Perscription Drug Abuse

BSN75 · Aug 14, 2008

I work in a physicians office and it seems that half the new patients we see are drug seekers. It's sometimes very hard to weed out the pts who truly have pain from the ones who just want drugs. Most of the time there are red flags though. When a patient comes to us and lists an address that's over 30 miles away, that's usually our first sign. Many of these people see multiple docs and send all the RXs through their insurance, so eventually we'll get a fax from the pharmacy that lists all the different providers and narcotics they've had. Also we have anyone on narcs sign a contract. If they waiver from the terms of the contract in the least, we reserve the right to dismiss them as patients. It's sad that this has become such a problem. I've heard the new thing is to crush and snort Oxycontin- YUCK! :eek:

Trauma Columnist · Aug 14, 2008

The trend that we see in the ER is to only provide a 24 hour supply of narcotics and by that time the expectation is that the pt will f/u with their own MD/provider.

I work in nephrology and when I'm on weekend call and get called for someone's narcotics refill, I only provide the bare minimum to get them thru till Monday morning.

Also - in IL we have a website run by the state that provides us with what the patient's have received, the prescribing provider, when they filled the script, where, etc.. It is our responsibility to check this.

Nightcrawler, BSN, RN · Aug 14, 2008

I work in a physicians office and it seems that half the new patients we see are drug seekers. It's sometimes very hard to weed out the pts who truly have pain from the ones who just want drugs. Most of the time there are red flags though. When a patient comes to us and lists an address that's over 30 miles away, that's usually our first sign. Many of these people see multiple docs and send all the RXs through their insurance, so eventually we'll get a fax from the pharmacy that lists all the different providers and narcotics they've had. Also we have anyone on narcs sign a contract. If they waiver from the terms of the contract in the least, we reserve the right to dismiss them as patients. It's sad that this has become such a problem. I've heard the new thing is to crush and snort Oxycontin- YUCK!

I think that it is a little much to ask everyone who gets a prescription for narcs to sign a contract! I can understand people who use narcotics routinely, but if I sprained my ankle and needed to take Vicodin for a week or so I would be offended to be asked to sign a narc contract before I got my script.

TraumaNurseRN · Aug 14, 2008

Drug seekers are the most frustrating to deal with. That being said though, their pain may be legitimate with the abuse also going on. It's like my father who has rheumatoid arthritis and has been on vicodin prn for years. We all know RA is very very painful, but after 10 years of being on vicodin, it becomes nothing more than a tylenol for pain control at some point. A pain sufferer may take 2 vicodin when just one does not work. My father is not a drug seeker by any means but his RA doc refuses to order something stronger for break through pain.....I find that shameful. I see med lists daily in the ER and so many drug seekers get their meds from docs/multiple docs and I think....dang.....my father can't get crap from his doc. (Some docs write the scripts to shut the patient up)

BSN75 · Aug 14, 2008

"I think that it is a little much to ask everyone who gets a prescription for narcs to sign a contract! I can understand people who use narcotics routinely, but if I sprained my ankle and needed to take Vicodin for a week or so I would be offended to be asked to sign a narc contract before I got my script."

Let me clarify: all chronic narcotic pts sign the contract. Or if a brand new pt we're not familiar with requests narcotics, they sign too. I would probably be offended too if I were the patient, but it does let them know that this is an office policy and is for eveyones safety. It's not done to single them out. It simply states the directions for taking the narc, what pharmacy they'll use, and they sign that they are not getting narcs from other docs.

Christy1019, ASN, RN · Aug 17, 2008

originally posted by bsn75

i work in a physicians office and it seems that half the new patients we see are drug seekers. it's sometimes very hard to weed out the pts who truly have pain from the ones who just want drugs. most of the time there are red flags though. when a patient comes to us and lists an address that's over 30 miles away, that's usually our first sign. many of these people see multiple docs and send all the rxs through their insurance, so eventually we'll get a fax from the pharmacy that lists all the different providers and narcotics they've had. also we have anyone on narcs sign a contract. if they waiver from the terms of the contract in the least, we reserve the right to dismiss them as patients. it's sad that this has become such a problem. i've heard the new thing is to crush and snort oxycontin- yuck!

i think that it is a little much to ask everyone who gets a prescription for narcs to sign a contract! i can understand people who use narcotics routinely, but if i sprained my ankle and needed to take vicodin for a week or so i would be offended to be asked to sign a narc contract before i got my script.

personally i wouldn't be offended to sign it, hell you gotta go up to the pharmacy counter and write a short autobiography just to get sudafed lol, and the hell i go through to get my adhd meds is ridiculous, but they have those in place to prevent drug seekers from getting their drugs! therefore i think its a great idea, keep a record of who got what and how often, and if they don't wanna sign it, let em drive another 30miles to a doctor whose dumb enough to give it to them w/out checking!

Christy1019, ASN, RN · Aug 17, 2008

drug seekers are the most frustrating to deal with. that being said though, their pain may be legitimate with the abuse also going on. it's like my father who has rheumatoid arthritis and has been on vicodin prn for years. we all know ra is very very painful, but after 10 years of being on vicodin, it becomes nothing more than a tylenol for pain control at some point. a pain sufferer may take 2 vicodin when just one does not work. my father is not a drug seeker by any means but his ra doc refuses to order something stronger for break through pain.....i find that shameful. i see med lists daily in the er and so many drug seekers get their meds from docs/multiple docs and i think....dang.....my father can't get crap from his doc. (some docs write the scripts to shut the patient up)

sounds to me like its time to get a new dr! especially for rheumatoid pain, vicodin? that won't do anything anymore, i mean you build up tolerances to every medication, the doctor should be smart enough to realize this and switch him to a diff. medication so he can go back to a lower more effective dose of a diff. med... i hate doctors sometimes!

Christy1019, ASN, RN · Aug 17, 2008

:(sorry in advance, i know im kind of all over the place on this blog but this is one that i have a lot if issues i have regarding the patients/the healthcare system itself/physicians.

i hate that we as er nurses who clearly know these ppl are drug seekers, its their 45th visit to our er, their story keeps changing about where the pain is, and they're allergic to everything but dilaudid... imagine that.. even morphine... duh lol, have to give them what they want because the docs dont wanna deal with them, and i understand the need for getting em out quick so we can treat patients that really do need emergency treatment, but that type of care is only adding to their problem, all we are doing is enabling them further, therefore adding to the vicious cycle all over again! the healthcare system is flawed majorly in that area, there should be some sort of criteria, like enough "red flags" of drug seekers that they can be refused medication. (i saw it on untold stories of the er and she really was a seeker and the md refused givin her meds, she went hysterical, but after that got into treatment and got clean and came back to thank him! true story!)

the other issue i have is the guilt that us non abusers get shoved upon us because of the seekers, now when i went to my family doctor first after i was pretty sure i had clinical depression, and 99% positive i was adhd (parents/friends/teachers) were pointing it out, that doctor had the nerve to think i was just a college kid trying to get adderall to do good in school, so he gives me this 10 question mood disorder thing where u pick yes or no to stupid questions like "do u often shop excessively and spend money frivolously" (well being that i was a teenage girl who is bouncing off the walls and cant sit still to focus.. yeah i do that lol) and others like "do u often feel depressed and sad (well duh doc i just came in about depression)... based on that test, and that test alone, without even listening to what i had to say regarding why i believed i was adhd and depressed and all the research i brought with me... he tells me i'm bipolar!!! and put me on zyprexa which made me so sleepy i still couldnt study and it made me put on lik 30lbs which made me more depressed! finally i go see a psychiatrist and after 20min. of talking with me "she goes, i'm gonna have a discussion w/that pmp of yours and tell him that until he learns the actual s/s of bipolar, don't even diagnose a patient w/it again lol, and then told me "i could tell u were adhd w/in five minutes of meeting you", and then some other private stuff had come up and she totally agreed i was clinically depressed. she said "u've never even had a single manic episode! you have every right to be on medication for adhd, especially if your failing in nursing school" so she put me on adderall which is a controlled substance, so i get crap at the pharmacy about it sometimes like im a drug seeker even tho i get my same prescribed dose every month like clockwork, and it was like night and day, all a's, my self esteem went up w/the ssri, i did well in school, it was the right diagnosis. if i had listened to the fool earlier i'd look like an oompa loompa w/narcolepsy and no nursing degree! stupid docs thinking im the one abusing meds!

sorry that kind of went off on a rant... but in conclusion, i'm mad at the docs for enabling these types of pts so they dont have to deal with them, im mad at the healthcare system for letting it go on as much as it does, and im mad at those drug seekers that make it so much harder for us responsible people on medication to actually get ouur medication! :devil:

:banghead:

MAISY, RN-ER, BSN, RN · Aug 17, 2008

What happened to pain is what the patient says it is?

Of course there are always abusers....but unless you have a crystal ball or are an empath:rolleyes: can you really know how someone feels? How sad if they are being undertreated.

I work ER, we do give some pain meds, we also contact the patients physicians. I don't see the point of a one day supply. If the patient lives in my area I can guarentee their doctor will not have an appointment for them-one day wouldn't hold anyone!

For those ER abusers we write care plans on how they are to be handled...they have very specific rules, and the abusers usually don't come back.

The health insurance companies could nip the doctor in every town with one simple prescription of each drug monthly-or at least question it!

I had a bad car accident 20 years ago, occasionally I get spasms...one bottle of flexeril will last me a whole year! Getting that bottle is another story! I resent having to do a tap dance to get it! I don't need anything other than I asked for....I am sure there are lots of patients that have similar usage of meds and face that same hairy eyegball!

JMO again,

Maisy:wink2: