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

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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.

Specializes in Rehab, Infection, LTC.
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 ;).

Honestly, I don't care to give them their pills either. It's the manipulation you have to deal with leading up to their med time that drives me nuts! They always have that behavior, never fail. They lie, say you didn't give it, try to manipulate you to give it to them early, and on and on and on. It's nonstop!

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Specializes in ED, MICU/TICU, NICU, PICU, LTAC.
Honestly, I don't care to give them their pills either. It's the manipulation you have to deal with leading up to their med time that drives me nuts! They always have that behavior, never fail. They lie, say you didn't give it, try to manipulate you to give it to them early, and on and on and on. It's nonstop!

And that I completely understand. I haven't worked in many situations where I would run into that particular behavior (ED I hear is a big one); I've done PACU and SICU (both situations where the drugs are ordered and definitely needed) and now I go between NICU and PICU. We don't send the little ones home on heavier duty pain meds too often; however we do get pts on sildenafil whose parents have been suspected of possibly selling it :(.

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Specializes in SICU.

at the risk of getting flamed...

My personal views are that manipulative drug seekers disgust me. I find it hard to feel any sympathy to their plight (real or imagined) That is just how i feel. That is the emotion that comes to mind when i am manipulated!

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Specializes in Medsurg, Homecare, Infusion, Psych/Detox.

Such honesty is refreshing. I feel exactly the same way. If you have ever had your shift held hostage by these professional manipulators then you can relate. They are insatiable. I find them repulsive and do not consider them to be real pts. But of course they are.

By the way, I can care less who flame me.

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Specializes in Med-Surg/Neuro/Oncology floor nursing..

Without hard evidence(like tracks on a patients arms) I refuse to police the patients who state they are in pain and request pain medication. As long as the medication is ordered by the doctor who are we to say a patient shouldn't have it? Oh a by the way even illicit drug users can be in pain at one point or another? I remember a patient in the CCU that was scheduled to have a valve replaced(because drug use had damaged a valve in the 1st place) asked for pain medication. All the doctor said was "give him what he wants...it's not our job to detox him and if he doesn't want help, we can't force him to get it." The doctor was right. You can't help someone who refuses to be helped(you can try to fight that uphill battle but in the end you can't save everyone). Meanwhile, other patients shouldn't suffer because you had a bad time with a few patients.

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It is the worst feeling to be duped by a patient who is a drug seeker!

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Specializes in geriatrics, dementia, ortho.

The drug seekers are irritating to me for several reasons:

1. They continue to state pain, complain, and refuse to participate in physical rehab or even to do the tiniest things for themselves because of it. It slows down their healing and we are stuck with them for longer.

2. They get angry when MD's cut down their doses, and they take it out on the people who have to answer their call lights. I get sick of being screamed at because the drug addict who is sick/injured as a result of their addiction is P******D off because they aren't getting their fix anymore.

3. A lot of times, their visitors are so sketchy I don't want to be in the room alone with them and the patient. I mean, if your skeezy boyfriend is in there clearly on the nod, and I have to confront you about the fact that you cannot smoke in the hospital bathrooms? I feel a lot less safe than I should in my workplace. I don't want your meth addicted boyfriend/girlfriend/extended family freaking out on me. Having you as an awful miserable patient is bad enough.

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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.
I can not find the highlighter or the faces but anyway it makes sooooo mad when I I here you can not be in pain you where asleep or druged (bull s&&t) I have neuropathy as well and two nights ago I woke up in 9/10 pain shouiting down my arm after two rounds of ultram I went for my old bottle of delotaid after 2 pill I was drugged not able to talk well and but was still in massive ,massive pain and moneing with my eyes closed . So you can be out and still in pain . Doctor told me later " narcs will not work on nerve pain" I think I found that out !
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Specializes in med-surg, psych, ER, school nurse-CRNP.

Sometimes it's very, very easy to tell a drug seeker.

*Youngish female, multiple visits in a few months to the clinic, always for pain. Last time, was seen by me, c/o pain. I took xrays (negative) and gave my usual cocktail of NSAIDs, steroids, and muscle relaxers.

A week goes by, she's back. Now, she hurting WORSE, she wants a referral to bone and joint and she doesn't want to be seen by 'that girl' ( she saw me walk by) again because 'she didn't give me anything". Red flag, red flag, red flag.

Pulled her up on the prescription database, and GASP, she's just had 2 scripts for controls filled. Less than a month before that, 2 more scripts, same med, within days of each other. All different docs.

The other provider wasn't going to touch that. I went in, examined her thoroughly, agreed that a referral was a sound move, and set up the appointment for her (after allowing her to choose her physician). The ortho requested additional xrays.

Patient requested narcotics, and I declined, citing that she should have analgesia available, as she had just filled a script. She played dumb,, until I was able to cite date, drug, drugSTORE, etc.

"Oh, yeah, those didn't help." Sorry, sister. You should have plenty left to keep trying. I would not budge on that regard, but I did offer non narcotic pain relievers.

She jumped up and stormed out, refused xrays AND the appointment that she claimed she wanted. Told her SO who was waiting in the lobby that we refused to help her.

So, I ask you, doctor-shopping, attempting to snow an unfamiliar face, refusing every treatment offered except narcotics, even with hard evidence of just having a script filled...sound like a seeker to me.

Oh, and NOTHING makes me madder than someone saying 'they didn't get any help', when I've just done all of the above. No, dear, you didn't get what you WANTED, but you DID get medical care appropriate to your condition. There's a difference.

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Your argument is on point and a reality that nurses, especially those who practice in low-income, drug infested neighborhoods face everyday. We took a pledge not to harm our patients and by enabling addicts, that's exactly what we are doing.

I suffered for three years with a horrible addiction. I have since been in recovery for over four years and am a new RN. I would have said and done anything to get my next fix. People don't change when things are easy. Consequences make people seek treatment. Pain (emotional) is a great motivator for change.

The culture in my hospital is to administer IV Dilaudid to anyone and everyone who asks for it. I spend most of my day pushing IV narcotics. It is very troubling to me to see the patient nodding out in their room or who won't go to sleep because they don't want to miss their next fix (and people want to say that we are not creating an epidemic of perscription drug addiction)? A new study published states that perscription drugs have surpassed car accidents as a leading cause of fatalities. As a new RN I am very troubled, especially for the fact that I am made to partake in this practice. I hope to be a change agent in my facility but I also don't want to experience burn out and frustration from the issue.

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First off, sorry if I sound bitter. But drug seekers are one of the major reasons I'm burned out. Compassion and non-judgmentalism are all great things, and of course, if someone has genuine pain I'll do my best to help them. Mental health dx, chronic pain, former addiction -- I don't care, if you're in pain I'll give you everything I can and call the MD for more if I have to.

But all of us who've worked in ER or on a surgical floor know that drug seekers are out there -- not just people in pain asking for their meds, but people with addiction asking for a high. Take the patient I'm dealing with tonight. She requested Vicodin, Benadryl, Phenergan, Xanax, and Ambien all at once. Tell me she's not looking for a buzz.

What gets me is not so much the drug seekers' constant requests for meds as it is their obnoxious, manipulative behavior. I just hate it when some unpleasant patient tries to guilt me into catering to their desire for meds around the clock -- and it's much worse when they try to play nurses off against each other, telling me how much nicer I am than the last shift. It makes me instantly suspicious of them.

And how is it compassionate to give more narcotics to an addict whose life is already out of control because of meds? If we really cared all that much about these people, wouldn't we work toward getting them off the meds and treating whatever underlying issue turned them toward addiction in the first place?

Again, sorry if I sound mean. Just to be clear, it's not the pain or the requests for meds that bother me. It's the clear message some of these people send -- "I want a fix, and I will do anything it takes to get it, including being mean, whiny, intentionally helpless, verbally abusive, or even aggressive." I wish I could muster up some empathy for these folks, but I haven't got any left.

Sorry, it just feels good to vent.

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Specializes in Surgical, quality,management.

I work on a surgical ward that does a lot of minor trauma, lots of alcohol/drug induced injuries. We also do a lot of emergency bowel surgery. Our population is young and it is often people that did not plan on coming to hospital, eg assults, abcesses from injecting drug mules gone wrong.

They are offered the chance to see addiction medicine but if they refuse we are not going to fix them on a short acute surgical admission. They have surgical pain on top of their addiction. I give them the meds as they are prescribed and as long as they have an airway and are not using their PICC to shoot heroin in the bathroom(long story) I'm happy.

I work with a nurse who will hardly medicate cancer patients let alone anyone else. As the charge nurse I am constantly listening to her complain about giving meds. Just freaking give them and save your judgement.

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