Prescribing narcotics to drug seekers

[Djuna]

The ED where I work is inundated with drug seekers as I assume all US EDs are. I have brought to my Managers attention numerous people who are frequent fliers, but nothing is ever done about it. I am not at the point where I want some serious questions answered and some changes made to our narcotic prescribing policy but I am unsure how to go about it.

Does anyone have any ideas?

Medical Board, the media, higher management? Who would I speak to?

[lifelearningrn, BSN, RN]

Wow- you're there to treat the patient.. not to decide whether they deserve pain medications or not.

With the technology in pain management, there is no excuse for allowing a patient to be in pain... just because they are 'drug seeking' doesn't mean they aren't in pain.

I don't think this issue needs to be addressed in a manner of more regulation that will put even more fear into medical doctors not to prescribe medications.

Not all pain med addicts became addicted because they like getting high. They are dependent on the drug to take the edge of some chronic pain.

A lot of people looking to simply get 'high' often find their drugs on the streets. Have some compassion.

[Djuna]

Wow- you're there to treat the patient.. not to decide whether they deserve pain medications or not.

With the technology in pain management, there is no excuse for allowing a patient to be in pain... just because they are 'drug seeking' doesn't mean they aren't in pain.

I don't think this issue needs to be addressed in a manner of more regulation that will put even more fear into medical doctors not to prescribe medications.

Not all pain med addicts became addicted because they like getting high. They are dependent on the drug to take the edge of some chronic pain.

A lot of people looking to simply get 'high' often find their drugs on the streets. Have some compassion.

Oh sweety, wait til you've been around as an RN before passing judgment on me. You have no clue what you're talking about.

[lifelearningrn, BSN, RN]

I have very strong beliefs on drugs, regulations, and addiction based my my own research and political beliefs. You dont need to be working as a nurse to have informed opinions about addiction, active pain management and recreational drug users. (None of which I am personally)

[JKL33]

Not all pain med addicts became addicted because they like getting high. They are dependent on the drug to take the edge of some chronic pain.

Agreed. And some patients with chronic pain have conditions for which narcotics have been shown to make that pain WORSE, who continue to seek out narcotics despite having been counseled by appropriate pain management specialists regarding that fact.

A lot of people looking to simply get 'high' often find their drugs on the streets. Have some compassion.

And there are a great deal of Rx narcotics on the streets via the exact path that the OP is attempting to discuss. You are surely mistaken if you believe that everyone seen in an ER for a pain complaint who receives a narcotic Rx is actually planning to use that Rx for their own pain needs.

I appreciate the spirit of compassion you wish to emphasize, but you really do seem to have a limited understanding of the complexity of these issues.

[lifelearningrn, BSN, RN]

And there are a great deal of Rx narcotics on the streets via the exact path that the OP is attempting to discuss. You are surely mistaken if you believe that everyone seen in an ER for a pain complaint who receives a narcotic Rx is actually planning to use that Rx for their own pain needs.

That is a very good point. And I agree that I have no experience in this area as an actual health care worker.. but I do have lots of experience with addiction (not my own) and have formed some very (some might call radical) opinions about decriminalization of controlled and illicit substances which would actually address that very issue. But that is definitely a different thread.

[Christen, ANP]

I agree with some of the posters that this is a provider problem. If the ED physician or NP or PA wasn't handing the narcs out so easily, there would be less of a problem. I know one local facility that became "known" as the place where you could get narcs for any complaint - it got to the point where the HCPs were being harrassed just trying to get to their cars! Ridiculous. Eventually, the provider who was writing for the narcs lost his license. People who use and abuse narcotics quickly find out what facilities hand out the narcs the easiest, and flock to them.

As a nurse, you have to be cautious here. You aren't the provider writing for the meds, and you don't want to put yourself in between the drug-seeking patient and the physician who diagnosed the pain and wrote the scripts. I agree with the poster who talked about narcotic contracts. That would be an idea you as the nurse could present, take charge of, and make a policy that the physicians would have to follow. Neatly circling around the MDs/etc, who would have to comply with policy.

If it gets really bad, to the point where it's dangerous for you to walk out -- there is always the DEA. I can think of a patient who was identified as a drug-seeker, the police were called, and they were arrested. Narcotic diversion is an arrestable offense in my state.

[nurse2033, MSN, RN]

I read about an ER that simply stopped giving prescriptions for narcs, ever, for anyone. I can't remember the hospital but you might google it. I would gather as much real information as you can from publications on the the subject. Don't forget that admin might not care, and might consider the loss of business and revenue if such a policy were put forward. From a nursing perspective you would want to find ways to help these people, screen for them, and generate a policy. Here is Colorado we have a state data base where providers with DEA numbers can check the prescription history of any individual. It is widely used to see what prescriptions the patient has filled recently. On that basis a provider can refuse to write a prescription, and I even heard of one case where a physician had the patient arrested for fraud! Yeah! If your state lacks such capability, maybe you could spearhead a legislative campaign to start one. Best of luck.

[tencat]

If you can't answer my specific question then please don't respond. I'm not interested on a debate on who needs narcotics for chronic pain. I am interested in helping our community address the prescription drug problem and ways our ED can control the wanton prescribing of narcotics.

I have to question what 'wanton' prescribing of narcotics means.....in order to curtail what some may feel is a 'wanton prescription of narcotics' YOU WILL BE PROHIBITING THOSE THAT NEED IT FROM GETTING IT. Think about that before you call in the troops for a crusade.

[jwyze11]

Ive been working in the ED for almost 10 years and at several different ER's. You know who is drug seeking, and these people are so crafty. It is definitely not a chronic pain issue. Most of them have been fired by there PCP, and jump from ER to ER because they are addicts. The problem is, ER physicians give narcotics out like candy in some facilities while others do not! These pts know which doctors will give them there fix, and which ones will not. There is no consistency! In one ER I worked in there was a No Narcotic Policy in place for those pts with "chronic pain", or your "frequent flyers", and what do you know: they stopped comming!

[tewdles, RN]

My experience is that there are people who abuse substances amongst us...

and there are people with chronic pain issues. It is not always easy to determine who is who.

When we see "frequent flyers" as drug seekers rather than as persons with some health issue needing care we run the risk of causing suffering, even if unintentional. As nurses, our role demands that we demonstrate unconditional regard for our patients and that we advocate for them individually. Making blanket policies about drug seekers does neither, IMHO.

[enchantmentdis, BSN, RN]

JKL33, thank you for your post. I appreciate the dispassionate outside view. I admit, I am angry. I am an overseas RN and in my country this phenomena is not as widespread. I thought I could facilitate change but I am obviously wrong.

Your post has made me rethink things a bit.

Again, thank you.

You can blame our flagrantly liberal politics in America for these problems in the ER. Lawyers want to make money and these drug-using bums only grow a brain when they decide to sue a hospital for abuse because they can't get their drugs filled out by an ER each week.

[canoehead, BSN, RN]

I moved from Maine to Canada a couple years ago, and it's amazing to see the difference in prescribing practices. What we gave out in a day in Maine would do us a week where I work now. We're very liberal with the IV meds while the patient is with us and getting diagnosed, don't get me wrong. Where the axe comes down in when it comes to outpatient scripts. If they don't have an acute problem, we give them a dose in the ER and tell them to call the PCP of record. It's absolutely amazing how the proportion of frequent flyers vrs acute illnesses changes with a small change in practice.