I give in to drug seeking patients

Horseshoe, BSN, RN · Mar 20, 2011

My experience is drug seekers know what they are allowed to have and when they can have it. And, they ask, how often can I have that. I don't even bother anymore to try to save them from themselves or resist. Otherwise, you will have a patient complaint filed against you. The customer is always right....

It could be that they are actually "pain relief seekers," therefore they have a vested interest in knowing what they are allowed to have and how often.

Horseshoe, BSN, RN · Mar 20, 2011

The premise that we shouldn't give in to drug seeking patients relies on us being reliably able to identify true drug seeking abusers, which is largely not the case. We too often misidentify behavior as drug seeking, and often even create the behavior we then attribute to drug seeking in our misguided attempts to avoid giving in to drug seekers in the first place. I think this drug seeker paranoia is a big factor in why we are actually pretty bad a pain control, which is too bad since pain control is so central to what nursing is.
Some common drug seeker myths:
Anyone who is asleep then wakes up complaining of pain is a drug seeker since they couldn't have been asleep with pain: Actually, patients will often sleep even with moderate to severe pain.
A patient who asks you to bring their prn pain meds when they are due is a drug seeker: Not only is this not an unreasonable request, it's actually law in the state of California for post-op patients. Vicoden and percocet are usually ordered every 4 hours for a reason, that's about how long they last. A patient will quickly learn that their pain will return in about 4 hours, and that it gets hard to catch up if they get behind on pain control. Patients only ask for pain treatment every 4 hours because we haven't been doing our jobs in re-assessing their pain about 4 hours after vicoden or percocet, which I've noticed is often because we believe doing so is essentially offering those meds, which is equal to "giving in" to them.
Patients who ask for pain meds when they are not yet in severe pain are drug seekers.: Basic premise of pain control: stay ahead of it rather than play catch-up. Keeping pain proactively controlled actually decreases overall opiate use and improves patient outcomes.
Patients who set their watch to remind them they are due for pain meds or call exactly to the minute they are due are drug seekers: This is more likely due to either inadequate pain control or because the patient has learned if he waits for the nurse to assess and treat his pain that his pain won't be treated appropriately. I have worked with many nurses, and seen nurses proclaim on this site, that Nurses aren't allowed to initiate the pain control process, the patient has to ask, then we accuse them of being drug seekers when they do just that.

Bravo. :yeah:

Warpster · Mar 20, 2011

People in serious pain who are not in control of their own medication via pump often display classic drug seeking behavior.

I had a tomcat after surgery who also did, meowing at me and meowing at the fridge where the Stadol was kept starting about an hour before he was due.

I tend to discount drug seeking behavior as such if there is a legitimate reason for the person to be in pain and the doctor concurs and has prescribed medication. If it's ordered and it's time, I'll give it.

I'm not their judge, not even if they're frequent flyers for migraine and back pain.

allnurses Guide · Mar 21, 2011

I work in an urban health center in a city with a huge opiate problem. Sadly, my experience and that of the other providers have made us suspicious of anyone who is asking for narcotics. Like everyone, I was taught that pain is whatever the patient says it is, but I'm somewhat cynical about that now, at least in the outpatient setting. That happens when you get called by the police because one of your patients was arrested selling percocet from a bottle with your name on it as the prescriber, or a patient says "No, I don't want vicodin, I want percocet; I can't sell the vicodin". So, as a result we have very strict policies for prescribing narcotics, make patients sign a contract and do urine toxs, pill counts, etc. One slip up and no more drugs. And of course, everyone has an excuse why dilaudid is in their urine when you prescribed percocet, or why nothing is showing up at all. Chronic pain patients are referred to pain management specialists. As someone said, the true drug seekers are a time and energy suck. I spend way too much time dealing with patients who don't want to take no for an answer. I've been threatened numerous times and have had to have security remove patients on more than one occasion. It makes me angry cause it takes my time away from patients who legitimately need it. Now all that being said, I truly have compassion for those that are in pain, and I really try hard to treat patients appropriately for it. But if I get any pushback at all about signing a pain contract, or if I get a story that doesn't seem quite right, then I won't prescribe the narcotics. I also check the prescription monitoring database in my state to see if patients are getting multiple rxs from multiple providers. Unfortunately, this database isn't realtime and is always lagging behind by a month or so. I do the best I can, but it's tough. I don't want to contribute to an already epidemic problem in the community, but I do want to treat pain appropriately. It's not always clear what the right thing to do is.

Itsallsunshine · Jan 31, 2018

I'm a home health nurse and I'm currently struggling with this problem. There's a tough balancing act between the "customer service" aspect of nursing that so many pressure us to achieve and the "tough love" part of nursing. Every week this particular patient of mine is asking for a new type of medication. Xanax, Ambien, Percocet, steroids, and so on. There's always an elaborate story why they need said drug, and of course some manipulation to try and get me to request said drug. Even though I see through the act, I can also see the patient is suffering mentally and physically. How can we help people without looking like a push over in the process?

allnurses Guide · Jan 31, 2018

If the doctor orders it and the patient asks for it, I wouldn't be inclined to step in and add my opinion as to what is truly motivating the request, unless that patient appears to be intoxicated.
I've always wondered though, when I read about how common it is for addicts to come in with false or misleading complaints, deal with the wait time, the delays etc all for a dose of narcotics that will wear off pretty quickly or a small number of Vicodin and more lectures and referrals to detox centers they will never go to.
Seems like a low return on investment if the goal is to get high. Maybe there is something to it I am missing.

This! Most people who go to the ER do have some degree of legitimate pain. They could get a fix on the street corner with far less aggravation and wait time.

I have found that most nurses (not all) who have these opinions about med seekers have no experience with what have chronic intractable pain feels like. I have three chronic pain conditions and I am always in pain. My operational level is somewhere between a 6 and a 9 and yes I watch tv and eat ice cream while talking on my phone. I refuse to stop living because of this pain.

Hppy

BrandonLPN, LPN · Jan 31, 2018

This isn't really that complicated. If the patient asks for it, and there's a valid order, and there's no clear reason to hold it (resp depression, etc.)..... just give the pain med!

RockinNurse2018 · Jan 31, 2018

This isn't really that complicated. If the patient asks for it, and there's a valid order, and there's no clear reason to hold it (resp depression, etc.)..... just give the pain med!

Agree