Nurses against Narcotic Abuse

[RoyalNurse]

As an Emergency Room Nurse for 5 years, and a Critical Care Nurse for 3, I still think the most harmful disease by far is prescription drug abuse. And with the advent of patient satisfaction driving revenue for vastly underpaid hospitals, prescription narcotic abuse has become a public threat. I have seen Percocet get prescribed to people with chronic back pain, abdominal pain with no known cause, chronic "fibromyalgia", and ovarian cysts that have ruptured months and sometimes years ago. I've seen patients receive up to 30 pills at a time, some people I see back a few days later, looking for more narcotics. I really think this is a symptom of our everything-right-now society, and I think it's probably the most harmful thing we as healthcare workers are doing to patients. A lot of Emergency room physicians have become drug dealers. They get asked for by name, because they order the right combination of Dilaudid, Phenergan and Benadryl, with a Percocet or Vicodin prescription to go home with. The entire practice has become exactly against what modern medicine was meant to stand for in the first place.

I would like to do something about this. I'm writing this to see if there are any nurses with kindred spirits out there who would like to help. I'm envisioning a letter-writing campaign to Washington, and to your state senators, followed by a public campaign/education project to really teach society how bad/insidious these narcotics really are. I think a large group of nurses is what it will take to get this issue under control; the public still trusts nurses more than any other professional. Anyone with me? Feel free to pm me or reply to this thread with any comments.

[roser13, ASN, RN]

Personally, I feel that my ED physicians, my back pain specialists, my chronic pain specialists (I say "my" in reference to those MD's in my network) are fully aware of the narcotic seekers, and only prescribe accordingly.

[Jules A, MSN]

I also have been fortunate to largely work with ED physicians who are not "Dr. Feelgood" and it is a constant battle with patients with substance abuse disorder who are coming for medications. We now have a state wide site we can search to see what controlled substances they are prescribed and how many ED visits a person has had which is helpful. Where I see the problem and have to deal with it is with the PCPs prescribing benzos and opiates and then when the person becomes addicted all the sudden they need to come see the "specialist" in mental health. There are already initiatives in place in my state urging prescribers to be prudent but I'm not sure if it is helping.

[KatieMI, BSN, MSN, RN]

In my humble opinion of a nurse who works in setting where 80+% of patients are addicted by the graces of the previous health care's contacts (LTACH):

- publuc campaign will bring nothing. Folks wanna to be "comfortable", eh.

- education should be standardized and mandatory. All customer-flattening "joint camps" and such must be eliminated at once. Instead, patients should be given a standard leaflet about surgery they are about to undergo containing the information about pain control options, explanation of regional anesthesia options where appropriate and the truthful info that they WILL experience pain in the process, given as an inevitable fact of life.

- within Obamacare framework, opportunities for getting physical therapy, water therapy and home visits paid by insurance must be wastly expanded.

- opportunities for APNs wishing to specialize in pain management must be expanded. Just like doctors must not go through 4 years of anesthesiology residency in order to do regional non-axis (that is, not connected with spinal column) blocks, advanced practice nurses should be able to do a year of intence training and do these highly effective shots.

- PCPs, mid-level or otherwise, should be closely supervised regarding their prescription authorities. More than "X" prescriptions for narcotics/ month for patients not belonging to selected categories (onco, known addicts, known chronic pain for certain time and with stable requirements) should bring a benign call from the State board. Practitioners who do not do medicine per se (DDMs and such) must not be able to prescribe narcs unless consulted by MD with script signed jointly.

- non - pharmacological pain management must be included in nursing scope of practice with notion that a nurse should be able to do more actions independently according to her nursing judgement. It is insulting that a cold pack cannot be applied for 15 min without His Majesty MD's permission.

- the question about pain management in Press Ganey card must be reformulated so that it is not implies immediate treatment of any pain from X to 0.

We cannot realistically do anything with people who are already addicted, that is. What we can do is limiting access for categories whose risks of future addiction overweight immediate benefits.

[Jules A, MSN]

We cannot realistically do anything with people who are already addicted, that is. What we can do is limiting access for categories whose risks of future addiction overweight immediate benefits.

Interesting post, thanks for participating. It always surprises me when something as interesting and widespread as this doesn't get more play but post about a fellow nurse bullying you by rolling her eyes when you said something stupid generates 100 responses.

I totally agree that preventing unnecessary dependence on opiates, which to my knowledge have not been shown to be effective for long term pain management is crucial but I disagree that we can't do anything about those already addicted.

Granted they are few and far between but I have successfully detoxed patients with true chronic pain off opiates with positive improvement in their function. At the very least they are no longer obtunded, depressed and constipated. Many times it is a matter of discussing the bottom line and if their pain score is a 6 or 7/10 constant while on opiates will it really increase when detoxed? In most cases their pain score is either somewhat improved or in the same range without opiates so where exactly is the benefit? Their motivation to participate in nonpharm methods usually increases also.

[KatieMI, BSN, MSN, RN]

I do my own version in where I work, mostly for people who are in LTACH but have good chances to get out of there alive and active AND either express concerns (and there are a lot of them, surprisingly) or experience severe side effects. I teach them "pain101", gate theory, principles of pharm action, make and discuss POC, non- pharmacological techniques including "hot and cold" and guided relaxation.Approximately 1/3 have positive outcome in terms that they stop being on the clock callers and/or stop escalating doses.

I wish I could do more but LTACH is a very busy place. Really hope that after I become FNP I could do more of it as I like to see results. Just yesterday I got one poor soul's cancer pain under control by"tailgating" technique alone... evetybody was so happy, it made my day.

[resqbug]

I'm on board with you and completely agree prescription pain medications are a huge health threat, in addition to many other prescription medications. When I was working, I got increasingly tired of being a part of a health care system seemingly run by pharmaceutical companies and physicians who would rather treat symptoms rather than illness.

To those who have already responded, I had no idea about any of those non-pharmacological pain techniques mentioned. You nurses have done your homework and that is commended considering little is touched on during school or in work environments. I've never seen a set of protocols to be followed to help patients alleviate their pain naturally before the administration of prn pain medications. Even if there were, most nurses do not have time to sit with a patient long enough to guide them through their pain relief naturally.

I have only heard of one physician brought to justice due to reckless prescribing of pain medications. I'm sure there are more, but I haven't done any research. It was the pharmacies that raised the flags on this particular physician. Some details of the case can be found here. I think there should be more investigations on physician prescriptions and if enough of them are busted, perhaps it will cause some others to re-think their practices. But, it's all about the mighty dollar $$

This is a sticky subject, but medical marijuana has been shown to be very effective for chronic pain and to augment the effects of opiates, yet many pain clinic doctors regularly speak out against its medical legalization. Note, "medical legalization", not even recreational. Talk about a conflict of interest. If there was a way for pharmaceutical companies to be able to monopolize on medical marijuana products, it would probably be legal in a heartbeat and rescheduled from a schedule I substance. Again, follow the $$$.

Lastly, it was also mentioned about nurses scope of practice being limited by physician orders. This is another issue that would have to be dealt with. More education of nurses in the field of natural remedies and even certifications might start to bring about change to the scope of practice.

There are a lot of roadblocks to real reform.

[Guest219794]

As long as providers are reimbursed according to customer satisfaction, they will try to satisfy customers.

Apparently, narcotics are quite satisfying.

[Jules A, MSN]

As long as providers are reimbursed according to customer satisfaction, they will try to satisfy customers.

Apparently, narcotics are quite satisfying.

Some providers but not all and in my experience it seems more a lack of understanding and current information about things like the risks vs benefits of benzodiazepines especially in geriatrics.

Many providers also have a low threshold for discomfort when a patient cries, threatens and tantrums to get what they want even if they are placing the patient at risk by continuing to prescribe the medications. For me it raises a huge red flag when someone's reaction hits the ceiling if I even casually mention a possible reduction in a medication. There are also the providers with no stones who hide behind "well they came to me on that regimen" as if when the patient accidentally overdoses it will be their former provider's problem.

[Altra, BSN, RN]

- education should be standardized and mandatory. All customer-flattening "joint camps" and such must be eliminated at once. Instead, patients should be given a standard leaflet about surgery they are about to undergo containing the information about pain control options, explanation of regional anesthesia options where appropriate and the truthful info that they WILL experience pain in the process, given as an inevitable fact of life.

This entire post is very much appreciated ... but the "joint camps" term is FABULOUS and sadly accurate ... and made me nearly spit diet Coke.

[CT Pixie, BSN, RN]

As long as providers are reimbursed according to customer satisfaction, they will try to satisfy customers.

Apparently, narcotics are quite satisfying.

I have to wonder, those that seek the meds and get them..are they ever really the ones sending back the surveys and giving the better scores thus giving the higher reimbursement. I'll go with a big fat NOPE!

[brownbook]

In a nearby town a 7 year old girl and her 10 year old brother were killed when a woman addicted to prescription drugs drove up on the sidewalk. The children's father is/was a leading executive for big name companies and undertook it to do something. The Calif. legislature is slowly moving some laws through the system...some to start effect in 2015, some in 2016...but it made my head spin to try to make sense of the law.

You can Google Bob Pack...and the California Patient Safety Initiative.

Honestly I thought, had heard of for years...that narcotic prescriptions would be, could be, checked on line so any prescriber could see what narcotics a patient was on. I guess that aint so yet!