Treatment for true drug seeker

teeituptom, BSN, RN · Jan 10, 2004

For me its easier to not bat my head against the wall. I let the ER doc decided how he wants to handle it and I support whatever they decide.

ernurse2244 · Jan 10, 2004

For the most part I agree with you. I don't give the orders, just follow them. The particular patient that I was thinking about when I started this thread makes us all crazy, though. He uses the ER as a free clinic...owes the hospital several hundred thousand $$. He comes in 3 or 4 times a week, usually with different complaints, but always 10/10 pain level...sore throat, coughing until he has chest pain (smoker), neck pain, headache, kidney stone (he really has those), UTI... Also always nauseated. Drug of choice is stadol/phenergan. If he comes in with nausea and we don't give him stadol, he develops a 10/10 headache. If we give only stadol, he starts gagging...just as soon as you tell him the doc didn't order the phenergan. most of the docs just give the stadol and phenergan and send him on his way, one will usually do a work-up on him according to today's complaint which means he will need another shot before all the lab and x-rays are completed. If he returns with the same complaint a second time, he will tell you he only had money enough to get the pain med filled, not the abx or whatever else he had rx for.

KarafromPhilly · Jan 10, 2004

Originally posted by ernurse2244
Are we facilitating the drug seekers by saying "its not my place to judge"? If, for whatever reason, you have defined a person as a drug seeker, what do you do when they present to the clinic/er? I'm not asking about the judgement part of pain management. I am talking about the treatment aspect for a true drug seeker. Especially for the ones who can't go to pain management specialists because they require payment upfront.

I don't get your question--is the patient a drug seeker, or do they have pain issues? To me these are two different things. Why would you send a, well, drug addict (no offense intended to anyone) to a pain management specialist?

fab4fan · Jan 10, 2004

Sigh...how do you know for certain whether or not this person has a true addiction problem? Has the pt been diagnosed by a qualified addictions specialist?

The ED is not the place to make those sorts of calls. You, as a nurse, are not qualified to make that determination...neither am I, neither is an ED doc.

Excellent point, Kara...I totally missed that until you pointed it out.

ernurse2244 · Jan 10, 2004

Please go back to my original post. Don't think he is addicted because can go several days without his shots. I do think he is a drug seeker since every bit of pain he has is 10/10 and requires injections to get him relief. Doesn't matter, really, I just want to know how others would treat him. I also agree that ER isn't the place to treat him, but that is the only place he seeks treatment and he does so frequently...3 - 4 times a week, more at times.

angelbear · Jan 12, 2004

Ever had a kidney stone? THEY HURT!!!

BarbPick · Jan 12, 2004

there are different kinds of drug seeking. Lupus patients who want extra steroids when they are being tapered down. the pain management clinic my husband went to, he was given epidurals in his spine. The anesthesiologists do not give out narcotics.

A lot of it is for attention. We are not to judge.

Fgr8Out · Jan 12, 2004

Sounds to me as if this individual has some poorly managed chronic and/or acute pain issues. If he hasn't already... he could probably use the expertise of a case manager or social worker to help him utilize his available resources and perhaps receive counseling.

When a person comes in for pain relief and there is no obvious source of pain, the health care profession can sometimes send the wrong message that the patient is faking or playing up their pain. This can lead to some patient's adopting behaviors that will allow them to receive medication... even crappy medication like stadol and phenergan (bleah), simply in an attempt to alleviate their discomfort.

I personally think the term "drug seeker" is inappropriate as it is not a valid diagnosis, but simply a label used for people with either poorly controlled pain, true addictions or simply tolerance to narcotics. We're frustrated with our inability to successfully treat such patients.

Additionally... at one time or another we all "seek" drugs. Case in point, I had a severe headache earlier today and set about "searching" for some tylenol or ibuprofen (along with a large quantity of water) to help relieve it. Finding what I required to ease my headache, I now feel much better.

As Nurses, we face many challenges such as this. ernurse2244, I hope the patient you described is able to find resolution to his pain issues. Because you've expressed concern for him, perhaps you will be the catalyst that helps him find the help he needs. Good luck!