Wednesday, January 5, 2011

A Comment on Drug Seeking Behavior

A while back I had the predictable response from one of my posts about drug seeking individuals; the respondent took issue with my attitude and begged me to consider that all patients with chronic pain complaints are not, in fact, drug seekers. My response:

"Yes, but why are you out of meds? Surely with a chronic painful problem you would make it a priority to contact your provider well in advance so you DO NOT run out; this is what reasonable individuals do who are taking responsibility for managing their health care. "I've run out of my meds and haven't had time to contact my doctor" is often how individuals seeking narcotics present to the ED. This is not to paint everybody with chronic pain issues with the same brush, I am merely pointing out why you may be treated like a drug seeker when you say you have run out of meds. You must understand that most of us working in emergency departments see the same individuals all the time with the same chronic complaints; most of these patients could be well controlled with medication if they are diligent. But that is my point, so many want only the narcotics. Their histrionics and constant drama suck the life out of us and take us away from legitimately sick patients. No, not everyone is a carbon copy, however when 9 out of 10 individuals with these chronic types of pain issues IS a carbon copy perhaps you can begin to see the problem".



For example:



Today a gentleman arrived with a complaint of "Getting a Migraine". No headache, but you know, he says, I've had these visual "bubbles" for a whole 20 minutes now and that's how it starts. He has had 25 ER visits in 2010 for pain-related complaints; most were without trauma, and those that involved a fall, lifting furniture, banging his thumb with a hammer were all without clinical findings. Of course the majority were for the Holy Trinity of pain complaints: Back Pain, Migraine, and Dental Pain. Amen. He had been prescribed 15 Percocet for 10 of those visits, 10-15 Vicodin for 6 visits, and Ibuprofen for 3 visits. He declined a dental block for two visits and just took the antibiotics.



Another well known individual with many, many visits for back pain always has the same story; my doctor is not available. In 18 of the last 19 visits, he has arrived at 5:15 pm ALMOST TO THE MINUTE. Of course his PCP's office is closed at that hour. He asked for oxycodone without the acetaminophen, which is oxycontin pretty much and very powerful stuff. He claimed that the Tylenol hurt his stomach; note that for 19 out of 19 visits he received a prescription for percocet. The ER physician informed him that she never prescribes pure oxycodone in the emergency setting and wasn't about to start now.



Both of these cases involve individuals with chronic pain issues who have either not been up front with their physicians about how much medication they are taking, or are simply lazy. Lack of planning on your part does not constitute an emergency.

8 comments:

Anonymous said...

My daughter was sent to the ER by her pain mgmt MD. She was in the middle of a pain flare as a result of a kidney infection. Because of her verified allergies to morphine and dilaudid, he sent her to the ER to be admitted for pain control. He knew it would be assumed she was drug seeking so he told her to instruct them to call him so that he could confirm her chronic pain diagnosis, drug allergies and current pain medications. Simple enough to confirm and proceed to treat correctly.
The ER doc refused to call. Apparently his ego wouldn't allow him to defer to another physician. After all, my daughter just fit the profile so it wasn't possible she was the one pt that wasn't a drug seeker. Complaint filed by pain MD.

Ian Nouvel said...
This comment has been removed by the author.
EDNurseasauras said...

What a shame. All of which could have been avoided had her pain managament doctor simply admitted her himself instead of taking the lazy way out by turfing her to the ER.

Anonymous said...

The big health care system only extends admitting privileges to certain physicians but not to their pain mgmt group. Stupid but true. She does everything possible to avoid the ED.

Amy said...

Bravo~

I am a chronic pain patient. My nephrologist urges me to go to the ER whenever my pain gets out of control, but I just don't because I'm scared of the drug seeking label. I always call to get my prescription filled 5 days prior to running out, I can't understand why other people don't take the responsibility to do the same thing. I'm sorry you have to deal with drug seekers, it would drive me nuts! On the few occasions that I did go, he called to notify he was sending me...totally smoothed the process

girlvet said...

It amazes me that ER docs keep giving these people narcs. Don't they look at the history? Nope they just pass it on and pass it on and they keep coming back.

EDNurseasauras said...

It infuriates me that it is so often the path of least resistance; give 'em the narcs and they will go away. But unfortunately they return, and return, and return.

Donna said...

I realize this is an old post but in case you really want to know how someone in chronic pain could run out of meds then I can give you some idea...

15 years ago my husband decided to throw me up against a wall when he was shitfaced drunk. I got 2 herniated discs out of that, and have 4 now. At first the pain could be controlled for long stretches with epidurals, but the last ten years or so I've been on narcotics.

I've been through withdrawal twice, the first time because the idiot pharmacist got me confused with another patient (I have a common name) and put the wrong birth date into her computer. That person's insurance wouldn't allow the prescription to be filled. I didn't know I was confused with someone else at the time, and it took 4 days to clear it up.

The next time I called on a Tuesday to say I was running out, then waited and waited and my doctor never called to tell me my prescription was ready. We are told not to keep bothering them and calling for prescriptions. So I waited until Friday morning and called again. They never got back to me. This was labor day weekend, a nice long weekend to suffer.

I never even considered that I should go to the ED over it though. Maybe I should have, since I wound up there a week later with syncope caused by hypokalemia from the withdrawal.