Drug Seekers Suck
Posted by WhiteCoat on February 4, 2008
This morning as I was leaving my shift, one of the local cops mentioned that they are having a real problem with Vicodin sales and use … in the high school. Kids strung out during classes. Must be a great learning experience.
Where do you think these teenagers are getting their stash?
Then there’s this article about a doctor who was sued for giving pain medications to a patient and not sufficiently warning the patient about its possible effects upon driving. (Hat Tip to Kevin, MD) Oral arguments and the opinion of the court are at this link.
Keep the above in mind as you read the following which happened a few days ago.
A lady with a previous history of chronic neck and back pain now comes in with frontal headaches for the past month. Of course, her pain is a 10 on a 1-10 scale. She gets dizzy at times when she stands. Sometimes she gets nauseous. She says that she has vomited twice in the past 3 days. She used to take Vicodin for her back and neck pain, but she’s out of them now. I look through her old charts. She seems to like Dilaudid and Vicodin.
It’s a busy shift, so she had to wait for a couple of hours. When I walk in the room, she’s laying on the bed with her arms folded. She seems upset with the wait, but she’s playing the “nice” card, I can just tell. She’s sizing me up from in between those fingers over her eyes. Very polite. Says “thank you.” Compliments me on being so nice even though we’re so busy. I engage in some small talk with her and she actually is a nice lady. The little voice in back of my head is literally kicking me in the mastoid right now. “Hey! WhiteCoat! Don’t be a sucker. She may be nice, but remember her history! Being overly “nice” is page 2 of the drug seeker’s handbook!”
Since her headaches are a “new” complaint, I examine her from head to toe. No fever. No sinus pressure. No temporal arteritis. Fundi normal. No photophobia. No meningeal signs. No abdominal problems. No focal neurologic deficits. Oh, by the way, she still has that chronic pain in her back. Can’t find anything abnormal on her exam other than her “10 out of 10″ pain.
I don’t care how nice she is, she isn’t getting Dilaudid. We give her some Phenergan for her nausea and some Imitrex for her headache. Her headache improves to a 5 out of 10.
“By the way, doctor, my head still hurts. Could you please give me something else for pain?”
“Absolutely,” I tell her. “But it isn’t going to start with the letter ‘D,’” I think to myself.
We give her some Toradol. Her pain is down to a 2 of 10. “See, lady?” I think to myself, “you don’t need narcotics to get rid of your pain.”
When we tell her that we’re going to discharge her, she is actually grateful. She thanks everyone for being so nice. “Kill ‘em with kindness.” That’s page 3 in the drug seeker’s handbook. Well it worked. I sent her home with some Imitrex, Phenergan, and a couple of days worth of narcotics. The little voice in my head pulled the otoscope off of the holder and whacked me in the back of the neck with it. What a sucker I am.
That’s not the end of the story, though.
Two days later she’s back. Of course there’s another doc working that day. Divide and conquer — I think that’s page 6 in the drug-seeker’s handbook. Now it’s the sob story. The pain medications aren’t helping. Her head hurts. She’s vomiting more. Her doctor doesn’t have an open appointment. Oh, and now she fell and hit her head before her last ER visit, but forgot to tell the ER doc. Her neck hurts from the fall, now. Just to add to the drama, she’s acting like she’s confused. It isn’t January 2008, it’s really January 2007, “isn’t it?”
“Oh well, what the heck,” the ED physician thinks, “why not irradiate her body a little more?” So he orders a CT scan of her head.
Brain cancer. Multiple metastases. Poor prognosis. As in she’s going to die soon.
This was one of those “Hey, you remember that patient …” moments for me when I came to work for my next shift. People were knocking each other over when I walked in just to tell me.
At first, I felt horrible about considering that she could be a drug seeker. But I got her out of pain when she came to see me. At least that’s how I rationalized it to myself.
Then I felt bad for not doing the CT scan when she came to see me three days prior. Was there really an indication for ordering it? Maybe, maybe not. Just like the Super Bowl, everyone can always sit back and second guess what might have happened if ….
Another rationalization.
All these warnings from our malpractice insurers about saying “sorry” as an admission of guilt have me too afraid to just walk upstairs to the floor, sit on the side of her bed, and ask her how she’s doing. I genuinely feel bad for what she’s going through. The little voice in back of my head started to mumble something. I grabbed him and whipped him against the wall. Maybe he’ll just shut the hell up for a while.
Maybe my human side will win over my chicken shit doctor side and I’ll hit the 4th floor button on the elevator after my next shift. Then again, maybe I’ll procrastinate long enough and she’ll be discharged.
When people complain that doctors don’t want to treat their pain in the ED, this is a perfect example of what emergency physicians and nurses go through every day. Where do we draw the line? How likely is someone to abuse the prescriptions we give them? Do I risk putting more drugs out on the street? Or do I risk not helping someone truly in pain? All we have to go by is someone’s history … just in case you were wondering, drug seekers lie.
It scares the hell out of me that a prescription I write could some day be sold to my own kids and start them on the road to drug addiction. Yet it scares me just as much that I could let another person suffer in pain because I was too afraid to write her a prescription for narcotics.
And the public wonders why we think drug seekers suck.
Dr. Greenbbs said
and i’ll be ordering head CT’s for all my headaches that come in for the next little bit.
EEK!
scalpel said
You relieved her pain. You treated her appropriately. The 2 day delay in diagnosis wasn’t medically significant. I don’t think she would have much chance of success even if she did sue you. Now if she’d waited three months to return…..eek indeed.
That’s what bothered me. What if ….
I’d be more worried if I’d seen her in the ER during the previous few months before the cancer was diagnosed but when it might have been more treatable if caught early. Any single mention of headache anywhere in the chart is going to be cause for a settlement. Vomiting, paresthesias, or “weakness” is going to be good for a NPDB listing too. That sucks.
I don’t know whether I’d go see her upstairs either. Probably not.
I didn’t. But now I wish I did.
Nurse K said
10/10 pain with no neuro deficits? For the purposes of ordering a CT scan: YAWWWWWWWWWWN. That’s why everyone gets a follow-up provider listed on their d/c instructions and that little “we treated you on an emergency basis only” blurb, no? Now, if she presented with a first-time seizure, that would be a different story.
Now she’ll get all the narcs she wants.
TK said
Wow – that is a rough story. Still, not all headaches need a CT in the ED as well all know. The important thing I think is that she was referred to a neurologist for the new headaches. Small mets would not have even showed up on CT and would have needed an MRI (which routinely can’t be ordered from the ED).
katherine said
thanks for your blog. I am a NICU doc. It is good to hear others voice the unvoiced worries about daily life in the trenches.
ERMurse said
I work in a small ED that gets a high percentage of “drug seekers”. Most Docs take the attitude of give them a shot (one of the D drugs), narc rx, and get them out. One doc that I have grown to respect has taken the stance that the only way you will get narcs if you stay for a work-up. Otherwise its toradol or something similar. Even the ones that seem to be obvious seekers get a CT and in some cases LP for the headache if they do not have one documented in the past year. Guess what, he has found several significant finds like the one you had on people that were previously dismissed as seekers. The ones that truly seem to be faking for meds refuse the work-up and don’t come back when he is on. Work them up, great way to separate the wheat from the chaff.
Yvonne ED RN said
You provided an accurate course of treatment based on the presenting symptoms and the response to the therapies thus administered. Defensive medicine is not Good Medicine. Usually a headache is just …a headache. Sometimes a Stegosaurus instead of a horse will be what we find when we hear hoofbeats. Thats the quirks of humanity. You did not make a mistake.
Thanks for the support.
SarahW said
How likely is someone to abuse the prescriptions we give them? Do I risk putting more drugs out on the street? Or do I risk not helping someone truly in pain?
I say the first two should not be considerations with much weight at all, if any.
Drugs on the street are used by people who will use ANYthing, the population of addicts is a fairly stable percentage no matter what they get their paws on.
I think it’s a mistake to put this gatekeeping role on physicians, who I see as more properly guiders for correct, safe use, and evaluation of pain’s causes, than gatekeepers from recreational use of medicine. It’s immoral to deny relief to the suffering just to make sure the undeserving don’t “get away” with something.
That’s the point, though. How do we determine who is truly suffering and who is “undeserving”? Do we just write narcotic prescriptions for everyone? The resources spent on drug seeking patients are immense. Why reward such behavior?
William B said
I do not use drugs, but can only say that my primary reasons, ( and they have thankfully been few) for needing medical attention in the past have been because I have been in physical pain. Why else would I go to an ER? Because I feel good? You self styled ” drug seeking detectives” are frightening. Do you work for the DEA, or did you take an oath to relieive pain and suffering? You ” medical professionals” should be ashamed of yourselves! I can only hope that I do not have the misfortune of being treated by any of you.
whitecap nurse said
I had an 18 year old girl with no medical history present with upper back pain after jumping rope the day before. Her pain got better after Toradol and Ativan. But at discharge, she said she couldn’t move her leg. I could have sworn she was just being a little drama queen, tearful, swaying from side to side and sinking to the floor when attempting to stand. Diagnosis later in the day – transverse myelitis. Another zebra!
enrico said
It scares the hell out of me that a prescription I write could some day be sold to my own kids and start them on the road to drug addiction. Yet it scares me just as much that I could let another person suffer in pain because I was too afraid to write her a prescription for narcotics.
Agree with another commenter that the first sentence is meaningless, provided that you script an appropriate amount of meds for them to follow up on the outside. 3 days worth of appropriately scripted Vicodin isn’t a drop in the street drug bucket either from either the abuser’s or seller’s POV. Your and my kids are/will be exposed to drugs guaranteed, so education and communication are the best defenses.
Just like our justice system, sometimes guilty people go free because the system is skewed to protect the innocent, and “reasonable doubt” is the litmus test, not “proof.” Nobody–and I mean nobody–should suffer needlessly because of the influence drug seekers’ behavior. Anybody that disagrees with that statement in principle should get the hell out of medicine yesterday. In practice, legitimate legal worries cloud the line, obviously.
I fear, however, that certain ED personnel care more about gloating, “I told you s/he was a seeker!” than “Thank God we caught this [fill in zebra].”
If Vicodins go for $10/each on the street (which is what I have been told by the police in our town), selling 20 pills will make you more tax free money in one day than many Americans take home in a week. Multiply that times several medical providers per week and your “job” could become quite lucrative. Sure beats working at McDonalds.
I agree that there are a lot of healthcare personnel who are too concerned with catching someone lying about their medication history. That concern sometimes clouds their judgment when treating patients in pain. That is the whole point of this post.
Your legal analogy is a good one, but I think you take it too far. We don’t do away with the criminal law system because we never want to jail someone who is innocent. We just put appropriate safeguards in place to minimize the chances of convicting the innocent. We have to draw a line somewhere.
Had someone come in a few days ago who said he only got medications from one pharmacy and one doc. We called around to several pharmacies and he got medications at all of them from six different physicians. Should we just toss him a script for a few days of Percocet on the possibility that he really could be suffering needlessly?
girlvet said
This is what makes ER medicine so tough.
Dr. Val said
I totally sympathize. This was hard. The one nagging issue – the complaint of vomiting. I don’t often find that drug seekers add that in to their stories… but the chronic back and neck pain would make most docs suspicious of drug seeking behavior.
Patrick said
Spot on, Enrico!
jerry said
Don’t sweat it. Like Scalpel said, the 2day delay does not make an inkling of difference.
Impossible to be 100% sensitive and specific in distinguishing the addict from the medical problem, and often they coexist.
Dr. Val: I find drug seekers vomit/dry heave/gag themselves all the time. It adds to the dramatic presentation. Or is part of their withdrawal.
Enrico: Agree in large part. Always giving people what they want is not always best. Enabling someown with a self destructive habit and not ever attempting to intervene/confront them toward treatment is cowardly.
EdDunkle said
Give the drug addicts their drugs! Who cares what they do to themselves? I doubt that many of them turn around and sell to others, especially high school kids with little money. And if they do, arrest them. Is there any hard data on this topic? (DEA propaganda does not count.)
Why do so many scientifically trained doctors turn into baptist preachers when it comes to drugs? Drug addiction is a medical problem, not a mortal sin (am I confusing my religions? well, you get the idea.)
If drug addiction is a medical problem, should I as a physician contribute to it further by prescribing medications to the addict? Do I next start buying bottles of scotch for alcoholics when they come in? Physicians have lost their licenses for prescribing narcotics to drug addicts that later died.
When people complain about lack of resources and increased costs, drug seeking behavior plays a significant part to those problems. See this post and this article.
LA said
Brain mets. Just curious… is the primary known yet?
Not yet. Didn’t look at her inpatient chart and haven’t spoken to her PCP.
arrrr said
EdDunkle: How about the more obvious point… giving them drugs encourages them to come back and annoy you again. Give them a 2 week course of Vicodin and they’ll be back in 5 days for another $10000 workup. And again. And again. And again. I remember a calculation about one homeless drugseeker who was estimated to have cost about 100,000 dollars in his attempts to get more opiates. Think about that for a second.
Insert complaints about rising health care premiums.
frodo441 said
Myself, having been a cancer patient seven years ago, experienced some if not a few more of these types of class two narcotics…I can’t tell how excruciating the pain in my ass was until I finally could get it cut out…and I was glad to see it go…I got the assumption from people dealing with pain med’s by experience that “pain management” became teaching patients to tolerate some of it with in reason if not find other modes of dealing with pain…
Kraig said
I am a former drug addict, but I did not use the ER as a source. I was cut off by a few doctors, but I always found a way. When a person is addicted, they will go to any length. Please don’t feel like you did the right thing by denying meds to someone. I had a back up plan that was an old woman with cancer. I hated myself for breaking into her house, but if the doctor said “No” I had no choice.
A doctor needs to form a relationship with the patient. If someone comes into the ER with pain, treat them. If non-narcotics don’t work, give them a narcotic. Make sure they come in for a follow up. If they don’t show, no more meds. Too many doctors, in my experience were simply aloof to a fellow human being in need. You might say that a junkie deserves withdrawal, but it is one of the most horrible experiences a person can endure. That is why you can’t stop addiction by not writing scripts.
How about being honest? Ask the patient if they want a narcotic or if they want to find the root of their pain. If they only want a narc, give it to them and tell them never to come back.
Finally, I can’t IMAGINE a drug addict getting a script and selling it to ANYONE, let alone a HS student. My meds only went to me and other people that I used with. If a teenager gets Vicodin it is 99% coming from someone’s mom, dad or grandparents medicine cabinet.
Lisa said
She’s sizing me up from in between those fingers over her eyes. Very polite. Says “thank you.” Compliments me on being so nice even though we’re so busy. I engage in some small talk with her and she actually is a nice lady.
I bet she would appreciate your concern. I don’t have as much to lose as you have on the line, but I know as a previously misdiagnosed & “nice lady” that it would probably mean quite a bit to her. Even if just to say, “I just wanted to check on you and see how you were doing.”
jesslev said
Interesting stuff! I think you should go see her too!
peggy said
“I had a back up plan that was an old woman with cancer. I hated myself for breaking into her house, but if the doctor said “No” I had no choice.”
Had no choice? Please, Kraig, stop lying. You always have a choice. Getting off those street drugs will cause you the equivalent of a really bad case of the flu for two or three weeks, max. Those who use, like it and simply don’t want to not use. THAT is a moral problem. There’s an entire industry employing thousands who would all be out of work if they didn’t go along with the myth that drug addiction is a medical problem, not a moral problem. It’s a character problem, for sure….witness your witless statement of having “no choice” but to steal pain meds from a woman with cancer.
Steph said
Drug seekers do suck. I can’t speak to what it feels like to have a diagnosis like that come back after you’ve discharged a patient. But speaking as a patient who is dealing with the frustration of looking for a doctor that won’t automatically assume that of me, your attitude is something I would be pleased to have. I’m glad to see that even though you see drug seekers every day, you’re still willing to accept that people can be in pain and look for ways to treat that pain.
I’ve had a lot of doctors misdiagnose me. I’ve had a lot miss the “oh, by the way, you’ll probably die because of this” signs. That never upset me; there wasn’t anything they could have done differently if they had been right. But I have always remembered and truly valued the doctors, nurses, etc., that took the time to treat me as a person, to listen to me and do their best to help me. It sounds like you did that for this patient, regardless of what the little voice in the back of your head was saying, and that really can be more meaningful than you know.
Thank you. I looked at your blog and hope that you continue it. There are a lot of doctors – me included – who could learn a lot from you.
SeaSpray said
What a powerful post!
The following is part of a quote I wrote that I keep on my
sidebar: “Sometimes in life, all we can do is our best and it’s not always going to be someone else’s best, but it is our best at the time and so we need to be forgiving of ourselves when necessary.” I omitted part of it but I think the rest of it applies here.
Also and I don’t know if it makes a difference because you indicated she is terminal, but maybe she needed to become an inpatient and if you had given her the drugs they may have delayed her getting the more important treatment she needs or possibly it would’ve been too late to get her affairs in order if she hasn’t already done that.
Maybe I am wrong but I really believe we are meant to meet certain people so certain events can play out in our lives for whatever reason.
You docs ARE between a rock and a hard place with these decisions.
You were nice to her and she appreciated it and told you. She couldn’t hear your little voice. You have that voice for a reason. You need to be discerning in your profession. You know some ED staff would have totally blown her off. You didn’t. You worked her up and didn’t find any reason to order a CT. BTW…remember your posts regarding excessive radiation?
Between a rock and a hard place…yep!
LawyerMom said
I read this and my first thought was, “I bet some plaintiff’s lawyer would like to read portions of this post to a jury (or, worse yet, make YOU read them) if this case ever went to trial.” (Assuming, of course, the lawyer was competent enough to link you/your hospital with the blog, a big assumption.) It’s hard to imagine that 2 days would make any difference whatsoever, but was this the first time she had mentioned her headaches at your hospital? Remember Dr. Flea?
I frequently think about whether something I write will some day be used against me. Those who have ulterior motives can always twist something someone says into something that meets their needs (i.e. reading “portions of the post to a jury”). But I’m not going to bow to a fear of what some lawyer “might” do. If we all become paralyzed from fear of lawsuits, no one would ever write another blog entry.
This was the first presentation of the patient for headaches. If the case ever went to suit and some attorney wants to try to grill me about the difficulties physicians have dealing with drug seeking patients, I wouldn’t feel the least bit uncomfortable about reading the entire passage to a jury.
Susannah said
Replying to an old blog post.
Sorry but i get upset. I am a chronic pain sufferer. By all means, it’s rarely a 10, but i am at 7-8 on a daily basis.
Before i finally found proper main manegement from a wonderful pain doctor i had to go to the ED many times. And Most doctors have been happy to help me, usually one or two Dilaudid shots and sent home with Tramadol (I asked for the Tramadol because it helped for years) I am now on the Fentanyl Patch 50mcg and Roxicodone 15 for breakthrough pain. Tramadol does not help anymore.
Anyway, on to my reason for posting this late reply. Like i said most Doctors in the ED were wonderful but a few times I got some Doctors who thought i was drug seeking and i can’t tell you how frustrating and heart breaking it is to have a doctor look at you like you are an addict when you are not and you are in horrible pain.
I don’t understand why some ED doctors are not compassionate about Chronic pain patients and why so many of you think we are drug seekers when we are not. Yes, i understand you probably see a few drug seekers a day and i understand it how frustrating that gets for you, but imagine how frustrating it is for someone in horrible pain and being looked at like they are an addict.
I think some ED doctors out there need to go back to school just for this sort of thing. Most people who go to the ED ARE NOT DRUG SEEKERS. Most of them are good citizens and good people.
Next time you are treating a chornic pain patient, try to have a little more compassion and don’t assume just because someone has been there 5 times in the last 6 months for chronic pain that they are drug seekers!!! Next time you or a loved one is in pain, remember… what if it was them going to the ED for REAL PAIN and they we’re turned away because the ED doctor thought they were a drug seeker.
This all makes me so mad. It’s not fair. But, at the same time i have had some great ED doctors who treated me wonderfully. But, once in a while I’d get that young whipper-snapper doctor who thought he was going to save the world by turning away someone who he mis diagnosed as a drug seeker!!!!
Health Care BS - ER OVERCROWDING: AN IMMODEST PROPOSAL said
[...] Is it not true that GruntDoc, Scalpel, Nurse K, Whitecoat, Shadowfax, and other medbloggers are always lamenting the large number of drug seekers [...]
Greg said
I was that guy for awhile.
The polite well dressed professional middle class guy in your E.R. complaining of rib pain. Well, lying about it anyway. I would say that I “slipped on the ice and just came down on a parking curb. Darndest thing, but no bruising, so I just put up with the pain for a few days until my wife said I could have a cracked rib and should go see a Dr.”
Of course it’s Sunday or 3 in the morning and “it just hurts to breath a bit, or cough, and it sure would be nice to get some sleep.”
I would even make it look like what I would really like was a script for a just few days of sleep meds.
I would be nice to the nurses. I would flinch as you, the Dr., would push on my ribcage. I would be “splinting” as one Dr. called it. Sitting up real straight on the table as if something hurt.
After a few X-Rays and some re-assurance that I would be O.K. , I was on my way out the door with a script for some hydros.
It never failed.
I’m sorry.
I admired all of you. I respected you as well. Yet I still burned you.
I was probably on day 2 or 3 of withdrawals because my dealer was temporarily out.
He got his merchandise from guys that were legit patients that just didn’t like the pills that the Dr.s gave them as much as the money that they could make.
I was a consumer. I never sold or gave away any thing prescribed to me. It was MINE.
The drugs that someone would try to sell to your child came from one of those many, many legit pain patients that are getting 90 to 120 10mg hydros (or maybe even oxys) a month and selling them off.
The seekers you see are in desperation for a 3-5 day fix until the supply returns. It always goes in cycles. Those scripts never see the street. Ever. Unless that seeker gets ripped off by some neighborhood kids.
Now that I’m clean I try not to think about what I did to you people. It hurts too much. The lying really does suck. I hated myself. It’s not a happy addiction. I spent my time, money, and energy on not just chasing a buzz, but avoiding being sick from withdrawals.
I never did break into any old ladies houses.
But the thought had crossed my mind a few times.
I am so lucky to have been helped by a compassionate circle of friends and family. Say a prayer for me that I can stay out of that miserable existence. And the next time I’m in your E.R. It will be because I ’should’ be there. And I hope that I will be able to say, right off the bat, that I am a recovering addict to opiates.
Please don’t worry about the seekers scripts getting out on the street.
Please remember that the pills on the street came from those legit pain patients with the endless monthly supply.
Money is stronger then pain for those individuals.
For the first time in a long time, I am not lying to Doctors
I kind of like it.
Once again…
Sorry I burned you guys.
Greg
I am truly glad for you that you were able to beat the demons inside of you. Keep up the good fight because I know that those demons will always be nipping at your heels.
Would you e-mail me (whitecoatrants-at-gmail.com)? I have something to ask you privately.
Thanks
WC
Teresa said
All these warnings from our malpractice insurers about saying “sorry” as an admission of guilt have me too afraid to just walk upstairs to the floor, sit on the side of her bed, and ask her how she’s doing. I genuinely feel bad for what she’s going through. The little voice in back of my head started to mumble something. I grabbed him and whipped him against the wall. Maybe he’ll just shut the hell up for a while.
Maybe you should be listening to the little voice instead of the insurance company. There was a very interesting article in the NY Times a few days ago suggesting that an apology and admission of wrong actually reduce the overall cost of medical mistakes. Most states have made such actions on the part of doctors inadmissible in court. You should check your state laws; it might be a comfort to you.
My own guess is that lawyers don’t want you to admit wrong, not just because it can be hard to defend (if it were admissible), but because if the doctor solves the problem with an apology, the need for the lawyers goes away. Think about it–by soothing the patient with a soft answer, you’re cutting the lawyer out of business.
We need more sophisticated juries. The average person in this country does not appreciate how much medicine is judgment and art rather than predictable treatment courses, especially in today’s rushed up environment.
And the problem with all juries in all cases is that hindsight is 20/20, and when you have unlimited time to think about something, it is easier to come to the right conclusion. Most liability cases involve fairly quick decisions on the part of the defendant. You accidently hit someone with your car–how much time did you have to think and react to the situation? Yet the jury can take as many days as they like figuring out just how, in that 2 seconds you had, you could have avoided hitting them.
Kayla said
My name is “Kayla”, and I am what some would call a “functional addict”. In reality, I am as dysfunctional as they come. I am a real person with real problems, who obviously does not know how to deal with them. My purpose in stating these things is not for self-gratification, but rather to put my problems out in the open, as this has been a secret for far too long. They say the first step to recovery is admitting that you have a problem. I see many blogs by ER and ED doctors and nurses about the drug seekers they see on a daily basis. Part of me wants to be angry at them, for being so crass and uncaring, but I can also see their perspective, too. They are real people as well, with real problems, but they aren’t popping hydros just to get through the day now are they? NO! I envy them. I envy the people who go through life on a daily basis with a smile on their face without needing a chemical to alter them enough to make them think they are happy. Are there resources available, medicines available to help this. I know substituting one drug for another is not the answer but at this point I am scared shitless. I need help and I know it. I do not want to become a statistic in your emergency room, as I have never had to drug seek in the ER.
Lilianna said
Ah doctor, doctor – you know that us chronic pain patients hate the term “drug seeker.” We prefer pain-relief seeker. Even if you don’t believe us. I won’t go into that – i’m pretty sure you’ve been to my blog so you know how I feel about doctors undertreating chronic pain.
I was just wondering how it came out with the patient. I don’t know if it helps any but among other pain complaints, I was suffering from chronic headaches (which I didn’t realize were migraines and I was pouring OTC sinus medicines down my throat), dizziness, blind spots, visual disturbances, nausea and vomiting and went to the emergency room a couple of times myself for it. Those doctors would just say headache (still, no one saying the word Migraine) and those doctors never gave me Toradol shots and they worked just fine. I was never given a MRI either. Couple months later….wait for it…..Central Retina Artery Stroke. But hey, my internal medicine doctor missed it too. It wasn’t until I was in my hospital bed with blood thinners running through an IV, that a neurologist said the word migraine. Migraine induced retinal artery stroke. Who knew? I was irritated that no one asked me How Much OTC sinus medicine I was taking until the neurologist – over 40 pills a week. Now I use midrin or Toradol shot if midrin doesn’t work.
By the way, I dumped my internal medicine doctor after the stroke. Why, you might ask. Not because he missed the diagnosis. It was only because a couple of weeks passed and he didn’t give me the courtesy of a phone call. And no, I didn’t sue him. I’ve been misdiagnosed before, all with drastic consequences to me, but I realize I am the zebra.
Those attorneys saw a windfall because…I hate to say it…a child was involved. Juries make decisions based on emotion, not facts. Superior Court judges, I read all the opinions and their decision wasn’t based on facts. Patients have a duty to be self-advocates and not put the public in jeopardy. Stupidity rearing its ugly head again.
Lilianna
Lilianna said
oops, I meant always gave me Toradol shots.
Lilianna
Kristina said
I read your blog often. As do I read other ones that were linked to yours. I actually stumbled across it while trying to learn exactly what a “drug-seeker” was. Unfortunately, I was labelled as one, and it cost my son’s life. I was pregnant. Reported to the ER numerous times because I felt as if I were dying, bleeding, cramping. Since I was not bleeding the first 6 times I went in there I guess they figured I told the blood to come out of there so that someone would believe me but they still didnt. I was sent home over and over again. 31.5 weeks pregnant and I was asleep in bed when my water broke. I had vag bleeding, cramping, and I do mean SEVERE cramping. I labored for 27 hrs before requiring an emergency c section. All this time, I was abrupting. I begged for an epidural. Unknown to me, the nurses had labeled me a drug-seeker. Well, I guess I was. I was in such pain that I couldnt see straight. I WANTED ANY DRUG THEY WOULD GIVE ME! I would have taken a hammer or iron skillet over the head if it would have knocked me out. My son required 20 minutes of cpr. he did come home, fed through a g tube, had HIE, many many problems, mechanically suctioned. I was urged by nurses at the NICU he was transferred to, that i needed to file suit against the hospital and nursing staff and my dr. Taboo huh? I never ratted these nurses out and I never would. How likely is a nurse who suggests you sue to get a job, eh? Well, I consulted an attorney. But no, I didnt follow through. And it took me reading your blog to make sense of some things. Initially I blamed insensitive and uneducated, crass, mean nurses and staff for killing my son. I was so angry at them. For calling me a drug seeker, at the expense of my child. Nothing could take away the pain of finding my sweet baby lifeless and blue, the blood already pooling to the side of his little face. NOTHING! I blame society! The drug seekers who swarm into your ER DAILY looking for drugs. They made this happen to me. They cause the medical field to doubt any one in pain, given the reaction. In hindsight, I guess I appeared to be looking for meds. I went in begging for them because I hurt sooooooo bad. Time after time after time. but even more, I wanted them to find out what was wrong, but it was too late. The people plagueing the ERs and other depts, made my life hell. They caused the medical staff to think my condition was not a true medical emergency, but rather a need for narcotics. I do understand why you get so angry and fed up with them.
As much as my child deserves justice for his pain, me sueing will not fix this. I wish there was something that could be done, some way to have a magic ball and know who is faking and who isnt. If you did, maybe my life would be different. Damn those seekers, THEY killed my child.
bladdergirl said
Firstly I think its a hard thing to fess up like you have and admit your initial assumption was incorrect.
That’s admirable. I wish all Medical professionals could do the same.
My last consultant never acknowledged what she didn’t do for me as a patient and it nearly cost me my life. I don’t hate her, nor am I bitter and twisted.I just don’t want her near me again. I believe that Doctors are human, and its not about making mistakes its about things that just go pear shaped. Every human body is different, and you can’t always get it right.Doctors aren’t gods. The job is stressful(I was married to one)They too suffer human responses. Anaesthetists have a high rate of drug abuse and suicide, which is sad. No occupation is infallible. Drug seekers piss me off too, because I don’t want to be labelled either.
I learned different ways to manage my pain. My last post I wrote highlights this. http://neo-conduit.blogspot.com/2008/09/pain-control.html
I use distraction technique and clean my house up when in pain while grooving to music.
What I do query though is does it mean your a drug seeker if your nice to the staff? That’s disconcerting as I would rather be respectful and genuine than get into full on yelling arguments like my EX Consultant did with me (and her other patients.
My other issue is I tend to leave things too long, and actually got a bollocking for leaving infections too long and going into sepsis. I would be asymptomatic, then thinking I was getting a flu I would wait it out, not wanting to annoy E.D staff. I have a G.P who’s marvellous but due to my condition her hands are tied as it often requires specialist intervention.
So should one stay calm polite, and respectful to staff and risk being labelled a junky when the medical condition may be life long? *Sigh*
I’m confused.
nogie1717 said
As a former drug addict, I find some of these posts to be right on point and others so far from the truth it makes me laugh.
First, the post by SarahW
“Drugs on the street are used by people who will use ANYthing, the population of addicts is a fairly stable percentage no matter what they get their paws on” is both sad and laughable. I was addicted to opioid pain killers, ie. Hydro and oxycodone, and later, Methadone. I would never use “just what I could get my hands on.” I disliked cocaine, meth, LSD, as well as other pharmaceuticals like Xanax, Soma, etc. The majority of narcotic (pain killer) addicts are exclusive to their drug of choice.
To the doctors out here: Drug seekers who go through the effort of the ED are NOT going to sell their pills. They are looking for a way to eliminate withdrawals or that awful feeling that precedes them, the anticipation of WD’s. Most scripts from the ED would only last an addict half of a day. At the height of my use, I would take anywhere from 20 to 30 Vicodin a day. Say what you want about liver toxicity from the APAP. I don’t know why I didn’t fall victim, but I didn’t. A script of 10 hydrocodone will be one ‘buzz’ for a true addict. They won’t even get high off of it.
In close, shortly before I admitted myself to a rehab facility, I went to a doctor (not an ED) and made up a sob story, literally, to get a few methadone. In my car was a gun. I didn’t know what I was going to do with it, but I was desperate. I probably would have robbed a pharmacy or killed myself or both if the Dr. hadn’t been kind enough to replace my “lost” pills. My advice is always do a work up, if they refuse, you refuse. Keep scripts small, write the number in longhand, and don’t be afraid to ask if the person needs help. During my addiction, most Dr.’s were coarse in their refusal of meds. Addicts don’t want to be the way they are, but the pain of withdrawal will drive them to desperate measures. Deep down, they want and NEED help. You could be their savior. Be objective in everything you do.
I like the idea of asking a patient if they need help. I had a very rewarding experience with a lady who I busted, but who I then saw several times in the ED afterwards to help her get through her withdrawal.
Thanks for sharing.
steph said
i am a drug addict .never thought i would become one all started with a toothache so bad i wanted to put my head into a wall ! i got my first scrip for vicodin at the ER . it took my pain away but also liked the way it made me feel . i would do any thing to go back and not have taken that first pill. i want to be honest with my doctor and tell him i need help but im scared he will pretty much laugh in my face ! so coming from some one who is addicted to pain pills give people in pain non narcotics first . because you never know like i said before i never planed to become addicted it is my falt i keep taking them i have tried to stop but i cant deal with the withdraws . and its way to easy to buy them off the streets .
I hope you get the help you need.
TM said
To all er doc’s don’t give narcs.
Benji said
The only reason I am even reading this web page is to get an idea of how doctors REALLY think about people going to the ER for pain relief. I am trying to deal with this chronic back pain without useing medication, but I don’t see any other way at this point. My main problem is that I am a young man (23) and as soon as I start talking about relief for pain, the doctor shuts down and labels me an addict. Since when does not wanting to be in pain denote you a drug addict? I have a strained back right now with a pain that will not go away, but I am honestly afraid to go see a doctor, because what happens when I pay them good money to just turn me away with a prescription that does nothing, or just some advice? I really don’t want to waste a doctors time when they could be treating someone with somthing more severe, but I woudn’t be wasting my time if I wasn’t in real pain. I have found that doctors are going to do whatever they think is best for you, and you no longer (if ever) have any say in what you think you need. I also can’t stand it when a doctor asks me, what would you like us to do, and my answer is “help me get rid of this pain” and their first response is “go home and take an ibuprofen”, are you kidding me?
unitygain said
Definitely a catch 22 between underprescribing and unwarranted suspicion at one end; license revocation and jail at the other.
What I haven’t seen physicians do (that seems to be the logical choice) is to take a real position on the issue of chronic pain and push it via a union arrangement or cumulative legislative push by a majority of doctors.
Either choose that treatment or erroring on the side of prescribing narcotics is in the best interest and run with it politically and legislatively, or decide that abstinence and suspicion is the best policy and run with that politically and legislatively.
Obviously, treatment with possible collateral damage would be the preferred stance. Doctors are all aware of the problem yet only the PRN seems to be actually DOING anything legislatively to get the DEA out of medicine.
Doctors UNITE, and DO SOMETHING TO HELP GET THE DEA OUT OF MEDICINE!
Stacy Newton said
I’m a reasonable person.I’ve had lots experience the legal aspects of the medical profession. I was a victim in a nearly fatal car accident. I had a burst fracture in my L5 vertebra.
The doctors misdiagnosed this for three days. Ask me how I’m doing now. This post is going to look sorry during your malpractice trial. Believe me, no matter what nice things the commentators have told you, you should be shaking in your boots. You made a decision based on ignorance and prejudice and you seem to think the fact that she’s going to die anyway is a mitigating factor. My lawyer mentioned if you had not voiced your opinions that she was merely a drug seeker, you’d have a shot at claiming missing the diagnosis. However, you’ve more or less admitted to not doing a through work up even when she complained of new symptoms. This leaves you open to a malpractice claim. I won’t ask how you sleep nights because it’s obvious you’ve justified this error and reasoned ” ah well, she was gonna die anyway.” But you have committed a form of ethical and legal malpractice. Get nice suit for court and consider real estate as your next career.
Jeff C said
“Peggy said”
“Had no choice? Please, Kraig, stop lying. You always have a choice. Getting off those street drugs will cause you the equivalent of a really bad case of the flu for two or three weeks, max. Those who use, like it and simply don’t want to not use. THAT is a moral problem. There’s an entire industry employing thousands who would all be out of work if they didn’t go along with the myth that drug addiction is a medical problem, not a moral problem. It’s a character problem, for sure….witness your witless statement of having “no choice” but to steal pain meds from a woman with cancer.”
Peggy you have no idea what you are talking about. Currenly I am a professional, just purchased a house for 570K and everything is in order for me. 7 years ago I was homless and deperate for drugs. This wasnt a morel choice I can tell you. Once addiction get hold of you its 1000 times harder to break than enduring a really bad flue for a few weeks… My god the ignorance in the medical profession amazes me…
Cana-doc said
Jeff, congratulations on turning your life around. I can’t imagine how strong you had to be to heal.
Let’s pick this apart, in an effort to cure ignorance.
Peggy:
“Had no choice? Please, Kraig, stop lying. You always have a choice.
*Peggy, do an experiment where you don’t drink any water for 2 days and see how much choice you have against the drive for the reward of slaked thirst. Please do this supervised in case you start to die.*
Getting off those street drugs will cause you the equivalent of a really bad case of the flu for two or three weeks, max.
*Withdrawl can kill someone. Incidentally, is Methadone free in the US?*
Those who use, like it and simply don’t want to not use.
*A lot of users don’t like it, recognise this, and use anyway.*
THAT is a moral problem. There’s an entire industry employing thousands who would all be out of work if they didn’t go along with the myth that drug addiction is a medical problem, not a moral problem.
*Addiction is a medical problem, read a few scientific articles about brain chemistry and Dopamine pathways.*
It’s a character problem, for sure….witness your witless statement of having “no choice” but to steal pain meds from a woman with cancer.”
*Interesting she’s calling you witless, when clearly Peggy demonstrates a complete lack of scientific or medical knowledge. If she’s a health care professional, I’ll eat my boot.*
On the topic, I’m reading ‘In the Realm of Hungry Ghosts’ by Gabor Maté, about the lives of addicts from their Doc’s point of view. It’ll really knock your socks off. Promise.
Davis Vaughn said
I suffer from chronic migraine headaches. They can be sometimes debilitating and can sometimes happen three times a day, for those of you who have never had a migraine will never understand or appreciate the amount of pain that migraines cause. I got my credit card stolen on friday. I haven’t been able to buy my prescription preventative medicine because the bank is closed on Sunday. I went to the doctor today because i was (and still am) in extreme pain. The last thing i wanted to do was drive across town wait in a waiting room full of contagious sick people for 5 hours listening to Fox news. Plus I’m not willing to make somebody wait on me while they were in pain. I find it very unethical to waste a doctors time when there are people who’s lives are on the line.I own advil, when i have a headache i take it. I wouldn’t go to the hospital if taking six advils had worked.
In addition, many of you are not giving enough credit to addicts. Not all patients are dumbasses, if i wanted to scam you, i would have. I sounded and acted miserable today because i was actually miserable. I came to the hospital today to stop my pain, since when is that such a fucking crime. Because i was in too much pain to put on my church retreat shirt and take a shower so as not smell like smoke The only think i could hope for was that he would understand that i did in fact require prescription pain medicine. In actuality i needed around twenty pills but i quickly realized that didn’t have a chance in hell so i was just straight up and I asked for two pills to help me get through until tomorrow when i can pay for my daily prescriptions
I just wanted to take the honest approach and explain why i needed the medicine. Instead of prescribing TWO , BIG BAD pain pills, he gave me TWENTY ineffective non narcotics. When i read about the pill it said it had a high potential for addiction. I feel like it was handled backwards. Because i am 20 years old, in a college town, and smell like cigarette smoke, i am given non narcotic pain medicines that are very ineffective. Not to mention it offends me to be labeled as a drug seeker when in all actuality i suffer from a extremely painful illness that makes life for days at a time, absolutely unbearable. Once i get back on my preventatives tomorrow my headaches will stop some time tuesday hopefully.
To the woman talking about about her addiction, its sometimes hard to understand because we each are indeed the center of our own universe, but not everyone is like you. In the first few years of my alcoholic mother’s (still) sober recovery she criticized anyone who drank alcohol but as she grew more comfortable with her addiction she began to realize that most people in this world are not addicts, they’re just regular people. Most people who come to a hospital have a very real problem, because coming to the hospital is a huge bitch.
Finally, to those who are so certain in their view on “drug seekers”, its important to remember that many times in life the truth lies somewhere in the middle so it is also important to keep an open mind, because each case is different and sometimes its not appropriate to have such strict profiling of people who appear to be “drug seekers”.
Peace
Moriah said
You recognized that pain in her head was a new symptom, did an exam realizing that looking for neurological deficits, treated her pain effectively, and I’m hoping that you didn’t let the fact you thought she was a seeker show on your face.
If you managed to do the last, I’d say you did everything reasonable.
I think it was absolutely reasonable for the second doctor to order the CT if the same patient presented back with a headache again very quickly. But I’ve had migraines before and a CT was not ordered on my first blinding headache — nor do I think it should have been.
I do have to say I really don’t want to ever be in that woman’s shoes, for a lot of reasons, but your treatment of her was not one of them.
BTW: remember to take care of yourself, that’s the only way you can take care of others.
msrep said
hello,
I sit here today on my fourth does of extra strength tylenol… i have a terrible headache, and i live in kentucky where they have realtime monitering for your perscription past. I have sever TMJ and MYofacial pain as a reslut of a beating i took in college, yes there are times when i am sure i have taken my oral pain meds when maybe something non narc might have worked. there are also many, many, many times were i have let myself get way more sick, and sick not going through withdrawls, but sick and let the pain get out of control because i was afraid that if i went to the ER they either would, not treat me or that i would be treated poorly.
Last year i commited sucide, yes thats right i was dead. I saved up my scripts, and i was also
a chem student and pharm student in college, (yes i wanted to be a doctor, not anymore), anyways i over dosed. I put on a dress, got in the tub, took a little bit of phengren and started to take thoose pills, my dad found me later passed out and then i was in coma.
I would say luckily i was givin CPR and narcam and some other things but this is one of thoose days when that isnt the case, I understand the need to ongiong therapy while reciving chronic pain mangement but, this doesnt mean that you should let someone stay in pain. You never know how far they are along in their pain, how long they truly waited before breaking down and coming to ER where they probally know they will be treated poorly.
I am now a new paintent at a new pain doctor where i am have been treated very badly. The debate will continue to rage on whether ‘drug seekers’ are engough reason to not perscribe meds, but the real answer when you are on this side of the isle, is no. they aren’t. Even if you only give someone one shot of narcs, not toridol although it is good to have that as well, you might be saving a life. I have never bought drugs on the street, until a year ago i had never lied to a doctor about the medicnes i was on, i was always open, Now i know better.
As i go to the bathroom to vomit and consider if the extra pain for breakign down to tears is worth it, i will keep you guys in mind. It does please me that atleast some doctors air on the side of caution when it comes to leaving people in pain, but what are the people in pain suppose to do. I am a compliant pain paitent i have been for for five years, my mouth locks up, my head hurts in a way i cant even explain. I had amjor surgery where my mouth was wired shut, and i now have almost a completly fake jaw joint, please if you see one of us. Have us pee in a cup or whatever, if there is a drug in there we didnt tell you about, then deny us. Dont write out take home scripts, if they pain is that bad admit them. Many times that should have been done for me.
You have probally read this an assumed wow another drug addict in denial but every 6 months since i was attacked thats over five years now, i detox on my home at home. And yes the longer i stay on these drugs, which is now off and on thankfully, the harder it gets and the worse the time off gets. But the pain doesnt get better, it stays as well as the memeories of the awful treatment that people give you stays.
I Hope this helps you understand. And i will continue to be as nice as i possibly feel up to with my ED and ER staff, they are overpain, and overworked and life is challengeing, but thats no need for me to spread a pain i wouldnt wish on my worst enmeny, i wouldnt wish it for the man that attacked me or the biggest criminal in the world.
thanks,
KEM
John smith said
People who seek drugs do not just wake up one day and do so, When i was 21 i started having a high level of staph and i would always get staph infections on a weekly basis, Now you ER guys and girls know what comes next,First comes the numbing injection(which hurts) then comes the draining and the last part(and the worse) the packing. Now i would be given doxycycline and hydrocodone APAP 325.I started to like the feeling of this hydrocodone and etc,The one thing you are all missing is that even if some one is labeled a drug seeker they don’t have to go to a ER or a ED to get what they want,A real addict will order these drugs online from other countries,And as most of these websites promise to deliver with lines like “If they don’t get to you do to a customs issue we will resend until you get what you ordered” it makes it all the better for that person, And for as little as $400 and sum odd dollars for 190 pills with no questions asked to a seeker this is not bad. I respect you for trying to stop this issue but the reality is,It can’t be.
Chelsea said
Start checking vitamin D levels and refer that back to the primary or to an endocrinologist as the new withdrawal therapy.
Carol said
I was like Greg too. I looked good. I had a great game. I did all those things. My pills never went to anyone else. I never purchased anything off of the street.
Today I don’t have to live like that.
Drug Seekers: Part 1 - Origins « ER Drama: The Blog said
[...] – As Whitecoat has mentioned on his blog, there appears to be a Drug Seeker handbook or Standard Operating [...]
Heather said
How many human beings woke up one day and actually said to themselves “I want to become an addict??” It hardly ever happens. Addiction occurs not only by poor choices, but sometimes by mistakes. As some of the above comments stated, some patients became addicted because they were diagnosed with an illness causing pain and they had no choice but to take narcotics, next thing you know, they are addicted! There are some people in this world that can take narcotics all day and never become dependant on them. Then there are those who get a nice feel for the “high” and decide that daily living is better with a narcotic, than without. Well, I am one of those people. I started having terrible migraines after I left my husband and became a single mother of three toddlers. Talk about stress. As soon as I told the docs what stress I was going through they pretty much skipped the exam! Not really, but they understood. I believe there ARE different types of addicts. Just to mention a couple, there are those who take narcotics anyday, everyday, anytime, anyway, and for no reason at all. Except to get high of course. You cant really say there is no medical reason because addiction is truly a disease which requires medical treatment. So moving on, another type is the chronic pain sufferer who does take the steps to better their pain, but has convinced themselves that the only treatable means for their condition is a narcotic. The last type I would like to mention is a binge addict. The person who stays completely clean for weeks sometimes months at a time, not really craving that “high” and then something stressful happens to trigger the craving and the person goes for a period using excessively. Lets not forget the addict who has been clean for years and managed to become healed and chooses to never use again, they are out there!!!
Has anyone here ever become EMBARRESSED to go to the ER????? Mainly because you have been there soooo many times?? Usually for the same things and always needing the same drug? I know the docs in my local ER by name. Im getting to a point where Im going to start asking for their Myspace addresses just for an occasional chat! “Yea, Im good today, was nice to see you yesterday, ill be in on Wednesday!!!!” My boyfriend assumes that I am seeing a staff member in the ER! Well the sad truth is, I’m one of those addicts who suffers from severe migraines still to this day, and I am convinced that only a narcotic will help! Of course I see a neurologist, pain management, primary, and a psychiatrist who sepcializes in addiction. Of course I have toradol, imitrex, naproxen, zofran, and lord knows what else in there. But no, everytime I feel a migraine come on, after i’ve turned to all the rest, only that ER seems to be the best!!!
One of the really unfortunate things about narcotics being prescribed for headaches, is something called rebound phenomena. How many of you have had a doc mention that to you?? Its a very true thing. Especially with some of the very strong pain meds. Most neurologists will look at you like your insane if you ask them for a narcotic for a headache because of that very side effect. I truly believe that some of my headaches are caused when I take a narcotic for them. Trust me, I know all the strings that us narcotics try to pull with ER docs. It gets really old after a while. Sometimes I feel like saying oh my god we both know why Im here so lets just get it over with! my local ER has a one hour guarantee, that from the time you walk in and get registered, they guarantee that it will be one hour or less until you see a doctor!! So, yea you can just imagine how many drug seekers they get in there!
Anyhow, I really have seen every doc in that ER at least once. Some of them are sympathetic to the fact that Im suffering from a migraine. The only thing that proves that I am in pain is when they take my blood pressure. It goes sky high from the pain, and sometimes they give me a higher dose of Imitrex in a muscular injection, or IV toradol, which is much stronger than pill form, and then soon after they take my pressure and 9 times out of 10 it goes back to normal. WOW!! The non narcotics actually took my pain away, and you know what? Heres my routine, if the doc I see wont start off with narctotics Ive just stopped asking all together and let them give me whatever else they order, because I believe when you are in true blue pain, you will be willing to try ANYTHING to feel better, its not about the high anymore!! If the doc doesnt ask anymore questions and pulls out the heavy armor, I just accept kindly, and then move on about my day. And yea, if the nurse pushes 2mg of Dilaudid into your IV and 15 minutes later you are still in “pain”, please God just go home!!! Dont waste your time asking for more drugs, you most likely will not get them. You addicts and docs know what Im talking about for all these patients who come in for drugs!! Yes being an addict means you have a low tolerance for pain and a HIGH tolerance for the drugs and its a terrible terrible thing to deal with!! Some docs understand this, and some dont.
I could go on and on, but I just wanted to relate to other addicts and also the docs. Next time you go to the ER for narcotics ask whoever sees you just how many drug seekers they think they treated in that day. And then ask the doctor if he or she thinks YOU are a drug seeker. You dont have anything to those, trust me.
Thanks for reading!
Elizabeth said
Interesting article about drug seekers. I started looking up drug seekers after I spent 12 hours in my local ED with a pain episode that resulted from a fall down a set of concrete steps. So what? You say…..I am a patient with a history of 2 spinal fusions (10 years apart-last one within the year). I have titanium rods, plates, screws and a few other sundries from L3-S1. I have been treated by the same surgeon for 5 years and the same pain management doc for 9. I get up and go to work – every day – and I am not a drug seeker. My current regime includes vicodin QID, MS Contin QID, muslce relaxants QID, and so on. All legally prescribed and taken as directed. This ED visit is the ONLY ED visit I’ve EVER had for back pain- and due to the fall I had experienced,my pain was severe. Naturally, my pain management doc was out of town. I sat in the ED for 12 hours, underwent labs, xrays, and was ultimately admitted to rule out an infection and the possibility of broken hardware. I was miserable.
In 12 hours I received one dose of dilaudid (2 mg), which was blessed relief from the pain I was having. Four hours later, I was given 1 vicodin and 1 MS contin (which I take every day). The oral meds gave me temporary and minimal relief from the pain I was having. When I asked for something additional, I was told I could not have anything beyond what was prescribed for me at home. Why would I seek care if this was adequate to control my pain?
I checked myself out of the hospital at 10 PM that night, becasue the hospital bed was compounding my pain, and the hospitalist decided I couldn’t have anything additional for pain. He made this decision without ever having seen me or assessing me. After many hours of misery, I decided I could not stay there for another 14-16 hours the way I was. I decided to go home. Because I did this, the hospital staff made it quite clear that they thought I was the trouble maker. I didn’t yell, scream, call people names, etc. I merely said I wanted to go home, where I stood a much better chance left to my own devices.
Nothing was ordered for treatment of the infection I supposedly had and no diagnostics were ordered to rule out broken hardware. I believe the plan was to let me sit there all night and send me home in the AM–what did this accomplish? Since I have been home, I read over the internet on “drug seeking behavior”, trying to figure out how I got labeled this way, when my xrays speak for themselves. I am not guilt of any of the behaviors that you physicians identify as “drug seeking” behaviors. Not during this visit and not duting my 10+ year history of back problems/pain. I spent an additional 2 days at home dealing with my acute episode, and no relief was provided to me until I was finally able to speak with my pain management doctor when she returned to town. I have missed almost 2 weeks of work because of the fact that I couldn’t get my condidion identified and treated properly. I am very angry that I was made to suffer as I did, and I will be extremely hesitant to seek care in an ED because of this singular experience.
To the medical community–please don’t focus on who might be taking advantage of you. You may miss the legitimate opportunity to help someone who really needs your help. That’s the more significant crime in my book.
Jynxed said
I feel your pain Elizabeth… literally. I have been on narcotics for the last several years because of a back injury. As a result my tolerance is quite high. % years ago I finally got to try for surgery, which happened only 3 years ago. My situation was compounded because I was in treatment for a back injury and on the road to recovery when I got hit from behind. This set me back (no pun intended) and while trying to get well from the latest I was rear-ended yet again. This resulted in a broken back.
The insurance was a fight so I had to wait until I could get better insurance to have the surgery I needed. In the meantime I was loaded up on opiates just to function so I could pay the bills.
Next I finally got the fusion at the L5-S1 area. There was a doctor on staff after my surgery that had no idea who I was and thought I needed to sign a pain management contract because I told them my pain wasn’t reduced with the percocet they gave me. I was furious. I climbed my way into a standing position and proceeded to start pulling the drain out of my wound site. This shocked the hell out of them and a sympathetic nurse asked me to hang on while she tried to get ahold of my attending physician. Thankfully she was able to and they got me on a morphine pump. This finally helped to take the edge off the pain and made it tolerable.
Now I find myself a couple years later, the injury area still giving me pain because I was screwed together in a conservative manner (rather than realigning the area, they stuck me together as is so it wouldn’t get worse.) Sadly I’m now even more tolerant to the drugs, and enjoying permanent nerve damage. Further, I am now beginning to experience paralysis and numbness in my left leg and foot.
Even with the documentation I still get flack. I’m in there begging them to get me off the opiates and fix me but they don’t have a fix. They expect us to live in a degraded fashion, rather than trying to improve our quality of life. I would have gone to illicit drugs long ago if I thought it would have helped or if I was addicted and just looking for a high. Considering these people are presumed to be the educated ones, they lack common sense. Why can’t they figure out the little things and help rather than hinder? Why must we all be labled because a few people abuse the system?
Were it me, I’d be more inclined to listen to my patient and try and work with them instead of presuming they are just there for a fix.
Even without meeting the criteria for the guilty behavior the label is still applied. I’m so afraid of being labeled such that I tend to just keep my mouth shut about how much I hurt. I don’t want to be a “burden” so instead of asking for something for the pain, I continue to seek referrals to alternative treatment which has yet to help but I continue to do so because I feel this is expected of me and I just have to keep plugging away at it. I keep doing the same thing and expect different results.
At any rate, I hope things start looking up for you. I know how hard it can be.
MJK06 said
unfortunately i was taking 32 paramol (UK branded codeine OTC drug) a day for over a year as it made me ‘happy’..also gave me headache so I took cheap stuff for those too. I did it also cos i didnt feel hungry and i lost over 25kg. It also helped me sleep at night which i had always had problems with. I had to trail around different pharmacies for my addiction and even got banned from two places for buying too many. Then i got them off the internet…3 packs a time. They made me more energetic and as i said happy, but they also messed up my body big time. I now have to visit the hospital a few times a years as my intestines are inflamed and bleeding and my stomach never feels right. I havent told them what i did for me to be like this as i am ashamed…they presume its colitis and give me pills for that. I wish i never did all that shit. I cost me a lot of money for what? A messed up body, pain, constipation, and i actually do feel better without. I still get tempted to get that high sometimes but prevent myself…i hope i can carry on with the willpower…
sandee said
Nurse K.
I have read alot of your post and I have to say that your what one would call a burned out *** that needs to retire and let someone with some compassion for Pt’s and passion for their job take your sorry place!