. If someone has never been that route it is hard for them to understand how something that seems so simple as a little back pain can change a life.