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.