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morphine ivp

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by oharnp oharnp (New) New

I have several kidney stone patients come through the ED daily as it is common where I work. Every doctor I work with is seeming to decide to go with morphine IVP or Demerol IVP for the patients pain. I have always tried to prescribe a less sedating approach. Zofran,Toradol,and bentyl. I have been aggravated with the docs telling me to order the narcs,because I don't like to prescribe narcs until a underlying cause is verified. And when the patient (As some are) is there once a week with the same complaint or different complaints,seeking pain relief. I will not just jump and order a narcotic when they are several alternative options for effective pain control. I have a young lady who come in every week who has been seen 89 times this year who always is asking for narcotics. Idont give in when I pick up her chart. What do your providers start with? What do your drug seekers come in and ask for ? do they get it? What are some of your seeker stories? and I know there are threads out there like this.

What do your providers start with?

Completely random. It really is a shot in the dark. It's called Random Reinforcement. http://outofthefog.net/CommonNonBehaviors/IntermittentReinforcement.html

It is excellent for repeat business.

What do your drug seekers come in and ask for ?

Usually whatever they got last time. Maybe 3 times in a row, they get 5 of morphine. Then the fourth, they get two of Dilaudid. Well, now it has been established in the record that it takes 2 of Dilaudid to to control their pain.

do they get it?

Random. Every now and then, a provider does what is medically indicated and in the best interest of the patient. That usually doesn't last. It is emotionally draining, and takes time away from dealing with real patients. Then, they get called in by admin to deal with the complaints.

What are some of your seeker stories?

The best drug abuser stories come from drug abusers. I got curious about this a while back, and did a little google research to see the view from the other side of the equation. Below is a collection.

My hospital has drug tx and detox. Looking at many of these pt's records, you can see the progression, and our role in their addiction. We give narcotics to known addicts for minor and unverifiable complaints. We give narcotics to people we KNOW lie to get narcotics. (plain and simple: If a person is "allergic" to multiple medications that do not get you high, but has never had a documented reaction to anything, they are lying.) We do not check the easily available state database.

Giving an addict narcotics and expecting him to use them responsibly is like giving an alcoholic a jug of wine, and expecting them to have 2 drinks a day, for it's benefits. It is not possible due to the nature of addiction.

Last night, I dispensed 4 vicodin to a guy. After being a couch potato, he was a little over exuberant using his home gym. Strained his bicep. Narcotics. Guy had no record with us of drug abuse. But, with a little luck, we could be on our way to developing a long term customer.

We are a critical part of both the supply, AND the demand chain. It is an excellent business model.

BTW- good luck.

I heard some stories people go into the Emergency room and say something like. i have been moving big things. shoving heavy gravel and tossing it being my back and now my back in going into spasms.

and they got a small shot dose shot of demeral and a small script of vicodin.

Ive never had insurance in years... anyone got any ideas on things to ***** to doctors and possibly get a one script of vicodin? because they cant bet too hard to get right. one year...i got an infected swollen tonsil after antibiotics they gave me 25 vikes and i woulda been find with out them. i have been through all more pain than that tonsil and got by fine..

http://zoklet.net/bbs/archive/index.php/t-241124.html

we all know it's very difficult to walk in to a doc you've never seen before and talk your way into a script for pk's... almost impossible for some people... myself included... but i have discovered an EASY, GUARANTEED way to get them...

http://forum.opiophile.org/archive/i...hp/t-3418.html

A combo of Soma and Hydro is MINDBLOWING. It actually stupifies my limbs. I feel a super rush and a drunken feeling w/ a little anxiety

http://forum.opiophile.org/archive/i...p/t-27174.html

OK, i've been reading different threads, and hearing "oh, i just left the ER with 60 dilaudid" etc etc. So, I've hit a couple spots to try and score some good drugs, and all i end up with is hydro, or codeine. I'm at a point where I'm about to not have any insurance for a little while, and I want to try one more time. (Sorry if this post ****** anyone off, but hey, I'm a junkie and I'm just trying to maintain.)

So, my question to anyone who might have some advice is: What should i tell the doc? Will fake kidney pain/stones work well if i drip some blood in my urine sample? Should i just go for bad neck/shoulder pain? My original horrible toothache story obviously isn't working. What are some good "unprovable" ailments that will get me some legit opies? Thanks in advance to any advice.

http://forum.opiophile.org/archive/index.php/t-15554.html

I urinated in a cup and afterwards pricked my finger and let a few droplets of blood mix with the ****... I was still expecting nothing and was expecting disappointment

That IV dilaudid every two hours is what popped my curiosity cherry about IV opiates. It was after that I tried shooting for the first time. Just a friendly warning.

Everytime dude needs $50 for this or $100 for that I keep telling him, "go get some happy pills from the hospital and flip 'em and use the money to pay your bills.

http://forum.opiophile.org/archive/i...p/t-19912.html

I am a DOCTOR shopper and i get narcotics from a million doctors by faking back pain and kidney stones...i just filled 20 lortab today....two days ago i got two shots of INTRAVENOUS dilaudid...what a rush!!! AND he gave me 30 extra strength 10mg percocets!!

http://www.experienceproject.com/con....php?cid=13134

I've gone to the ER with fake injuries, real injuries that I'd caused myself, and with narcotic withdrawal hoping to get some pity.

http://isitnormal.com/poll/have-you-...-drugs-105995/

You have to use different pharmacies that are not linked by a database. CVS and Walgreens are linked. Most grocery stores are linked. I cant find one dr to prescribe me pain meds so its not an issue anymore but in the past, my Every day DR was prescribing me and my pain management dr was prescribing me as well. I just used Walgreens with my insurance for one and Target claiming to have no insurance and paid cash. Their databases were not linked. Never use insurance if you are going to go to more than 1 place. A month of Hyd is like $22 at Target so its not like its expensive to not use insurance.

http://www.drugbuyersguide.net/index...r-prescribing

And, while I am on a tear........

Last week, I found a personal best. Quite sure there are more impressive ones out there, but this was pretty good.

Had a pt who had been prescribed narcotics by 9 prescribers in 12 months.

More accurately: Our EMR links with pharmacies that pt's tell us they use. If you filled a rx at a pharmacy you haven't told us about, we would never know, without checking the database. If you get drugs out of state, of course we wouldn't know.

So, the 9 prescribers I found with 3 clicks of a mouse could be it, or could be the tip of the iceberg,

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

Are you an NP, who is being told by supervising physicians to order opioid analgesics?

I just wanted to clearly understand your situation.

And if your facility is still using Demerol IVP commonly ... there are certainly other issues that probably need to be addressed.

meteorite36

Specializes in Emergency. Has 22 years experience.

I am an RN so I don't prescribe meds, but I have noticed that if it is really a kidney stone, Toradol works best.

We have providers that routinely go straight to the iv demerol. i absolutley will not order iv and not order any dose higher than 12.5mg IM i wold prefer to order toradol abd norxo for pain.

I agree i have had kidney stones my self and the doc in the er ordered at first Dilaudid 4 mg IVP and Zofran 8 Ivp then i was still in pain. So he ordered 2 of morphine i recieved toradol ivp and was instantly pain free.

Realistically, when somebody wants narcotics, nothing but narcotics will make them say that they have had pain relief. If past providers have used narcotics in similar situations, you will not achieve customer satisfaction without similar doses of narcotics.

NSAIDS provide excellent pain relief for kidney stones for many. If you see in a PTs record frequent visits for pain, it is unlikely they will report pain relief after NSAIDS.

As far as Toradol goes- We have all seen it's fantastic effect on kidney stone and other pain.

Interestingly, despite our anecdotal experience, it is no better than ibuprofen.

http://cjem-online.ca/v9/n1/p30

ADeks

Specializes in Current: ER Past: Cardiac Tele. Has 3 years experience.

For kidney stones, the usual order is Toradol 30mg iv, Zofran 4mg iv, and Dilaudid 0.5 mg iv. Then off to CT to r/o kidney stones.

I was talking to an ER doc and she told me there's a big push for better pain control in a 'timely manner'. Especially within so much time of signing in.

I just figured it was to get control of their initial pain.

Yes i am being told by the prividers to order narcotics for all complaints of pain

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

For kidney stones, the usual order is Toradol 30mg iv, Zofran 4mg iv, and Dilaudid 0.5 mg iv. Then off to CT to r/o kidney stones.

This is pretty similar to what I see in our ED. There a few docs who just go with toradol (no narcs) and some patients who refuse narcs. I really don't think it is a bad idea to give IV narcs to a suspected kidney stone…plus, I would rather give a narc to a "drug seeker" than make an honest person with a stone sit there because I need to be on a high horse about narcs.

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

Yes i am being told by the prividers to order narcotics for all complaints of pain

As in any and all complaints of pain? Even narcs to a person with sprained ankle pain? Maybe I missed it earlier, what position are you in where the providers are telling you to order something?

Holy Ef.... IV Demerol for kidney stones? Yikes.

I've done the Demerol dance back in the day (as a patient) and all I can say is, "I understand how heroin junkies become junkies." That's a big ol monkey to put on someone's back and it gets there in a hurry.

Demerol works the charm but nothing to be trifled with.

Toradol with a touch of morphine is the way to go IMO

As in any and all complaints of pain? Even narcs to a person with sprained ankle pain? Maybe I missed it earlier, what position are you in where the providers are telling you to order something?

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

Gabby-RN

Specializes in Emergency Nursing. Has 4 years experience.

Where. I work we start with toradol 30mg, zofran 4mg, a liter of NS, and Morphine 4mg q5m x 3 doses. I give the toradol, zofran, fluid, and 1 dose of morphine. Then send them off to CT. The morphine starts to work faster that the toradol and tends to relax the patient a little, enabling them to stay still for the CT . True kidney stones HURT! Many patients never require the additional doses of morphine, many do.

We do not use Demerol in the hospital where I work.

Once the CT confirms its a stone and able to pass, we make sure the patient is somewhat comfortable, has a ride home, give them a screen, a urology referral, some teaching, an Rx for ibuprofen 600mg, percocet 5/325mg 5-10 tabs, and zofran 4mg ODT.

A true kidney stone is very painful, I have no problem giving narcotics when narcotics are needed.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.

As a provider the MD is telling you what to do? I'm confused. I haven't seen Demerol used in a LONG time.

Since bedside nurses do not "order" meds this might be answered in the Advanced practice forum.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Im a nurse practitioner who works in a 69 bed er and the attending docs are constantly telling us the midlevels were not very good at treatingpain.they are telling us to order narcotics as a first line treatment for ALL complaints of pain. yesterday i had a young py.with a stubbed toe for pain i ordered 1 gram of tylenol. the doctor that was there seen the pt. canceled the order dor tylenol and ordered the patient as follows Dilaudid 4mg IVP,valium10mgIVP,and Percocet 10/325 x 2 tabs. i avout died the only thing wrong with the patient was a stubbed toe.
Thread moved for best response.

We do not use Demerol in our ED - ever.

As for those reporting that patients can come in and they have no way of knowing if the patient is seeking or not - NYS has a centralized database for tracking controlled substance RX's. Do other states not do this? Granted, its based on the patient presenting a real ID with the real name, DOB,etc on it but it's better than nothing.