Overuse of opiates?? Opinions?

teeituptom, BSN, RN · Jul 7, 2004

The best thing you can do is not worry about it, It will just drive ya crazy if you allow it to.

In todays everyone must be painfree world, pain meds are given out rather readily.

If im ever in an accident, I dont want the other people tested for alcohol but for drugs.

People allowed to drive wearing fentanyl patches and taking soma and po dilaudid while they drive.

Majorly scary

Gator,SN · Jul 7, 2004

NiteShiftNut,

There are patients that are addicted and they show up in every unit of the hospital. Doctors supply high doses of narcs to these patients while they are admitted and during outpatient treatment. WHY? I don't know. Lack of caring or understanding about pain management perhaps, possibly because these patients do have real chronic pain and over time become addicted because the doctor has allowed them to become dependant rather than looking for the real problem or solution. I medicate patients that I know are in pain as well as those that ask for ordered pain meds even when they "look" fine. The reason: because I have a family member with chronic ABD pain that is often overlooked and almost cost her her life because several nurses and physicians thought that they knew better what "real pain" looked like. She was labeled a drug seeker in the ER and sent home. She was misdiagnosed several times. We heards lots of apologies while she was on the vent fighting for her life. Pain that would put me on my knees, she has learned to function with. Pain that most people couldn't tolerate, has become her way of life. It is not up to us to judge another persons pain. As a nurse, we advocate for the patient. Ask for a consult with pain management or social services. DO something to give them an alternative. Just please don't judge.

Gator

Rapheal · Jul 7, 2004

This is a legitimate issue to be discussed. I do not want to judge someone's pain but I too see patients admitted with intractable n/v who are ordered 50mg Demerol q4 with 25 Phenergan. Some of these patients are on the floor for 2 hours and start demanding their dosages be increased and also demand to be off NPO status because they are hungry. These patients many times have psych issues. The docs do not want to be bothered so they increase the dose even though the patient may have been admitted a half a dozen times in the last year with no diagnosis that supports their c/o pain.

So what to do? I think that when they are medically cleared we need to look for other problems such as psych or addiction problems. Sometimes that is hard to treat as many psychiatrists will not treat medicaid patients or the patient is unwilling to admit addiction. We are not helping these people by feeding their addictions and not treating their psych issues.

There will be some patients who are misdiagnosed and will have true unresolved pain issues. But truthfully- when they are discharged they will not be receiving IV demerol. So they need further treatment for pain mgmt.

We need to stop just treating pain and look into curing or managing pain. One definition of insanity is to deal with a reoccuring problem the same way, again and again, while expecting a different outcome. This is what we seem to do for these patients.

leslie :-D · Jul 7, 2004

unfortunately it is the narc seekers that disqualify those in real pain. it makes for a cynical perspective and difficult to separate the chaff from the grain.

leslie

z's playa · Jul 7, 2004

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:

100mg an hour? holy crap.

surprised he/she didn't sieze. or did they.

NiteShiftNut · Jul 7, 2004

just to clarify, i did say 100mg of demerol every hour. yes. and the most disturbing part of that situation was the fact that the patient wasn't even slighty affected by such a large dose. he was still awake, cursing at the staff, threatening to leave ama if we didn't call the doctor and get him more pain medicine and a diet order that would allow him to eat a cheeseburger. please, if you are in that much real pain, you would not be thinking about a big mac. i agree that there are people who are in real chronic severe pain, i don't doubt that, and i believe many times they fall through the cracks because we are so used to seeing the drug seekers that we become suspicious of everyone, but 9 times out of 10, these patients are just looking for a high and a free meal and the doctors are more than willing to hand it to them. i know my complaint is a waste of breath, i might as well be beating a dead horse, but thanks for letting me vent. :stone :stone :stone

SmilingBluEyes · Jul 7, 2004

good grief, we don't even use demerol anymore where I work. 100mg an hour? I am stupefied , frankly, that any doctor would order it. And I agree w/Leslie, these few "abusers" ruin it for the rest of us who have real pain and are afraid to ask for anything because we may be acused of "drug seeking" or see our nurses/doctors roll their eyes at us when they think we are not looking.....too bad.

LBaker517 · Jul 7, 2004

I do not agree with judging someone's pain. That's the doctor's duty. If he wants to give out pain meds like candy, then that's fine. As long as I'm not the one that is writing the script. You never know what that person is feeling regarding pain. You have no idea where that person has been either.....

i got my wisdom teeth pulled a few yrs ago, the pain med they gave me did NOT work. i told the nurse and the doc., who, while i was under "sedation" said I must take a lot of illegal drugs for it not to work. Needless to say, I felt a huge amount of unnecessary pain that day.

dont judge. i don't want to be judged. :coollook:

Tweety, BSN, RN · Jul 7, 2004

Deb, for many narc addicts (including nurses who divert) demerol is a drug of choice. Conviently they are "allergic" to morphine, dilaudid, NSAIDs, etc. until demerol is their only med of choice.

Why do docs order it? One, to shut the patient up so they can take care of other people and not be called all through the night. But also, because not treating pain appropriately can get them sued.

So patients say they are in pain, nurses call the docs, and the meds are ordered. I have a reapeat offender this week. Just discharged a week ago after having a million dollar workup for abdominal pain, severe and unrelieved with heavy narc doses. Nothing wrong, but did get sent home with a psych consult so we tried to address his issues. This week he's back in the hospital same thing. Only this time after a couple of days he started wicked dt's and is hallucinating and restrained, and interestingly enough not complaining of pain, doesn't wince on palpation like he did when he came in. sigh..

They are a challenge and a drain, and make good nurses jaded to legitimate complaints of pain, or chronic pain patients.

JimmyMallo · Jul 8, 2004

I think one of the BIG problems I see is that we are nurses are so damn judgemental. If a patient has standing orders for narcs and states a specified pain level the nurse gives the drug, there is no judgement call orders are orders. If the person is an addict that is the DOCTORS fault! Why would we as nurses say something like a few addicts ruin it for everyone!!! We despense medication ordered by doctors, if a doctor orders narcs for an addict them I give the drug if I start looking for addicts I see one in every patient and quality of care suffers. Why would I give the addict the power to lower my overall nursing care? If he talks the doc into narcs then he has a problem, but it's not my problem. Pain is little understood and poorly treated in general and I feel nurses should be more open in general to pain management. If you serve a few addicts to help 1 patient in genuine pain who looks OK to you then I say good job. What is it that makes drug seekers soo important to nurses that we alter our care based on our perception of how patients like the meds? Bottom line, it is the person who is in pain that is important not the drug seeker. If everyone gets their ordered meds every time we would have happy patients and happy addicts and less stress on ourselves trying to find the difference.

Tweety, BSN, RN · Jul 8, 2004

I think one of the BIG problems I see is that we are nurses are so damn judgemental. If a patient has standing orders for narcs and states a specified pain level the nurse gives the drug, there is no judgement call orders are orders. If the person is an addict that is the DOCTORS fault! Why would we as nurses say something like a few addicts ruin it for everyone!!! We despense medication ordered by doctors, if a doctor orders narcs for an addict them I give the drug if I start looking for addicts I see one in every patient and quality of care suffers. Why would I give the addict the power to lower my overall nursing care? If he talks the doc into narcs then he has a problem, but it's not my problem. Pain is little understood and poorly treated in general and I feel nurses should be more open in general to pain management. If you serve a few addicts to help 1 patient in genuine pain who looks OK to you then I say good job. What is it that makes drug seekers soo important to nurses that we alter our care based on our perception of how patients like the meds? Bottom line, it is the person who is in pain that is important not the drug seeker. If everyone gets their ordered meds every time we would have happy patients and happy addicts and less stress on ourselves trying to find the difference.

I hope I wasn't sounding judgemental becaues I was merely relating. Yes, a patient says he is in pain and we do what we have to.

It's when you give them 125 mg of Demorol and they give the academy award winning performance of a lifetime and you wake up a doc at 2AM, get yelled at, go into to give them their new pain medicine and they are sound asleep, off the floor smoking, eating calmly, laughing at a TV show or yaking on the phone. Only to have the show repeat itself in another hour when they are in severe pain again. Judgement, no. Frustrating yes.

Do we need to be able to honestly vent our frustrations without being labeled judgemental? Absolutely.