What's the deal with pain pills?

[Nuieve]

I work in a rehab center. We're famous for accepting patients every other single nursing home refused. Mostly drug junkies, alcoholics.

I noticed in hospitals they rarely get more than 5-10mg of hydro or oxy.

Once they come to a nursing home (or I noticed from records from other nursing homes), their pain pills prescriptions start growing exponentially. 5mg, in a week 10, in two weeks 30 and so on... Start with hydro 5, in a month they have MS 30mg TID and Oxy 20mg QID.

Now I know SOME of them do have pain. But most of them are just homeless guys with nothing wrong with them to warrant such high doses of narcotics.

I know how it works, patient comes to the doc and says "it's not working for me, I'm in a lot of pain". Doc has no other choice but to bump pain pill dosage.

Now I wonder, are docs required to up pts dosage of pain meds whenever they ask? Are they legally required to? Afraid to end up in a lawsuit and just decide it's easier to give these people what they want rather than deal with lawsuits later?

Maybe it's my particular place, but 1 year ago 80% of narcs were hydros. Now I maybe have 10-15 cars of hydros, and about 80-90 of mostly MS and oxy with some dilaudid and methadone in between.

The other problem is that once they taste hydro once or twice a day, they get hooked up and keep asking for it regularly after that even if source of their pain supposedly resolved.

And then you find them drunk... and/or selling those MS tablets to strangers that come to visit them.

When I was doing my clinicals in the hospital, the nurse I was with... she just completely ignored new pts with drug seeking behaviours. She would go on with her assessment and not run for pain pills or look for doc to up them. Many pts come from hospitals c/o that it takes forever to get a pain pill in a hospital. It's like hospital docs/nurses are more confident or better protected. In my place, you don't give a junkie his oxy so he can go and get drunk/high, you can get reported to the state/fired. So there dear, take all you can have. It's all yours, enjoy... go buy some whiskey with that, I heard it makes it even better. The law wants you to have as many narcs as possible, we don't have enough addicts in this country. Should I ask the doc to up your MS from 120mg TID to 180mg TID because you have a boo-boo on your finger? No problem...

[CoffeeRTC, BSN, RN]

Wow...not like that were I am.

How often are the docs coming in to see the residents? What type of supporting documentation are you doing for the pain meds and assessments?

If there is really that progression of pain meds then there is a problem. For the most part, we are treating and healing or reducing what caused the need for pain meds in the first place. Granted, some people have chronic pain so that won't go away and is a valid reason for the progression of pain meds.

I'd say the MD needs to be evaluating them more often and pharmacy needs to get involved in the treatment plans.