Sometimes it's hard to tell a drug seeker from a patient in pain.

[tiroka03]

There are some people I care for that like the feeling of being high, and they admit it. It isn't my call, but the doctors who prescribe. If they know the magic words, I give pills. Drug seekers do take up a lot of time, so I feel it's better to get it over with and give them their high. However, there are times a patient can have all the outward signs of a drug seeker and have actual pain. Is it my job to deciede, or the doctors. I don't really want to drug a person silly, what is it you do? The other day I worked hard to wake a pt for a scheduled med. Instantly and still slurring her words from sleep, she rattled off a list of drugs she expected me to fetch for her. I waited to see if she would fall back asleep, but she was instantly awake and mad for the 10 min. wait.

[pockunit, ADN, RN]

if they are asleep, they clearly are very comfortable.

That is not necessarily true. VS and behavior are NOT reliable indicators of pain levels. The pt is. If their VS indicate it's dangerous to dose, then of course you shouldn't. But just because someone is "asleep" doesn't mean they aren't in pain.

[vintagemother, BSN, CNA, LVN, RN]

But just because someone is "asleep" doesn't mean they aren't in pain.

Thanks so much for saying this! I can fake / half sleep while in pain waiting for help...I'm remembering the "sleep" i got while in labor with my son. I rested, sort of, and my eyes were closed, but I did hurt badly. Of course the memory of the pain faded when I was able to push that boy out! LOL! :) (13 years ago tomorrow)

[That Guy, BSN, RN, EMT-B]

Dope em up until they are barely awake so you have a reason to withhold medications

[xtxrn, ASN, RN]

Welcome to my world of straight up drug addicts wanting more and more drugs.

Please keep in mind that a doctor can write an order for anything he chooses. However it is the nurse who administered it will be held liable if something goes wrong.

A patient can OD and slip away from you just like that, (just ask Conrad Murray).

Murray was a fool. Big difference

I loved drug/alcohol rehab patients....yeah- they had some really hard times. But they knew what they were. And, imo- and ime, methadone maintenance is cruel for the patient who actually wants to get OFF of heroin.....the detox from methadone makes heroin detox look like Mardi Gras. And heroin is bad enough.

[wyogypsy, RN]

I try to not judge and medicate them based on what they state their pain level is; but sometimes I have to grit my teeth. I would never 'slam' it in, I give it the way the drug handbooks advise - diluted and slowly.

In long-term care and hospice it does bother me when nurses say they didn't give the scheduled midnight pain med because the patient was asleep. The patient usually has to be turned or changed, and the reason the med is scheduled is that nurses weren't giving the prn med to keep the pain adequately controlled, so we had to put them on a schedule. By not giving the med, the patient wakes up in pain and we sometimes have difficulty getting their pain back under control.

[talaxandra]

I work in acute care - that's in no way the best time to be working on issues of addiction and dependence unless that's part of the reason for the admission. So for my patients who have issues with dependency or addiction I'll offer a referral to the Drug and Alcohol Nurse, but while they're acutely ill I'm happy to give them whatever they're prescribed.

My only proviso is if they're using while an inpatient - I'm upfront that any suspicion of street use means closer scrutiny before getting any prescription meds, because the interactions are too unpredictable.

[talaxandra]

Re: Conrad Murray - one of our former frequent fliers had a decades-long history of chronic back pain that a GP had somehow decided to treat with patient-administered IM morphine, diazepam and midazolam Scar tissue as far as the eye could see (seriously no anatomical markers from waist to mid-thigh) and multiple admissions with tunneling abscesses because of very poor hygeine and injection technique, though the patient couldn't be told anything about anything.

It was really, really frustrating - until we got a new consultant. As horrified as the rest of us, instead of talking with the patient about changing this ridiculous regime she rang the GP and gave him a week to cut the patient off before reporting him to the AMA. Patient was admitted for detox and is now on a significantly reduced, oral pain management program.

[SuesquatchRN, BSN, RN]

We treat pain very aggressively but then, I'm in hospice. When I was in the hospital I found myself furious at the seekers, not because I care that they want to be high, but because of the amount of precious time they demanded. And even in hospice we have people ( a lot) with hx of sunstance abuse and they can be impossible to manage because they OD or sell their medication. So their meds are doled out one or two days at a time. It's time consuming but just because you're dying doesn't mean we can kill you.

[classicdame, MSN, EdD]

agree with Spikey9001. You are not going to do any behavior modification and it is not your place to prescribe. If it is ordered, give it. Meanwhile, please know that physical and spiritual and mental pain interact.

[leslie :-D]

Chronic pain pts don't generally become addicted. They develop a tolerance. Two totally different things.

do you have a source to back up that "chronic pain pts don't generally become addicted"?

i tend to (generally) doubt that.

of course they develop a tolerance, necessitating higher doses.

but chronic pt pts can become addicted as easily as any other pt population that needs their pain treated with prescription drugs.

why wouldn't/couldn't they become addicted...i'm not following the rationale here.

leslie

[PetsToPeople]

You are not responsible for another persons addiction, simple fact. They say they are in pain, give them their prescribed meds and/or advocate to the MD to get them their pain relief. Make yourself available to help them with alternative/conjunctive pain relief methods or to refer them for counseling, etc. You are their nurse, not the cops.

[MN-Nurse, ASN, RN]

It shouldn't matter to you what their reasons for seeking pain medication are. You're not her, so stop playing the moral police and let her have her drugs as long as it's prescribed legally and she's allowed to have them.

Yeah! Stop it! Even if she no longer remembers her own name, is drooling, and her resps are 4 and shallow!! Give the drugs! You are a dispenser, not a thinking RN!