narcotics

Narcotic abuse/misuse is a HUGE problem in this country. Having worked in Pain Management, I've learned to be cautious and have learned how to assess patients who are indeed in REAL pain and those that are "working the system".

My advise to those NPs working in areas other than Pain Management who are faced with patients with opiate needs is to perform a really thorough baseline assessment on the cause of their pain. ESTABLISH a strict and professional AGREEMENT with the patient laying down YOUR rules of how to dispense and take narcotics AND have a RANDOM TOXICOLOGY screening every so often, making sure that your patient is indeed taking prescribed narcotic. AND, if any illicit drugs show up other than what one expects to be present, THEN dismiss that patient from your practice OR substitute NON-OPIATE meds instead.

I had a chronic pain patient confess to me a long time ago, that she only took the necessary opiates, enough to show up on her urine test in the office and that she would SELL the rest to meet her financial needs for the month. She was 73! Needless to say, eventhough her intentions were from financial need to live, it was WRONG! I had to dismiss her from the practice.

This is the SAD reality of today. People desperate for money because they've been laid off work, etc, are turning into one of the easiest illegal market of prescription drugs diversion.

Be careful!

V.

I am new to the field, less than a year expierence and I thought that I would actually be helping people, and well I know that I am. However I have seen nurses just burned out because they are being abused by people who feel that it is there duty to insure that the doctors keep their narcotic supply up to "their standards". Xanax, lortab, percocet, methadone, constantly over and over again. The poor ladies at the front office, the receptionist, they get phone calls constantly, cursed daily by narcotic abusers. I am all for treating people who what is to be thought of as serious pain. I also realize that pain and anxiety is totally subjective, who am I to say that someone is not in pain or is not having acute anxiety. But those who take 90 lortab 10 in 15 days, or those who curse you because they get darvocet and want lortab from the doctor that is abuse that am just tired of receiving.

In my office, we are required to run drug screens at least once a year on all our narcotic-using patients, and supposedly governmental regs are suggesting we do it more frequently. Be sure to become familiar with the lab that you use because you will have questions.

For example, we recently discovered that in some patients that have been using oxycodone for long periods, their urine will be clean for the oxycodone but oxymorphone might show up. This has only happened once, but it might happen again...