"She's a drug-seeker!"

[tachybradyRN]

Had a hard day today. I'm training to take 8 patients ultimately, and today I had five. One of them was a 39 yo female with chronic epigastric pain 2* severe gastroparesis. She told me she came in because she ran out of pain medication [takes Vicodin @ home] and her primary physician wouldn't renew her script, her pain management dr. was in trouble in quite an infamous incident last year regarding reusing syringes and she doesn't feel comfortable seeing him anymore, etc etc. Today she was scheduled for D/C, but I had to call her dr. three times this morning d/t her vomiting 2-400 mL of bile on multiple occasions despite being given Phenergan IVPB x1, Zofran q6* IV ATC, and Reglan q6* IV prn for nausea/vomiting. She honestly looked to me like a classic opioid withdrawal patient today, and I had to express to her dr. that I did not feel comfortable sending her home in this condition. We got her stabilized and she was eventually able to be discharged [after the dr. had cancelled the order for me, and now I called her back to get the order renewed]. It just was such an uncomfortable day with many of the healthcare workers I dealt with [including those who came around during multidisciplinary care rounds] constantly referring to her as a "drug-seeker". Sure, maybe that's the case, but it felt like it took the humanity out of her situation and I honestly felt bad for this woman. I did what I could within my scope of practice to care for her and advocate for her, but I wished I could have done more. At the end of the day, at least I released her knowing she was stable, had information about pain management, and had the name of another pain management dr. she could begin to see. Such a tough issue, pain.. especially because it's so subjective, who am I to judge?

[NC Girl BSN]

Wow 8 patients! Thats insane. I guess I should never complain about having 4-5 patients at night. Sounds like your doing a good job. hang in there. I deal with alot of people hooked on pain meds. I work on a neuro floor and we do alot of back surgeries. It wears you out givin all that pain medicine but I try not to judge. Its hard looking at it through their eyes.

[jessi1106, BSN, RN]

umm ya... 8 pts is a lot. I only get 4.

sounds like you did all you could and should have.

many, many people are dependent on narcs.

good for you for assessing, involving MD, and having a non judgmental attitude.

[november17, ASN, RN]

This is stuff that you will see again and again and again and again...ad nauseam. The epigastric/abdominal pain, nausea, and especially this statement, "I just want *insert pill/shot here* so I can sleep."

Trust me, if you give it to them, they won't go to sleep. They'll probably go out and smoke. Rinse, repeat 4 hours later (or whenever they're due for more.

The only reason I'm saying this is because although calling them a drug seeker may take the humanity out of it, you aren't particularly doing them a favor by playing the "call the doctor 20 times in a day" game. Although you might feel that there is more you SHOULD do, more you COULD do....that feeling never changes- but that feeling is just the feeling of letting yourself be manipulated. I'm 2 years into it and I've learned to address the issue directly with the patient instead of skirting around it and just throwing more meds at them constantly. You just need to learn to do it in your own way.

[Jules A, MSN]

This is stuff that you will see again and again and again and again...ad nauseam. The epigastric/abdominal pain, nausea, and especially this statement, "I just want *insert pill/shot here* so I can sleep."

Trust me, if you give it to them, they won't go to sleep. They'll probably go out and smoke. Rinse, repeat 4 hours later (or whenever they're due for more.

The only reason I'm saying this is because although calling them a drug seeker may take the humanity out of it, you aren't particularly doing them a favor by playing the "call the doctor 20 times in a day" game. Although you might feel that there is more you SHOULD do, more you COULD do....that feeling never changes- but that feeling is just the feeling of letting yourself be manipulated. I'm 2 years into it and I've learned to address the issue directly with the patient instead of skirting around it and just throwing more meds at them constantly. You just need to learn to do it in your own way.

It might sound harsh but I'd have to agree. I also refer to them as med seeking if that is the assessment I'm comfortable with based on the situation.

[azhiker96, BSN, RN]

I think you did a good job for that poor girl. I don't know if she needs pain management, surgery for some underlying condition, or detox. Whichever she needs, it's not in your practice.

I get addicts post-op, some from the street and some from high rent areas. My job is not to cure their addiction but to address their post-op pain and other sx. It can be very challenging, especially if they held their morning meds due to NPO for surgery. I had one pt. post wound debridment with skin graft. As she was waking I started aggressively applying my order of Morphine 2mg IV q5m prn pain. It seemed like I was pushing water. After the third dose she said that Dilaudid 2mg usually worked well. Hmmmm, she came from a care facility so I checked the chart and her MAR. She gets Oxycontin 120mg po bid with Dilaudid 2mg IV prn breakthrough. Her morning oxy had been held due to NPO status. So, I called the anesthesiologist and informed him of her meds. He said, "We aren't even close!" He gave me a verbal for her Oxycontin and Dilaudid and I started playing catchup on her pain.

[jcgrund]

Pain is a tricky thing. I am an EXTREMELY new nurse, and don't have much clinical experience with this sort of thing, but I have had personal experience with a family member. My husband had a problem with chronic pain related to fx vertebrae and ribs because of Cushing's disease. He was going through Vicodin like candy, saw a pain specialist and eventually had to have some nerves deadend. Luckily now, after surgery and physical rehab, he has recovered completely. He was not drug seeking. My view is, a pt might be drug seeking, or they may have chronic, uncontrollable pain, and there is no way to know for sure. So, I would do my best to help control the pain.

[Wondergirl0905]

My view is, a pt might be drug seeking, or they may have chronic, uncontrollable pain, and there is no way to know for sure. So, I would do my best to help control the pain.

Agreed! I always "default to the good" so to speak. I can't know for sure whether a particular patient is addicted to pain meds or has such chronic pain that they have become dependent on narcotics just to get through their days. I'd rather risk giving narcotics to a "drug-seeker" than to withhold them from someone who needs pain relief.