I give in to drug seeking patients

MassED, BSN, RN · Mar 7, 2011

I used to feel that way.

Until that same chronic back pain 30 something year old guy who has had a huge workup multiple times, has just shown up for the 3rd visit this week. He was just given a take home pack of Oxy's, a script, and shouldn't be back for back pain and certainly shouldn't be out of his pain meds, but oh yes, his prescription was stolen.... again.

yeah, right. Meanwhile, I have a patient who is having an MI, a child with RSV, vag bleeding patients.... blah blah blah.... easy to see why most of us call it like we experience it. For the obvious seeking behavior they display.

missladyrn · Mar 7, 2011

I tend to think that if they have an addiction, they also probably have a high tolerance and may actually be experiencing pain a normal dose might not cut it. I work on an ortho trauma unit, so if they have a broken bone and a history of pain clinic etc, I still do medicate them for pain when they ask if it is ordered. If the Dr orders it, and they can have it, they get it. Not my place to judge. Some of them do make me sad though.

blue heeler · Mar 7, 2011

i am not here to judge a person's pain. i don't care if they are a seeker. i will medicate them as long as it is safe to do so and i talk to them to find out if they have chronic pain/narcotic tolerance.

Orange Tree · Mar 8, 2011

I don't mind them too much because they are super drug-tolerant and hard to kill. I worry more about giving a one time dose of IV narcotics to an elderly person than I do about the patient who gets Q 2 IV everything. On the other hand, drug-loving (or drug-needing) patients can be very time consuming. Sometimes I wish I could just deliver a tray of narcotics to their room and maybe leave a mint under their pillow.

I never assume someone is not in pain. Well, once I did. Seriously- only once.

nurse2033, MSN, RN · Mar 8, 2011

I don't get too wrapped up in the morality of it. Our system is biased towards giving the meds. You are just a cog in that wheel. It is annoying, especially in the flagrant cases, but I try not to fret about it. We are not the bad guy here, whether you believe them or not, we still have to chart what they say, and give the meds as ordered. I'm not saying we are devoid of responsibility in informing the MD what we think, but they have the accountability which favors giving the drugs. True reform exists at the institutional level, should you want to get involved. I read recently about some ERs that no longer prescribe narcs to patients being released. They are treated, then discharged with no Rx :)

MassED, BSN, RN · Mar 8, 2011

i am not here to judge a person's pain. i don't care if they are a seeker. i will medicate them as long as it is safe to do so and i talk to them to find out if they have chronic pain/narcotic tolerance.

you don't work in an ER. It bogs down the system. They need to follow up in a pain clinic.

RNperdiem, RN · Mar 8, 2011

I have no trouble here.

If you are in my unit and have been hit by a bus, I do believe you are in pain no matter what your drug history.

People aren't faking pain where I work, and double that for the burn unit.

blue heeler · Mar 8, 2011

lots of people bog down the er for various reasons, not just seekers.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Mar 8, 2011

If you prescribe it, they will come. And come. And come. And come. Perpetuating their abuse/addiction is not helping them!

heron, ASN, RN · Mar 8, 2011

OP, beware of getting into a power struggle ... and the phrase "giving in" indicates that this might be so. You won't win and will just exhaust yourself.

Besides, the expectation that you can identify "seekers" and, in addition, control their drug abuse is totally unrealistic. For one thing, google "pseudo-addiction". Not even the commonly described indicators of the "seeker" are reliable.

For another ... consider what you are treating ... are you treating addiction or some other medical problem?

The key is to avoid investing your own ego into controlling whether a patient is asking for medication to treat pain, get high or avoid withdrawal. It'll make you crazy. The best you can do is all you can do.

Setting limits on addictive behavior requires major teamwork, starting with the MD and including all nursing staff, as well as support from management. Some facilities are able to access prescription data bases to track patients' shennanigans with prescriptions. Others have a blanket policy of no narcs in the ER. It's hard on nursing, though, when admins insist on high Press-Ganey scores and the docs won't back you up by limiting orders.

colleennurse, ASN, RN · Mar 8, 2011

I work on a behavioral medical unit and we get a lot of repeat visitors who are looking for meds. The providers on our floor do not order anything stronger than Tylenol unless they can find a medical reason for the pain. So we have a lot of people leave AMA and they are usually told when they are admitted to our unit that they will not be getting any narcotics. But if you have an order to administer pain medication and the person is complaining of pain, then what can you do.