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?

[jb2u, ASN, 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.

Consider this....saying that a drug seeker should not get narcotics IS treating the patient. Giving the narcotics would be treating the problem, right? I mean, a patient comes in with a toe fracture, and I give them smoking cessation advice before they leave. Why? Because I am there to treat the patient as a whole and not just the problem they are there for. Now the patient has every right to tell me to go fly a kite, but that doesn't mean that I should give them a pack of smokes and send them on their way. If this patient has a problem with pain med addiction, and I truly care about helping them, then I will advise them to seek help for their addiction and not a Rx for pain meds. If I don't care about them, I'd just give them the Rx tell them have a wonderful day and say "I am glad she's gone. She just wanted pain meds anyway."

Yes, even addicts have pain, but that does not mean they should be given an Rx every week, especially if they were given d/c instructions to see Dr. so&so for their stomach pain, headaches, flank pain, etc. and they never go see Dr. so&so. And before anyone states how "going to the doctor costs money," so does getting an Rx filled!! Now I agree, trying to sort through who is in pain and who is not is very tricky. Pain is subjective. However, IMHO, I believe that as nurses that care, truly care, for our patients we should TRY to figure out who is in need of pain meds and who needs help with addiction, no matter how difficult that task may be.

[Fribblet]

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.

PCPs can prescribe narcs too. People aren't being prohibited from getting a script just because an ER doc isn't writing for it.

Think about that.

[Tweety, BSN, RN]

You can blame our flagrantly liberal politics in America.......

No it's Mr. Bush's and the conservatitve politics fault as the problem escalated under his watch. Sorry couldn't resist.

I do agree with you that that MDs and EDs are afraid of lawsuits and the liberal settlements these patients get. Also, sometimes, it's just as easy to write a script and get them out of the ER and on their way, than listen to their dramatics.

The prescription drug addiction problem is rampant and becoming a greater and greater problem. The laws are so lax here in FL drug seekers come from other states to get drugs. Even grandmothers are in on the drug selling act, selling Percocets on the side to make ends meet.

To the person that claimed the OP had no compassion, it's not that at all. One can have compassion for the addicted person presenting to the ER only to get drugs (not to treat chronic pain) and still express frustration with that and try to keep them from getting their drugs. They are sick people and need help. Unfortunately in these times of budget cuts, there's not a lot of help out there to get them what they need. But it certainly isn't societies job to keep them supplied in drugs either.

[inteRN]

I totally understand where you are coming from...

I just quit an ER that was majority chronic prescription drug seekers. Some of these people would give fake identity (OK-- that's fraud), fake phone numbers, fake SS#, and some would come straight from the ER across the street. Ti was out of control. They would get LIVID too if the doctor did not give them what they "wanted". Guess who gets to put up with this temper tantrum? The nurses. Treated them with more narcs can be dangerous in some cases.

The ER I work at now, some pts get pain contracted which means if they demonstrate behavior of drug seeking example( comes in every 2 days and was given 20 vicodin) there is no way they would finish all that if taken appropriately...

Anyway, I was sick of nothing being done about it at my last job. I would go to the Medical Director because this can be dangerous the patient....plus it takes valuable time away from more critical patients....Good luck! :)

[ehanke00]

This was a really interesting topic. I am a new graduate nurse and will be starting in the ER. Prescribing narcotics to drug seekers is a problem and I think that there should be some type of regulation as well. I like the idea of having the patients sign an agreement about a narcotic policy. Nurses who have compassion do worry about this issue because we are treating the whole patient and want what is best for that patient. However, as one person posted, it is ultimately up to the physician to prescribe or not prescribe the medications. I do not think that means that we should just let it happen either. Maybe one of the first steps could be to conduct some type of research and gave relevant data and present it to the hospital the you work at or go to the state level and present it to a legislator. I do agree that some people really do have chronic pain and need medication to control it, but I think with the help of objective assessment one can differentiate a drug seeker from someone with chronic pain.

[Mrs.0]

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.

The problem is, the emergency room is not the place to be demonstrating unconditional regard for a patient who is attention/drug seeking. Sounds like a social work issue.

And the nurses can get back to treating EMERGENCIES.

Not trying to be insensitive, but if a patient has been to the emergency room several times for the same "problem" that "no one" will solve, perhaps they are not following up appropriately.

Or they are drug seekers. Either way it's a major drain on emergency room resources.

[Fribblet]

And, lets be honest. There's a major difference between a CA patient that frequently visits an ER for various complaints like, persistent NV, fever, pain that is beyond normal, and a patient who visits frequently for vague abdominal complaints, has received multiple CT scans that are perfectly normal, whose lab work looks better than mine, and still (after 2 years) has not bothered to follow up with the GI doc that they were referred to.

Let's really not start trying to confuse the two.

[Mrs.0]

And, lets be honest. There's a major difference between a CA patient that frequently visits an ER for various complaints like, persistent NV, fever, pain that is beyond normal, and a patient who visits frequently for vague abdominal complaints, has received multiple CT scans that are perfectly normal, whose lab work looks better than mine, and still (after 2 years) has not bothered to follow up with the GI doc that they were referred to.

Let's really not start trying to confuse the two.

Well said.

[inteRN]

Consider this....saying that a drug seeker should not get narcotics IS treating the patient. Giving the narcotics would be treating the problem, right? I mean, a patient comes in with a toe fracture, and I give them smoking cessation advice before they leave. Why? Because I am there to treat the patient as a whole and not just the problem they are there for. Now the patient has every right to tell me to go fly a kite, but that doesn't mean that I should give them a pack of smokes and send them on their way. If this patient has a problem with pain med addiction, and I truly care about helping them, then I will advise them to seek help for their addiction and not a Rx for pain meds. If I don't care about them, I'd just give them the Rx tell them have a wonderful day and say "I am glad she's gone. She just wanted pain meds anyway."

Yes, even addicts have pain, but that does not mean they should be given an Rx every week, especially if they were given d/c instructions to see Dr. so&so for their stomach pain, headaches, flank pain, etc. and they never go see Dr. so&so. And before anyone states how "going to the doctor costs money," so does getting an Rx filled!! Now I agree, trying to sort through who is in pain and who is not is very tricky. Pain is subjective. However, IMHO, I believe that as nurses that care, truly care, for our patients we should TRY to figure out who is in need of pain meds and who needs help with addiction, no matter how difficult that task may be.

Very VERY good point. I think some nurses confuse treating with enabling...

[fulltilt]

I have a question for the R.N. was it your intention to become a R.N. so that you may help people in there time of need and be compassionate trying to make your patient feel safe and comftable to the best of your abiliaty during there visit to the emergency room? I sure hope so cause if not you picked the wrong caree. If you are the type of person or have became the type that is highly judgemental, quick to lable everyone a drug seeker, treat your patients with a holyier than tho attitude well you are not doing your job infact you are doing the complete oposite of what you swon to do witch is to help the sick NOT critisize and treat them as if '' how dare you come to my place of business and be in pain n expect me to treat the pain '' even though its a E.R.

Its just like the case workers people are assigned to when they need asst. such as food stamps, medical ETC. they act like its there money and talk down to you like ur a scrumbag for recieving these benefits, why the hell get into the business where your helping the public if can't treat people with respect and dignity find another caree!

[Altra, BSN, RN]

Its just like the case workers people are assigned to when they need asst. such as food stamps, medical ETC. they act like its there money and talk down to you like ur a scrumbag for recieving these benefits, why the hell get into the business where your helping the public if can't treat people with respect and dignity find another caree!

Though it was difficult to read your post through the typos ... I do agree that little is achieved if a nurse cannot communicate effectively with people.

However, about the "act like it's there (sic) money ..." Let's remember it is my money ... and yours ... and every taxpayer's. How do you think assistance programs are funded? What do you believe is the source of the operating funds for the government?

[tewdles, RN]

I believe there is room for and have observed the practice of unconditional regard for patients by professional nurses even in the emergency department.

I am always saddened by nurses who believe that this facet of nursing is not important in their area of specialty.