How often are you asked for opiates?

Jules A, MSN · Jul 15, 2018

Its not just those with substance use disorder asking for inappropriate medication. In psych its for more for benzos and stimulants but yeah its near constant. Maybe I'm fortunate in that I have a high threshold for saying no as well as being threatened.

bryanleo9 · Jul 15, 2018

With the government cracking down on these drugs, it would be wise to be very selective with opiates or the highly sought after psych meds. In the prison, the inmates crush up and snort a variety of drugs to get high.

djmatte, ADN, MSN, RN, NP · Jul 16, 2018

I'm at a clinic with providers who have a long history of prescribing opiates and anxiolytic meds at higher than currently recommended doses. New mid level providers here have been reining them in and the new Michigan laws are finally getting these providers on board. When I was brand new, I'd say at least half my patients were in for refills of 60+ opiates and 30+ Xanax. Often with no imaging to document a specific injury/problem. A few I've successfully transitioned to more appropriate therapies. Others I've reduced and continue to make headway. Others simply opt to only see their pcp and I'm ok with that too. The one that chaffs my @ss though is the phenergan and codeine for a persistent "cough" that's never been further evaluated.

bryanleo9 · Jul 16, 2018

Gabapentin was heavily prescribed and abused in the prison system for decades. It is now being weaned off of every inmate that doesn't have true neuropathy. They are not happy at all. I have been told by many inmates that this was a favorite to snort.

Trauma Columnist · Jul 16, 2018

I work in nephrology with ESRD and yes, I do prescribe opiates and benzos - not daily by any means but certainly weekly. I also document (as required) my surveillance of the IL Prescription Monitoring Program website to ensure they aren't doctor-shopping.

As a rule, we use fentanyl for our calciphylaxis patients as well as our cancer pts. We do this so that we aren't dialyzing out their meds. We also use gabapentin but as the renally adjusted dose is 300mg/day, abuse hasn't been an issue.

allnurses Guide · Jul 16, 2018

I don't think a day goes by I don't deal with some sort of controlled substances issue, but that is part of the job.

Been there,done that, ASN, RN · Jul 16, 2018

With the government cracking down on these drugs, it would be wise to be very selective with opiates or the highly sought after psych meds. In the prison, the inmates crush up and snort a variety of drugs to get high.

Mouth checks are not done , in the prison setting?

Neats, BSN · Jul 16, 2018

As having history as a prison nurse I can say we did mouth checks or the correctional officers did mouth checks for scheduled II narcotics. We had many parolees come back from the outside on multiple opiates that we worked hard to reduce in the prison system. Many times it seemed like a losing battle. I can say however I do reflect at possible pain and the need for opiates for patients

I think because of all the malingering with narcotics that not only the patient but the medical community helped create, we are jaded when it comes to this type of medication and use. Let us remember that there are some people out there who do have diseases that flare and need relief of the pain in the form of opiate use.

Jules A, MSN · Jul 16, 2018

Mouth checks are not done , in the prison setting?

Sometimes and the crush and float in water method is used for the known hoarded agents. Cheeking is a skill in its own as is swallowing then regurgitating and selling to your cell buddy.

bryanleo9 · Jul 17, 2018

Yes crush and float is the order for narcotics. Some lvns don't follow this though which fuels the inmate drug trade. Other times you will do mouth checks on them, only for them to go back to the cell and vomit up the pill to sell it. Classy I know.

Trauma Columnist · Jul 17, 2018

For the crush and water method - this would only be utilized for immediate release narcs right? Then, don't you have to re-dose more times, thus taking more time?

(Just curious as I haven't worked in the prison setting.)