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

southernbeegirl, BSN, RN · Jan 4, 2012

No, there is not a difference.

I am a drug addict in recovery, almost 8 years now. I also suffer from chronic back pain that is, at time, almost crippling. I have struggled, with my doctor, to find a pain regimen that works for me that is the least amount of pain med possible. I have been on tramadol for 5 years now.

Dependence vs addiction? you can say there is a difference all day long but I assure you, those are only words. Dependence and addiction are one and the same.

I tried to take myself of of tramadol a year ago. I had convinced myself that I didn't need it. I went through 7 days of hell from the withdrawal, despite having a husband that is a drug/alcohol counselor who detoxed me with a small amount of benzo as is done inpatient. It was also apparent after 2 weeks that I had no choice but to take something for the pain as I could not stand up straight.

So am I dependent on the drug? Yes. As a result of taking it 3 times a day, am I also addicted...yes again. I don't know if I have addictive behaviors because I am so scarred to not have the drug due to the pain or my disease. But really, what does it matter in the end?

You can call it whatever you want but they are one an the same, IMO.

AngelfireRN, MSN, RN, APRN · Jan 4, 2012

In my casde, it's a bit different. I'm an NP, and whereas in an inpatient setting as an RN, I was expected to medicate as directed, now it's ME giving the directions. I also just left a pain clinic, which left a very bad taste in my mouth so far as proper dosage and adherence.

Now, I'm in a state that allows me to prescribe controls, and I am by far the most stringent one at my clinic. If you've been in 4 times in the last 4 weeks c/o a toothache, and frankly tell me you "can't afford a dentist" or come in 4 times a month with vague, nonspecific complaints and refuse to follow up as directed, you absolutely will not be getting a control from me. Ain't happening. And screaming profanity "Give me my ******* pills!" doesn't move me, nor do tears. Been there, seen it. If you're well enough to throw that kind of fit, you're OK.

Bottom line is, now it's MY license, not the doc's. And I refuse to be a candy girl, someone's supplier, or a doormat who dispenses "just to save a fight".

*Please note that, I DO prescribe, just not by the bucketload. If you're in legitimate need (acute injury, etc.) you better believe you'll get something for pain. But to just come in and expect morphine because "that's what it always takes", sorry, not here. I work at a walk-in clinic, just FYI, and yes, that really did happen.

leslie :-D · Jan 4, 2012

So am I dependent on the drug? Yes. As a result of taking it 3 times a day, am I also addicted...yes again. I don't know if I have addictive behaviors because I am so scarred to not have the drug due to the pain or my disease. But really, what does it matter in the end?
You can call it whatever you want but they are one an the same, IMO.

i'm sorry you're hurting so much, sourthern.

seriously, i mean that.

to me, it doesn't come across as you having addictive behaviors...because you are genuinely focusing on your pain to be relieved.

and it's not as if you're on a controlled drug (i don't think ultram is controlled...it wasn't before, i know that.).

to be truthful, i don't fully understand the fine line between dependence and addiction.

but i do know once someone crosses that line, from treating pain to recognizing the overall euphoria it provides, addiction sets in.

you're right: in your situation, it doesn't matter - you need to do what is right for you.

and it's ultram - not vicodin, percocet, dilaudid, etc.

be easy on yourself.

In my casde, it's a bit different. I'm an NP, and whereas in an inpatient setting as an RN, I was expected to medicate as directed, now it's ME giving the directions. I also just left a pain clinic, which left a very bad taste in my mouth so far as proper dosage and adherence.
Now, I'm in a state that allows me to prescribe controls, and I am by far the most stringent one at my clinic. If you've been in 4 times in the last 4 weeks c/o a toothache, and frankly tell me you "can't afford a dentist" or come in 4 times a month with vague, nonspecific complaints and refuse to follow up as directed, you absolutely will not be getting a control from me. Ain't happening. And screaming profanity "Give me my ******* pills!" doesn't move me, nor do tears. Been there, seen it. If you're well enough to throw that kind of fit, you're OK.
Bottom line is, now it's MY license, not the doc's. And I refuse to be a candy girl, someone's supplier, or a doormat who dispenses "just to save a fight".
*Please note that, I DO prescribe, just not by the bucketload. If you're in legitimate need (acute injury, etc.) you better believe you'll get something for pain. But to just come in and expect morphine because "that's what it always takes", sorry, not here. I work at a walk-in clinic, just FYI, and yes, that really did happen.

bravo to you, angel.

just, bravo.

leslie

Roy Fokker, BSN, RN · Jan 4, 2012

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

Ummm, not really. Especially if you work where I work.

The 95th visit in less than 22 months for "migraines"?

The 55th visit in less than 24 months for "abdominal pain/back pain" even though you're on "pain management"?

These are but a couple quick examples.

And it's more than just 'visit history' - it's the general attitude of the patient. And sometimes, it's the specific attitude of the patient.

I maybe young but I wasn't born yesterday.

And it definitely doesn't help when you lie to me.

I have no issues treating breakthrough pain - even with folks who have chronic pain or are on pain management.

One of my best friends is dependent on pain medication from wounds suffered in combat.

I also have an aunt who suffers from debilitating migraines who every once a while can't take the 3 days of continuous nausea and vomiting who comes in looking for relief.

I get that.

I understand that sometimes pain gets so bad that folks have no option other than showing up at the ER looking for relief.

But they're few and far between.... and a far cry from the 'usual suspects' who show up - either looking for a high (including one who managed to score and despite being advised to 'not drive', assured the ED staff that a ride was coming to pick 'em up.... and proceeded to "drive away" anyway); or looking for a script so that they can sell the pills for a profit (as was deciphered by an RN based on what was overheard between a discharged pt. and someone else in the waiting room)...

I despise playing the long arm of the law. I despise playing 'drug enforcer'. Personally - I don't particularly care what you chose to inhale/swallow/shoot into yourself.

But I DO have a problem if your said actions could affect other innocent human beings. I will NOT be party to an investigation revolving around why we as health care professionals allowed XYZ to be in possession of ABC narcotics!!

cheers,

southernbeegirl, BSN, RN · Jan 4, 2012

I always just give what is ordered. I'm so tired of drug seekers too. The patients in LTC are getting younger and younger. When we see a young person (40s, 50s) on the admit list, we all dread it because it seems they are the ones that always have the drug seeking behaviors. Really though, it is so much less stressful, for me anyways, to just give it. I used to make deals with people that I would bring it when it was time if they didn't try to get it early. I'm also the last person you want to try to manipulate because, as an addict, been there done that and I will call you on it. There is no way I could work in an ER.

I had to go to the ER on thanksgiving after falling and hurting my back. When I first said what I was there for, I got the "here we go again" looks of them thinking I was drug seeking on a holiday. The first 15 minutes were not very nice for me but once they realized I really was hurt, they completely changed and took awesome care of me. i didn't take offense to the first part of the visit as I know what they were thinking. I thanked them a bunch when I left.

southernbeegirl, BSN, RN · Jan 4, 2012

I also want to say something but am NOT preaching or trying to ruin a vent thread, k?

I have posted about this before I think.

My first husband lived in horrible pain. He had porphyria and would be in the hospital for 2-3 months at a time sometimes. It caused severe neuropathy, especially to his abdomen and prostate. He was on IV morphine even at home. (That's where I started using drugs like a junkie. I stole from him.)

He looked like a biker...long hair, tatoos, rode a harley.

He lived in pain all the time. I wish I could tell you the times i saw nurses refuse to give him prn pain meds because he fell asleep. When you live in pain, you have to sleep, so their bodies adjust. They also don't show pain on their faces like we do. I witnessed some horrible treatment to him by nurses and doctors both. It still makes me mad to think about it.

I know I always try to give the patient the benefit of the doubt. at first at least.

leslie :-D · Jan 5, 2012

I know I always try to give the patient the benefit of the doubt. at first at least.

you would agree the behaviors of those who are legitimately in pain, versus those who are addicts, are worlds apart, yes?

it is the demanding, inflexible, obnoxious behaviors that we oppose...

and sadly, most of those behaviors are from med-seeking addicts.

even though your (deceased) husband had a legit dx, they still gave him a hard time??

if so, that is unconscionable.

hope you're doing well these days, southern.

leslie

OCNRN63, RN · Jan 5, 2012

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

Margo McCaffery has a pain mgmt. book that addresses this. In fact, I believe she even cites the percentage of patients who develop addiction in that scenario. There are multiple sources in that book. I've read that same statement in other literature.

leslie :-D · Jan 5, 2012

Margo McCaffery has a pain mgmt. book that addresses this. In fact, I believe she even cites the percentage of patients who develop addiction in that scenario. There are multiple sources in that book. I've read that same statement in other literature.

you've read that chronic pain pts generally don't become addicted?

interesting.

i haven't seen any of that while researching this very subject.

i have seen some varied and broad estimations, like 3-40%...

but nothing stating that most don't become addicts.

not sure i understand why another population would/could, but chronic painers - no.

doesn't make sense to me...

esp where depression is so prevalent amongst chronic painers.

the potential to self-medicate would seem even more risky, imo.

my main concern is that those with true, real pain issues, get treated.

and so, if they do become addicted, it becomes a risk vs benefit issue...

with benefit obviously being the more pertinent advantage.

leslie

Quark09 · Jan 5, 2012

Lots of really good replies on this, and I've nothing really profound to add - only that if I have a patient saying he/she is in pain and I've an order for the meds, I'll give it. I'd rather a drug seeker get their fix than chance someone who is truly in pain be denied medication because their behavior might be a little suspect, or doesn't fit into preconceived notions of how someone in pain should be acting. Then again, I don't really have to worry too much about drug seekers in peds .

NocturneNrse · Jan 5, 2012

I too struggled with this.. but after getting other peoples opinions on A.N. I agreed that I cannot differentiate btw real pain and someone who is drug seeking. So, I give the medication as ordered/when requested. Granted, the patient doesn't appear "snowed" and the administration of the pain could = trouble. You can never be completely sure if the patient is "faking" it or not.

The ones that state they like the high.. hey, they still might have some pain. You'll make yourself nuts trying to figure out who is in real pain and who is just seeking a high.

southernbeegirl, BSN, RN · Jan 5, 2012

you would agree the behaviors of those who are legitimately in pain, versus those who are addicts, are worlds apart, yes?
it is the demanding, inflexible, obnoxious behaviors that we oppose...
and sadly, most of those behaviors are from med-seeking addicts.
even though your (deceased) husband had a legit dx, they still gave him a hard time??
if so, that is unconscionable.
hope you're doing well these days, southern.
leslie

I told yall about my husband because I did see some talking about how patients were sleeping. that was all. How he was treated is for another thread someday. But it was one of the reasons i became a nurse. I shouldn't have said anything on this thread, sorry. and I hate thread hijackers, lol.

but please, don't get me wrong. I was agreeing with everyone about dealing with drug seekers. I hate it as much as everyone! I was saying that I will actually call them on their crap and tell them to stop it sometimes. Drug seekers are the worst patients to ever care for, IMO. They suck the life out of you! I can't stand them. It's constant, nonstop manipulation and lies. I despise them too. I'd rather poke my eyeballs out than deal with them! or THEIR eyeballs if I wouldn't go to jail. And yes, I think their behaviors are obvious. Sometimes not at first, which is why I said I give them the benefit of the doubt at first. But it doesn't take long to recognize the behaviors does it? They are THE WORST ever!