Drug seeking patients?

sanakruz, ADN · Feb 20, 2003

Working in psych I have seen plenty of drug seekers. Usually it's benzos-Highly addictive and really just bandaid threapy for anxiety.( Anxiety can be a symptom of depression also, which carloladybell experienced).

My take on this- Something is " psychic-ly " wrong with this pt. Many individuals equate suffering with pain- but it's not the same thing.Pills=control over anxiety. Anxiety = suffering (not that I doubt this) Or- "Im suffering since my accident; my whole life changed in a minute. Now I 've got to have relief!"

We cant not identify this if we are to provide care for someone with drug seeking behavior.

I believe the key is to educate the individual about the addiction process in a supportive way. No one is a bad or weak person for wanting relief.

That said -It's really trying to work with someone in the throws of addiction!!!

dianthe1013 · Feb 20, 2003

I have worked in a retail pharmacy. I've seen people who tried to refill a Rx for #120 Vicodin 5/500 (1q4-6h) after three days. I've encountered people who said, "Hold the NSAID, give me the narcotic." While sans lab jacket, I've heard teenaged patients in the pharmacy parking lot chat about how they needed more C-II Rx's so they could make more money at school. Hell, I've seen people come in with forged Rx's who were so high/negligent that they couldn't be orificed to spell "Tylox" correctly!

And it made me spitting angry. I'm non-PC enough to admit that.

Then again, I have felt what was, to me, the worst pain imaginable. When I broke my coccyx, yes, I gratefully accepted that Vicodin and Skelaxin cocktail. I couldn't have made it without those drugs - literally. Unfortunately, when my doctor gave me a follow-up Rx for Darvocet, I only took it the first day, because it made me have auditory hallucinations. Talk about scary as hell. I was too frightened after that to go back to taking anything stronger, so I took Tylenol. It was hard, I'll say that; I wouldn't do it to a patient of mine.

There are people who want drugs for legitimate relief. There are those who have various other needs, physical, mental, or monetary. I do find it a bit fairy-tale-ish to not admit to the existence of drug-abusing seekers.

Unfortunately, the whole thing reminds me of those IBM commercials with the imaginary, magical products. "There are no magic business beans." There aren't any goggles we can put on and say, "A-ha! I see now this man has no pain! He just wants morphine for the buzz!"

So everyone gets treated at their word. At least by most.

Donna :)

sandyth · Sep 13, 2003

While I did my preceptorship in the ER, the veteran nurses that worked there would point out the drug- seekers. They knew these people by name and "they would be allergic to everything under the sun; except Stadol and Morphine" Go figure. They visited the ER like every 2 days.

krisssy · Sep 7, 2005

i don't like the term "drug seekers". if a person is chemically dependent, that person is just as sick as a person who has any other painful medical disease. chemical dependency can kill, so it is just as serious as any disease. so why would a sick person with a drug problem not be treated with just as much warmth, caring and compassion as we treat all other diseases. because they have a choice? maybe they haven't learned that they have a choice yet or how to cope with their disease yet. i don't believe that nurses are there to make judgements on addicts or anyone for any reason. a sick person is a sick person no matter what their disease. there is no such thing as a "drug seeker". there is a thing called a human being who is sick calling out to the nursing and medical profession to help him or her. what would happen if a nurse threw a "drug seeker" out of the ed because he was just "seeking drugs" and then he walked out on the street and overdosed. isn't that the same thing as turning away a person with stomach pain who goes out onto the stereet and the appendix bursts and peritinitis sets in and he dies? let's treat all sick people equally and get rid of the term "drug seeker"

please note a 2 year gap in the posts on this thread.

krisssy · Sep 8, 2005

l.rae what would be so bad if you called in a social worker and tried to get the "Drug Seekers" help for their own disease of ADDICTION. Did you ever go through opiate addiction and experience the pain physically and psychologically these people feel. Whether they were initially given it from the streets or if they were in real pain and put on it, the withdrawal is horrible, and these people have a right to medical care just like anyone else.

Patma · Sep 20, 2005

This is a tough issue. I agree that drug-seeking patients are in the minority and that we don't have a right to decide another person is not in pain. In nursing school, they teach you that "pain is whatever the patient says it is". Unfortunately, it's not that simple.
There IS such a thing as a drug-seeking patient and as nurses we need to use our assessment skills as well as our instincts and common sense or we risk doing a great disservice to those entrusted in our care.
I remember one patient who complained of horrible, agonizing pain for seven or eight months after his hip fracture had healed. He was on Vicodin and a morphine patch and still he reported pain. No one could find any physiological reason for his pain and he reported that all non-drug methods of pain relief (and believe me, we tried them all) were ineffective.
I reported and documented my findings and I spoke to his doctor no less than six times about what I felt was a drug problem. So did the other nurses, and we all continued to medicate him as ordered.
Finally, the doctor stopped ordering the pain medicine and put him on Methadone. Shortly thereafter, he overdosed on cocaine.
Maybe nothing could have helped this patient but I wish we had all been more aggressive about what we damn well knew was a drug problem and less concerned about appearing "judgemental".
If I've offended anyone with this post I am sorry, but I had to say what I feel.

I just had to respond to this post because you mentioned cocaine.

Today, when I was visiting my PM Doctor for my monthly visit, we sometimes get to talking about drug seekers and the like. I've been his patient now for over 18 years and have had nine cervical and lumbar surgeries during that time, but not all of them by him. The damage was from a birth defect and I have lived with it all of my life, but the last three years have been the worst. I was able to work for 31 years and retired when my health got so bad with chronic pain.

As in all cases of pain managment, a patient must sign a contract, must only use one pharmacy, must only receive narcotics from one Doctor, and must submit to a UA upon request, which has never been a problem. I follow my agreement with him exactly as written. He has never asked me for a UA and I told him I had to go by and get some bloodwork done for another Doctor and would he like me to have a UA done at the same time. He said to me if I had given him any indication that I was lying to him or violating my contract, he would have ordered one a long time ago....that remark made me feel trusted and respected.

I am 51 years old now, and my Doctor told me that some of his patients are my age and older who violate their contracts by using illegal drugs such as cocaine when they have not taken their legal meds as ordered and have run out, which of course throws them into withdrawal. My point is, where in God's name do Senior citizens get illegal drugs like cocaine? I would have no idea where to even go for something like that and besides I would be scared half to death of being arrested or worse dead from taking that crap. I mean we are talking about 50 and 60 year old men and women.

I asked him how he knew which ones to look out for and he said they are the ones who always "lose" their prescriptions, their teenage kids stole them, they left their medicine at the cabin up north while on vacation, someone stole their purse with the scripts inside, ask for early refills constantly from the Doctor's office, go to ER's all over town, or the pharmacist has called him and said a particular patient was always coming in early for refills and havings fits when they are told NO!

So, I would think if these particular patients end up in an ER and the ER staff call their Doctor, he could easily advise them of that patients's status with his office and the ER Nurse would know then for sure if they were seeking or not.

I would like to know if a patient presents themselves to the ER seeking drugs and are in full withdrawal, is that dangerous if they are not treated? I mean Patients that are on 600mg. of Oxycontin daily and with Actiq, Vicodin, etc. for break through pain.

I have met patients that are on unbelievable high dosages of narcotics and I wondered if they could die if they were not treated.

Patma · Sep 20, 2005

Z, I truly just wanted to know if a person would or could die going thru withdrawal from taking large amounts of narcotics given to them by their pain management Doctors. I'm sorry my post was so long....guess I was truly shocked that 60 yr. old people can obtain cocaine when they run out of their legal narcotics by taking too many and run out before the next refill.

P_RN, ADN, RN · Sep 21, 2005

Uh 60's not OLD anymore IMHO.

grannynurse FNP student · Sep 21, 2005

Uh 60's not OLD anymore IMHO.

Nor in my mind, having turned 60 this past August.

Grannynurse :balloons:

68RN · Oct 16, 2005

I will never forget an incident that happened to me a few years ago. i was vacationing in Fort Collins,Colorado when a muscle pull landed me in the ER at their hospital there. I was in such pain and had a history of undiagnosed pain for several years. I was placed in a room and a nurse stuck her head in a doorway and stated "Oh your the nurse from oklahoma". She was gone no sooner than she arrived and I thought to myself that the staff had a good laugh at my expense. The physician was wonderful. They drew lab as I had a history of pancreatitis and sent the results to my physicain at home. I also was given nausea and pain medication. But I never forgot the nosey nurse!!!

Even in the hospital i worked at, I made numerous trips to the Er for undiagnosed pain control. The docs were never very helpful and I finally made an appointment with a local internist and within a few visits I was diagnosed with fibromyalgia. I had never even paid much attention to this diagnosis befroe and had to do alot of research on it. I am now scheduled with a rheumatologist this week for a possible RA diagnosis.

All the above contributed to my demise as a hospital RN. I feel if I had really been listened to before and gotten proper care perhaps things might have turned out different.

My last job was inpatient rehab and it was the hardest physical job as a nurse I have had. Never enough help with all the heavy patients. I wore 3 hats each night. I was the charge nurse, staff nurse with a full load of 10-11patients, and had to assist the techs with the heavy patient care. I t was nonstop all night. I also had 4 children at home and a husband that drove a big rig and was gone alot. It all caught up with me and my health plunged.

The pain,depression, and loss of my carreer as an Rn has been devastating. I never ventured far from bedside nursing as that was my love and I was a great nurse. I was a typical type A. These type females are open prey for fibromyalgia and I also have autoimmune problems.

I feel like my employer failed me also. I gave 100% when was on duty. Did everything I could to advocate for more help, but it rarely happened. I drove home many mornings in tears from pain. But i kept on going cause noone seemed to interested in finding out what was wrong with me. I started having a major nosebleed one morning as I stepped off the elevator to go home. I went into the bathroom and grabbed some papaer towels and reported to the ER. I left the bathroom in a mess and told them as I went into ER. A coworker called me and told me that the housekeeper got in trouble about the messy bathroom!!!!I informed her i had told the er staff!!!

duh!! Did I really care!!!

I am getting off subject. Just remember to treat everyone with pain control issues. Chronic pain changes you. The longer one is in undiagnosed pain the harder it gets to control. People with fibromyalgia have pain amplification cause by a malfunction in the CNS. My internist put me on a high dose of Effexor which he explains helps with this pain amplification problem. I also have DDD of neck and lumbar spine and have had two knee replacements. I am becoming the patient rather than the nurse. Luckily

I have a doctor that is not afraid to give me the pain medicene I need. Some days I need just tylenol, some days nothing, or Darvocet some days and a back up of Hydrocodone for a particularly bad day with back pain.

I have not been to emergency room for over two years because of good pain control. While I can no longer work as a nurse, I joined this board so perhaps I will be able to add some insight sometimes. I love all the posts. Thank you for letting me vent a bit!!

sarndrat · Dec 31, 2005

I agree with MOST of the answers and comments here and it gladens me to see them - is our job not hard enough without making judgement calls?? Wheather or not a person is so called "Drug seeking" what has it got to do with us - sure we are in a real bitchy profession, and by all means have an opinion, but don't you dare inflict that on the person who says they are in pain - remember pain is what the pt says it is - so come on girls, get out of this arena - you are not being asked to support an addicts habit, just treat their pain and get over the rest. IMP - what goes round comes around. How many times you heard, "they can't be in pain, look at them they just popped outside for a smoke" Who gives a contential - you want to get your Morphine, Management and Myths up to the 21st century and go with your patients perception of pain - treat the pain first and if you still feel they have a problem, treat that next.

leslie :-D · Dec 31, 2005

first, i would like to address chronic pain vs. acute.

people that suffer chronic pain can have vitals wnl.

they have acquired adaptive behaviors over the years and therefore can appear 'normal'; until they overexert themselves or breakthrough pain occurs.

i had a hospice pt.

from an automobile accident yrs before, his limbs were so contorted that they were knee to chest. both hands were also contracted. he told me the amt of pain he was in (very private gentleman) but after yrs of experience, learned to keep it to himself since no one believed him or could find an etiology. the only med he was prescribed was a muscle relaxer.

the other nurses i worked with also disagreed w/my findings as they observed him to be sleeping (therefore not in pain :angryfire ) and he would sing the blues alot.

i had a long talk w/the medical director, who finally agreed to prescribe him a duragesic patch,75 mcg and vicodin hp 2 tabs q 4 hrs prn. the only way i could attain this was to have the pt share his pain with the md.

my heart really goes out to those who suffer chronically yet md's cannot find a cause. after going through every conceivable test, the md recommends you to a psychiatrist! what an insult. but just because a cause cannot be found amongst those who suffer w/chronic pain, does not make it any less real or tolerable.

as for the drug seekers? their stay in the hospital is ltd. if there's an order for a narc, i don't pass judgement. but i do confer w/the md where a referral is made to a detox facility at discharge. the choice is theirs. sometimes we really need to walk a mile in a sufferer's shoes before we become less judgemental.

leslie