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Tips on how NOT to appear like a Drug seeker

Having read through some of the threads regarding Drug seekers in the Emergency Department I must admit I now feel quite nervous of being misperceived in this way. I take medication which causes some urinary retention and increases my risk of Kidney stones. Hopefully this will never happen, but if it does and I need to present to the ED, what advice (on behaviour and what to say for example) can people here give me so I don't get wronly perceived as a Drug seeker. Taking into consideration I am a former Heroin addict, sensitive to NSAIDS and can't take Ibuprofen or Aspirin type medications due to asthma.

gonzo1, ASN, RN

Specializes in CEN, ED, ICU, PSYCH, PP. Has 15 years experience.

Just tell them the truth being sure to add the information about former drug use. We really appreciate it when people fully disclose so we can help them better/safely. We easily pick up on lies and half truths and unfortunately then start forming our own opinion, so just give it to us straight.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

Sadly to the unskilled the fact that you are allergic to NSAID's and Ibuprofen and ASA, with a history of kidney stones may get you lumped in to the drug seeker catagory reguardless . One of the best non-narcotic drugs for kidney stone pain cant be used for you because of that. Your best ally in your case is to always be very detailed with your history and to not leave anything out or be short with staff no matter how uncomfortable you are.

If your are having 10/10 pain try to look like you are having 10/10 pain, I know pain is subjective. Dont be talking to you friends, brothers sister on the cell phone at triage. Dont be asking for something to eat 10 minute after barfing you guts out. Dont make it look like the pain from the IV start is worse than the pain you are having, we notice these things. Having said that I have seen enough kidney stones, hundreds if not a couple thousand, to know I never want one.

Rj

Having read through some of the threads regarding Drug seekers in the Emergency Department I must admit I now feel quite nervous of being misperceived in this way. I take medication which causes some urinary retention and increases my risk of Kidney stones. Hopefully this will never happen, but if it does and I need to present to the ED, what advice (on behaviour and what to say for example) can people here give me so I don't get wronly perceived as a Drug seeker. Taking into consideration I am a former Heroin addict, sensitive to NSAIDS and can't take Ibuprofen or Aspirin type medications due to asthma.

Be willing to try whatever's offered if you're not allergic/sensitive to it......"Dilaudid's the only thing that works on me" is not a good thing for us to hear. And stone pain is pretty hard to fake, if you're passing a stone chances are you will be believed.

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

My sympathy to the OP.

It's very sad that things are the way they are nowadays that someone asks how to not appear as a drug seeker.:(

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

I worked as a case manager in the level one ER for about two years and it was my job to deal with the chronic patients. Drug seekers are those who continually seek care from DIFFERENT ER's, they don't follow discharge instructions, give different names and social security numbers, shop from one ER to the next and alter prescriptions. The other ERs as well as pharmacies call around to each other.

So...given this criteria, you should have no problem. Especially if you are upfront about your problems, I don't think there would be a problem. It is not a problem for patients in pain to receive excellent care. The biggie red flags are listed above.

Good luck.

hospitalstaph

Specializes in ER. Has 3 years experience.

Be willing to try whatever's offered if you're not allergic/sensitive to it......"Dilaudid's the only thing that works on me" is not a good thing for us to hear. And stone pain is pretty hard to fake, if you're passing a stone chances are you will be believed.

The only problem with this is that those that do have severe pain r/t perhaps a chronic condition DO know what works best for them. What do you suggest in that situation? Is there a proper way to distiguish oneself as an informed patient as opposed to a drugseeker? (I mean besides staying off the cell phone! LOL)

T

EDValerieRN, ASN, RN

Specializes in ER, Peds, Charge RN.

If you have a chronic condition, the pain is best managed outside of the ER.

smoo

Specializes in CNA for 5 years, LPN for 5 years. Has 10 years experience.

My sympathy to the OP.

It's very sad that things are the way they are nowadays that someone asks how to not appear as a drug seeker.:(

I was thinking the same thing..........

Smoo

Thanks a lot for the advice. I am always upfront and honest with ER staff about my past drug history, afterall they're gonna know anyway as soon as they see the scar/track on my arm and I figure it's better just coming straight from me. I really wish I wasn't sensitive to Non Steroidals, from what I've heard they work really well for pain relief (better than narcotics in some cases), if I could take them I would. I've had a couple of bad experiences in the ER being misjudged as a drug seeker when I was there for legitimate reasons, but most of the time I've found the nurses and staff to be very helpful and kind. :kiss

Jennifer, RN

Specializes in ER, telemetry. Has 11 years experience.

How can you take class II meds daily, worry about going into withdrawl if you don't get your daily meds and still work as a nurse?

rehab nurse

Specializes in rehab; med/surg; l&d; peds/home care.

How can you take class II meds daily, worry about going into withdrawl if you don't get your daily meds and still work as a nurse?

if you're referring to me, i don't work anymore. i'm on medical leave until my disability benefits go into effect. i sometimes work as a consultant from home, but i cannot do direct patient care because of physical limitations.

and i don't "worry" about withdrawal because i take my meds as directed. however, if one is in the hospital or er for treatment and KEPT without their meds, one who is physically tolerant of the medications will go through withdrawal. basic pain management.

Jennifer, RN

Specializes in ER, telemetry. Has 11 years experience.

Don't come in with BP of 110/60, heart rate 60, chewing gum, talking on your cell phone, c/o'ing of pain 10/10. Pt's who are in severe pain usually present with elevated bp and pulse (unless they are on betablocker), diaphoresis, and agitation. They also usually don't care if you stick a 22 or 16g needle in them, since that is not the worst pain they have ever had (compared to the pain they came in with). The pts who present in pain I will seek out pain meds. The others have to wait to see a doc.

I worked as a case manager in the level one ER for about two years and it was my job to deal with the chronic patients. Drug seekers are those who continually seek care from DIFFERENT ER's, they don't follow discharge instructions, give different names and social security numbers, shop from one ER to the next and alter prescriptions. The other ERs as well as pharmacies call around to each other.

So...given this criteria, you should have no problem. Especially if you are upfront about your problems, I don't think there would be a problem. It is not a problem for patients in pain to receive excellent care. The biggie red flags are listed above.

Good luck.

I work in pain management and it's pretty easy to figure out who's faking pain and who's diverting their meds. The other day, I had a pt ask me if I could give him 8 Oxycontin 10 mg instead of the 80 mg caps...he said he was allergic to the dye in the 80 mg - I called the pharmacist and the same ingredients were in the 80 mg caps. Another red flag is when the patient starts crying at every single visit or they are wanting to switch meds all the time. It's always a huge red flag when the patient knows how to convert from one opiate to the other, or knows more about the drugs than the practitioner! Also, people who take methadone AND a benzo will get a buzz, although with methadone alone they won't. Hydrocodone and Soma together really gets them off, so I never prescribe the two together. I'm amazed at how many new pts tell me that Lortab and Soma are the only 2 medications that work for their pain! When a breakthrough med (opiate) is given to patients on methadone, they won't get the "high" that they would when taking the breakthrough med alone. Therefore, a lot of people have OD's while they're on methadone, because they keep taking more and more of the opiate trying to achieve that "high."

Don't come in with BP of 110/60, heart rate 60, chewing gum, talking on your cell phone, c/o'ing of pain 10/10. Pt's who are in severe pain usually present with elevated bp and pulse (unless they are on betablocker), diaphoresis, and agitation. They also usually don't care if you stick a 22 or 16g needle in them, since that is not the worst pain they have ever had (compared to the pain they came in with). The pts who present in pain I will seek out pain meds. The others have to wait to see a doc.

Totally right on! If they aren't willing to get an intervention , even though they claim they're in severe pain, then that's a red flag.

rehab nurse

Specializes in rehab; med/surg; l&d; peds/home care.

Don't come in with BP of 110/60, heart rate 60, chewing gum, talking on your cell phone, c/o'ing of pain 10/10. Pt's who are in severe pain usually present with elevated bp and pulse (unless they are on betablocker), diaphoresis, and agitation. They also usually don't care if you stick a 22 or 16g needle in them, since that is not the worst pain they have ever had (compared to the pain they came in with). The pts who present in pain I will seek out pain meds. The others have to wait to see a doc.

excellent advice. the only other thing i can offer is to always be upfront about any past drug abuse issues. but, you are already doing that, so, you shouldn't have any issues.

if you go to the er with a kidney stone, don't worry. everyone will know it! hope you don't worry too much about this.

ERNP

Specializes in ER, critical care.

Don't run out of chronic pain meds on Friday at 5pm. Even if you "called the office and they didn't call you back". Plan ahead!! Call them before Friday when you know you are getting low. If it is time to have a refill they will usually get one called in for you. If you are too early they will assume you have either diverted your meds or not taken them as directed.

Don't call administration to complain that you didn't get your drug of choice.

Don't throw your soda on the floor and go into full "writhe mode" as soon as you see me walking into your room. I have already been past your room and had found you resting comfortably. I don't hand out awards based on performance, like the Emmys.

Don't call back 2 hours later requesting a new prescription because you lost, your dog ate, or you washed the old one.

Growing new allergies during the discharge process is a dead giveaway. "What did you give me?" "Ultram". "Im allergic to Ultram", "That wasn't listed as an allergy nor did you mention it earlier in our interview... you remember when I asked.... "Are you allergic to any medications?" Were you not allergic to it then?

I could go on and on... there is so much of this in our community.

gauge14iv

Specializes in ICU, ER, HH, NICU, now FNP. Has 23 years experience.

Someone who wasn't a drug seeker wouldn't even be concerned about this.

P_RN, ADN, RN

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

gauge14 I have to disagree slightly with this. When my first HNP happened they gave me demerol.....it helped a lot, but I hallucinated seriously.

So I asked for darvocet.....the doctor laughed and said to give me fentanyl. I can tell you I WAS seeking because I was in real pain. There's a difference in intolerance and allergy.

I know darvocet works to take the edge off. When you are in pain it's best to let the doc/NP make the first decision, but hopefully they will be aware enough to listen to their patient.

Someone who wasn't a drug seeker wouldn't even be concerned about this.

Oh really? Reading through some of the threads on here about the assumptions that are sometimes made regarding who is and who isn't a Drug seeker, as well as hearing testimony from others who have mistakenly labelled as "drug seeking" and mistreated because of that fact, along with the fact that I have personally experienced being mislabelled as a "just a junkie looking for a fix" by ER staff, I seriously beg to differ with you on this point.

In 1997 I presented in severe pain to a local Emergeny Dept. I was sent there directly from an after hours medical service and was suspected of having a Pneumothorax. I had been experiencing severe headaches and earaches all that day, by night time I was vomiting and being wracked by extremely painful spasms all through my neck, back and stomach. I have never experienced anything more painful in my life so far, and that includes crush injuries and fractures to my foot and post Laparoscopy/Hysteroscopy pain, I was literally screaming with pain and I could not help myself. When I got to the ED right from the start I was treated badly. The admissions Nurse berated me for not being able to say more than 2 words at once through the pain to give my details properly, the Nurse who was assigned to look after me once I was admitted was very short and abrupt with me, at one point she lowered the back of the bed down and it set off a series of extremely painful spasms, so she quite roughly shoved the bed back up to a more upright postion and walked off with a huffy "there hope your happy" comment thrown back at me. At all times, whilst I screamed and cried and begged for pain relief, I was made to feel as if I was just a huge inconvenience and annoyance to them. When the X-ray came back clear for Pneumothorax, do you know what they did?? The Nurses and The Doctor who were supposed to be looking after me went and stood in full view of me drinking coffee, laughing, pointing, rolling their eyes in my direction and making comments about "junkies looking for a fix". I was discharged with a valium and one Panadeine Forte tablet. I half squat walked, half crawled out of that ED, still in excruitiating pain and still vomiting. 2 weeks later it was finally realised that I had Bornholms Disease.

So after an experience like this please do not try and tell me that only a Drug Seeker should be worried about being seen as such.

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