Patients that are not allowed narcotics

[Jo West]

I am a student nurse and just finished a preceptor rotation where I had opportunity to be in the ER with a RN preceptor. There were patients who arrived there with various complaints that were termed "frequent flyers." The ER personel had orders not to give narcodics to those thought to be misusing drugs. I witnessed some, one patient in particular, that left furious stating that she was going to another ER in the region. The PA had the staff and himself call ERs in the area to make aware of this patient's order not to receive narcodics. I felt bad for this patient. I didn't know what to do for the patient. I asked some nurses there, and didn't get any specific answers. Do ERs normally have literature for these patients to read to seek help or counseling, or are any specific groups (like the police) alerted? Any ideas on how these situations are handled?

[SlightlyMental_RN]

In my area, they are often directed to my unit (chemical dependency detox/psych.)

[PostOpPrincess, BSN, RN]

This is real life.

Some of these people are not fixable..

They can be referred to rehabs, but most of them do not follow...

Accept it.

[Altra, BSN, RN]

Let me tell you a couple of stories from my first 3 months as a new nurse in the ER ...

The first time I encountered Eve* (not her real name) she was well-dressed, soft-spoken, and was able to describe her complex migraine symptoms in great detail. She was cooperative, pleasant, and seemed appreciative of care -- until I administered her 3rd dose of IV Dilaudid in a port high up the tubing of the IVF she was getting. Then her demeanor completely changed. While 30 seconds before she had said, "you're so sweet to look after me like this" ... her tune was now an angry, "I like my medicine pushed in fast down here!" (pointing to her hand) I observed her playing out this scenario several more times before our docs got tired of being her drug pushers. She was one of the most manipulative addicts I have ever seen.

Then there was Janice. Janice had end stage lung CA and was getting some home health services despite a rather ... off-the-grid lifestyle. She looked worse each time she showed up in the ER complaining of breakthrough pain and that her Mediport was not functioning and stating that she was enrolling in hospice "next week". And her port would indeed be messed up, because Janice and her boyfriend would attempt to inject heroin & crack into it.

Both of these women initially brought out my new nurse indignation -- here was someone who needed something and I was going to be the one to fix it for them! A little experience is a great teacher.

So yes, probably every ER has a handful of frequent flyers whose behavior has caused the ER docs to decide that enough is enough.

[shoegalRN, RN]

I am an ER nurse and I'm sorry, but some pts do not need pain meds for PAIN. They need it to feed their addiction. And yes, there are quite a few frequent flyers on our ER list that the docs will NOT give pain meds to, no matter what.

And after I worked the floor and CAUGHT a couple of inpatients actually sniffing oxycontin extended release then I am even more skeptical.

And some of the pancreatitis patients are starting to get the side eye from me. Whenever a pt can use the term "mcgs" (pronounced mikes) and ask how much did the doctor order, and how many mcgs are in one mL, and want to see you draw it up and try to talk you into giving them the extra amount that should have been wasted, then I have a hard time believing they are really in pain.

And if you can set your cell phone for the next time your "fent shot" is due and your respirations are down to 6/min and you get Narcan and is IRATE we took you out of your "heroin nod", then I have a hard time believing you are in pain.

And the best one? "Push it fast" even with fluids going and they want it to the closest port to the vein instead of the top port closest to the fluids hanging.

So yes, our docs are tired of getting called in the middle of the night by the floor nurses for "come to Jesus meetings" with the patients who are DEMANDING the doctors come and see them at 0200 to discuss their need for more pain meds.

[Penelope_Pitstop, BSN, RN]

Apparently the EDs in my health care system have a database called "exceptional patients."

These patients have been informed by the ED physicians that they will receive no narcotics if they come to the hospital. It does not stop a number of them from coming to ED almost daily.

[BridgetvdpGN]

Pain is what the patient says it is. They do not come to the ER for rehab. I personally feel horrible giving someone narcotics when it's obvious they are addicited, but it is unfortuantely, the way it works

[lifelearningrn, BSN, RN]

So is everyone coming into the ER complaining of pain automatically suspected of drug seeking behavior?

Is it possible any of these people have legit pain control issues and just need help?

I guess I feel bad for people who are in so much pain and are denied medication that is READILY available because medical staff has decided they don't really need it.

[wtbcrna, MSN, DNP, CRNA]

So is everyone coming into the ER complaining of pain automatically suspected of drug seeking behavior?

Is it possible any of these people have legit pain control issues and just need help?

I guess I feel bad for people who are in so much pain and are denied medication that is READILY available because medical staff has decided they don't really need it.

Worked in ER much?

Chronic reoccuring pain doesn't belong in the ER, and chronic use of opioids only makes pain worse not better. Log In Problems

[lifelearningrn, BSN, RN]

No- I've never worked in the ER.. but I imagine if someone was in serious pain and the doc was closed they'd make their way there.

I don't know much about prescription pain meds other than I refused to take them after my csection because they made me feel horrible!

[Liz520]

Absolutely not, everyone coming to the ER complaining of pain is not considered a drug seeker, its quite the opposite. If that were the case then 99% of the people arriving to the ER would be labeled “drug seekers.” When patients arrive, pain is addressed right away.

The “drug seekers” and or “frequent flyers” at my hospital have lots of documentation about their drug seeking behaviors, interventions, and help (i.e. pain management clinic, dependence programs). Wtrbcrna is right about chronic pain not belonging in the ER but that’s where the addicts go in hopes for a quick fix.

[Lunah, MSN, RN]

We usually give patients the benefit of the doubt ... until they lie to us and it becomes clear that their goal is to obtain narcotics, be it for sale or personal use. Our providers can check a database to find out which narcotics they got filled, when, where, and who prescribed it. It's very handy.

That's not to say I don't feel sorry for them, because having nothing to focus on but your next fix doesn't sound like a fun life at all. But that doesn't mean I want to be a part of the problem, either. We can refer them to addiction treatment all we want, but they typically don't go until they realize they truly have a problem, and want help.