Overuse of opiates?? Opinions?

Nurses Safety

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would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. :uhoh3: :uhoh3: :uhoh3: :uhoh3:

I have been a nurse for a long time but apparently not as long as you to see patients in pain and to be deeming them all "junkies" and "drug seekers". It is impossible to know for sure what a patients pain is and people all deal with it in different ways-you know that. I know that there are the drug seekers out there that ruin it for the pts truly in pain, but you have to remember that addiction is a disease too. If anyone is to blame-it's the doc's that start all this in the first place. Please try to remember that addiction is not a moral deficit. Alot of the people you work beside may have been through the same thing(yes, nurses too). Please don't be so harsh.

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I believe it is OUR problem. It is societies problem as well. I'll tell you why it bothers me to dope up our drug seekers. First of all, many if not most of them are unemployed. Most are usually on medicaid and other forms of government assistance. Everytime I cater to a drug seekers request for demerol and such I'm thinking--ok, the government is going to take even more out of my paycheck so I can pay for this loser's drug habit yet I won't be able to pay for my child's college tuition. Do you really not see a problem here?

Sounds to me like the only problem here is a judgemental one. Who are you to say who exactly are the drug seekers and who are in pain? Can YOU tell by looking at them? Well, Hats off to you. You have more nursing skills than I. Remeber who will be judged in the end.

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Do you feel the same level of indignation at other Medicaid recipients such as non-compliant diabetics, smokers who get CA, chronic heart pts. who continue to smoke and eat the wrong diet, etc?

Even an addict is entitled to pain relief, and that may include the use of narcotics. This is not my opinion, it is in all the current literature on pain mgmt. (Surely you don't suggest that a "seeker" should have surgery/broken bones/sickle cell crisis and just "suck it up.")

I mentioned in a previous post that I'd had a bad exp in the ED with a judgemental nurse. Because I had been in the ED before with migraines, she immediately labeled me and blew me off. Thank God the ED doc didn't, or I may not have lived.

Unless someone is gifted with the ability to see inside a pt's body and know for a certainty that his pain is real, IMO it's better to give the pt the benefit of the doubt.

And we ALL pay taxes for things we don't agree with. That's life in an imperfect world.

You sound like an excellent nurse and able to view patients the way they ought to be with no judgement. I can't believe some of the responses from nurses that have absolutley no compassion. Keep up the good work!!

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Dear heavens, this post made me want to cry. I am so sorry for what you went through! (((((HUG)))))

You hit it right on the money!!! I agree with every thing you have said. I have been a patient myself and looked at by nurses and could tell that they just think your " another drug seeker" . It really is too bad that so many nurses are still so narrow minded that they believe they have the power to see inside someone and know their pain. Thanks for that post. You have said it all.

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Moia, thanks for sharing your story. Gives a nurse much to think about.

I refuse to get defensive. Your pain and you are not the type of patient I was talking about. I can't say I've seen anyone talking about using pain medicine to feel superior, but your perspective is entirely different and I will quietly dismiss myself from this discussion.

I will only say there is a difference between venting one's frustration and actually acting on that frustration by not believing a patient leaving them suffering when they say they are suffering. I'm not that kind of nurse, but as I said I refuse to defend myself or my venting.

Even if you are not "venting" where a pt can actually hear you, you still relay a demeaning message to that patient. You can tell when a nurse is doubtful of you and it's too bad for those poor patients in pain that are afraid to ask you for any relief.

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Specializes in ER, ICU, L&D, OR.
I have been a nurse for a long time but apparently not as long as you to see patients in pain and to be deeming them all "junkies" and "drug seekers". It is impossible to know for sure what a patients pain is and people all deal with it in different ways-you know that. I know that there are the drug seekers out there that ruin it for the pts truly in pain, but you have to remember that addiction is a disease too. If anyone is to blame-it's the doc's that start all this in the first place. Please try to remember that addiction is not a moral deficit. Alot of the people you work beside may have been through the same thing(yes, nurses too). Please don't be so harsh.

Addiction may be a disease

but the question here is

Is it my job to feed an addiction

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for those people in physical pain, narcotics are appropriate....

but the stark reality is, there are definite narc seekers to feed their emotional pain and addictions, and it is those people that some of us are talking about, that can make it unfair to those who are actually suffering.

i highly doubt there are nurses that automatically deem all patients med seekers.

and as a nurse that was instrumental in implementing a pain mgmt. protocol at my former place of employment, i represent thousands of nurses who are genuinely sensitive and sympathetic to those who suffer, and who are quite experienced in assessing pain.

but it's those few bad apples that can bruise the entire population.....

leslie

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Addiction may be a disease

but the question here is

Is it my job to feed an addiction

But my point is: How can you be so sure it is an addiction? Do you just "know" by the way they look or act? How do you know that their behavior isn't due to pain? Isn't pain subjective? You are supposed to take it as they say it is. Nurses are not the ones to decide whether we should give a pain med that is ordered when the patient asks for it. The Doctor orders it and it is his call , not ours. The only reason I think that we should withhold ordered pain medicine is if the Pt is too out of it to need it. No Nurse is supposed to feed an addiction and I doubt that they were admited for "addiction treatment" or you would be working on a detox unit. It is your right to practice nursing the way you see fit though, it is your license and reputation. I know that some Doc's are clueless when they over order pain meds to the point where it is almost dangerous and the pt is always doped, but it is our responsibility as nurses to advocate for the pt and try to get something changed or at least try to suggest a pain consultation. You shouldn't punish the pt just because you think he is a "junkie". That's just not right. And patients do know when you are doubting them and I am sure that they sense that and makes them feel very worthless. What if that "junkie" really is in pain and you choose to withold or "not feed his so-called addiction?" I believe that would be very poor nursing care. That's just the way I feel. (Not trying to offend or attack personally)

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Addiction may be a disease

but the question here is

Is it my job to feed an addiction

Have you heard of pseudoaddiction? It's when pain is undertreated and the patient acts like a drug seeker, clock-watching and always seeking more. It looks like addiction but they are just trying to get out of pain.

I did have a pt with substance abuse problems today . . . I confess I didn't run to get him morphine when he complained of back and buttock pain. I told him to try getting up to a chair first (and I know he could) because anyone would have pain after sitting on their rather large butt all day. He wouldn't even consider getting up, and he didn't say it was because it hurt too much to get up. He just blew me off. If he won't even consider another suggestion, well, I do think that's probably drug seeking.

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Teeituptom's remark about people 'driving around w/ fentanyl patches', etc. is particularly offences. :nono:

I was diagnosed about eight years ago w/ severe stenosis and degeneration of my C-spine, resulting in nerve compression and damage. This began as a gradual discomfort which progressed to intractable neck and arm pain, as well as numbness, parasthesias, and decreased motor function. (they started call me 'ol dropsy' when I was scrubbed-in) :imbar

I have had THREE cervical fusions, which kept me out of a wheelchair but left me w/ permanent nerve damage. The result of this is chronic pain, including episodes of severe breakthrough pain. (Think of a hot poker being jabbed into your posterior neck several times daily!) Otherwise, I am in my mid-thirties, of average weight, happily married and a very good nurse!

I am also on a 50mcg Fentanyl patch, prn hydrocodone 10/325, as well as other non-opioid medications. I will (hopefully) have a spinal stimulator implanted within the next two months. Up until two months ago, I was working full time as the Neurosurgery Coordinator for a major community hospital. NEVER ONCE have I EVER felt, behaved, or been accused of appearing 'medicated', seeking drugs, or using poor judgment. On the contrary, if I were to NOT take my meds, or have a patch that's a 'dud', the ONLY thing that kept me from driving, working and functioning as a human being and a nurse, was the PAIN. My colleagues were aware of this, and would be glad to support me without pause if so challenged. I resigned from my position because it required a 25% clinical aspect, which was intolerable due to the pain. I was forced to give up my love - perioperative nursing. It was a devastating blow.

Before I was an O.R. nurse, I did a stint in correctional nursing (both med-surg and psych), I dealt daily w/ drug seekers and addicts.

The significant difference between addiction and dependence is this:

Addicts have no pain and seek medication to escape life.

Med dependent people are prescribed medication to prevent pain, and to return normalcy to their life.

God help any nurse who doesn't treat EVERY patient w/ compassion and understanding. One day, you or a loved one might have this same situation, although I wouldn't wish this on anyone.

As nurses we do NOT have the right to judge. If a physician diagnosis a pt w/ chronic to severe pain, it is our duty to assess that pain and administer the prescribed medication as ordered!! Our conscience may require that we report potential abuse, HOWEVER, pain is still SUBJECTIVE, and the moment we forget that, the moment our ability to treat our patients w/ subjective compassion is lost.

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I'm almost afraid to post my opinions. Let me start off with this - I graduated in May of this year and will be the FIRST to admit that my experience is limited. I have seen patients in severe pain whose pain was discounted only to discover later on that their pain was real and the delay in diagnosis was detrimental. I have also seen patients who became addicts having never touched an illegal drug but from developing a dependance after receiving pain meds for a legitimate medical complaint. I dislike oxycontin intensely. When a patient's oxycontin is discontinued, they suffer withdrawal symptoms including abdominal and bone pain. It isn't pleasant. Oxycontin used for terminal illness or chronic, unrelieved pain I can understand. Oxycontin for the treatment of more transient or temporary pain, I cannot. When the med is discontinued, the withdrawal pain is real - the patient doesn't know it is withdrawal, they just know that they are in pain and return to their PCP or the ER for something to stop the pain.

Follow the doctor's order? That's all well and good but, sometimes my conscience nags me to consider the toll it is taking on the patients' lives. There are many cases of patients who became addicted to oxycontin and whose lives were ruined by it. There is a campaign to ban oxycontin in some of the Canadian maritime provinces - even some MD's are pushing for the ban.

Yes, pain is what the patient says it is - but, we need to ask ourselves (as one poster has already stated), what is CAUSING the pain? If the cause cannot be cured, then by all means, continue long-term pain medication at a maintenance dose that allows for life to be lived. But, if the pain is actually due to a physical dependance on pain medication, then gentle withdrawal is necesssary and should be assisted and the patient should be counselled about the withdrawal. Individuals addicted to street drugs will seek assistance with their addictions when THEY are ready. But, if the addiction is to a prescription medication and there is no longer a physical need for the med, then the medical system has CREATED the problem and should take the responsibility for it and the steps necessary to correct it.

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This thread has been an interesting read.

I've been doing research into pain and am working on competencies for our nurses who, as Fab4 has said, are working with outdated information.

I have a number of sites that relate to pain but I'm looking specifically for something I can use to write pain competencies for our nursing staff.

Any ideas? We really need to educate our staff.

Thanks.

steph

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