Deaths tied to painkillers rising in the U.S.

[TraumaRN]

I feel as an ER nurse I must chip in on this topic.

Let me put to rest a couple things right off the bat.

I can tell pretty much within a few moments can tell if someone is in my ER drug seeking. As can most of our doctors and other staff. I've been an ER nurse for 6 years, I'm NOT an idiot and if you think your story is somehow inventive, trust me it's not and either myself or someone else on our staff will sniff you out. And don't worry we compare stories especially if things seem fishy, so you better keep your story straight. Moreover, if we discover in the course of your visit that you are breaking the law regarding prescription drugs, we won't be afraid to call the police. (No joke, got a young woman charged with a few different things after we discovered she was using a fake ID, and her sister's medical insurance card. Myself and another worker remembered this girl, and were surprised that her name wasn't what we expected, we checked our records, found two different names with exceedingly similar signatures, same birthday, different photo ID but same photo, confronted her about it, she fessed up and our legal dept advised us to call the police, so we called the local PD, who basically chewed her out then informed her they'd be taking the case to the prosecutor for fraud and drug charges, related to the fake IDs, and using multiple medical insurances, and having an assload of prescriptions drugs that were not hers)

Second, we have the technology to check on where you get your scripts filled. And not just that but other electronic medical records flag those who have a history of drug seeking so as to alert staff of such.

Now onto my own opinion about the matter. Drug seeking patients are a massive waste of my time as an ER nurse every single day. I now work in a smaller ER and in an average 12 hour shift I personally see approximately 30 patients, of those I will average 2-5 drug seekers PER SHIFT.

The problem is that bad. So anyone who legit needs pain meds to function...that is why it is so hard for you to get drugs.

If you are drug seeking, except no sympathy/empathy from me. As far as I'm concerned you are wasting my time. To those who legit need pain meds, I'm sorry if I seem so overtly suspicious. You are simply a rare bird in my world. I might see someone who legit needs pain meds once every two weeks.

As far as what needs to be done, well honestly I'd like to see more public awareness to the problem more than anything else. Make people aware that tens of thousands are dying. Remind people that just because it is a prescription doesn't mean it's safe, or that you can get addicted quite easily to some of these drugs. Secondly, crack down on the pill pushing doctors/pill shops. I'd like to see a bit more monitoring/oversight of pain clinics, especially because more than a few of them are fronts for moving large quantities of pain meds. Third, we need to educate doctors on not prescribing these pain meds in the first place for conditions that don't need them. We have people ask all the time for vicodin or percocet for a sprained wrist or ankle. The answer is always no. Motrin and tylenol when taken at correct dosages will alleviate most of the pain. Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain. Pain meds basically make things tolerable and most of the time don't take pain completely away. I try every day to educate patients about these things when I discharge because so many of them do not know.

 

[Hayabusa Rider]

I feel as an ER nurse I must chip in on this topic.

Let me put to rest a couple things right off the bat.

I can tell pretty much within a few moments can tell if someone is in my ER drug seeking. As can most of our doctors and other staff. I've been an ER nurse for 6 years, I'm NOT an idiot and if you think your story is somehow inventive, trust me it's not and either myself or someone else on our staff will sniff you out. And don't worry we compare stories especially if things seem fishy, so you better keep your story straight. Moreover, if we discover in the course of your visit that you are breaking the law regarding prescription drugs, we won't be afraid to call the police. (No joke, got a young woman charged with a few different things after we discovered she was using a fake ID, and her sister's medical insurance card. Myself and another worker remembered this girl, and were surprised that her name wasn't what we expected, we checked our records, found two different names with exceedingly similar signatures, same birthday, different photo ID but same photo, confronted her about it, she fessed up and our legal dept advised us to call the police, so we called the local PD, who basically chewed her out then informed her they'd be taking the case to the prosecutor for fraud and drug charges, related to the fake IDs, and using multiple medical insurances, and having an assload of prescriptions drugs that were not hers)

Second, we have the technology to check on where you get your scripts filled. And not just that but other electronic medical records flag those who have a history of drug seeking so as to alert staff of such.

Now onto my own opinion about the matter. Drug seeking patients are a massive waste of my time as an ER nurse every single day. I now work in a smaller ER and in an average 12 hour shift I personally see approximately 30 patients, of those I will average 2-5 drug seekers PER SHIFT.

The problem is that bad. So anyone who legit needs pain meds to function...that is why it is so hard for you to get drugs.

If you are drug seeking, except no sympathy/empathy from me. As far as I'm concerned you are wasting my time. To those who legit need pain meds, I'm sorry if I seem so overtly suspicious. You are simply a rare bird in my world. I might see someone who legit needs pain meds once every two weeks.

As far as what needs to be done, well honestly I'd like to see more public awareness to the problem more than anything else. Make people aware that tens of thousands are dying. Remind people that just because it is a prescription doesn't mean it's safe, or that you can get addicted quite easily to some of these drugs. Secondly, crack down on the pill pushing doctors/pill shops. I'd like to see a bit more monitoring/oversight of pain clinics, especially because more than a few of them are fronts for moving large quantities of pain meds. Third, we need to educate doctors on not prescribing these pain meds in the first place for conditions that don't need them. We have people ask all the time for vicodin or percocet for a sprained wrist or ankle. The answer is always no. Motrin and tylenol when taken at correct dosages will alleviate most of the pain. Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain. Pain meds basically make things tolerable and most of the time don't take pain completely away. I try every day to educate patients about these things when I discharge because so many of them do not know.

Good points.

I've fine tuned the drug seeking behavior "look" so that most times I can tell what the prescription will be for before I see it. Education is important and sometimes they are over prescribed, but often you have one person seeing multiple pharmacies and practitioners.

I have to leave for work in a minute or two, but in essence we can really really really use a national health care database, which we can access with NPI and passcodes when we're treating patients. That would do a whole lot for health care, including this. NY scripts have a barcode which is scanned into the system, but we don't have access to what the state uses. Instead they have these incredibly onerous new laws just making hydrocodone containing prescriptions c-IIs like Percocet.

We'd have immediate access to labs, histories etc. Less duplication of tests, having a complete and updated patient history etc. I think it would be the single greatest tool we could have to improve outcomes and reduce costs.

 

[Charles Kozierok]

Some fine observations and first-hand experience here; thanks TraumaRN and HR. High-quality stuff.

TraumaRN, your description of how you deal with drug-seekers reminds me of being an administrator of an online forum and having to deal with spammers. Different underlying issues, but many of the problems are the same -- people with dubious goals trying to impersonate those with legitimate need, and having to develop an eye for spotting them over time.

 

[TheVrolok]

Much of the debate had already been covered by waggy, HR, and TraumaRN, but I will say one small thing. I think a lot of the issues with prescription pain meds are societal; paramount of which is our increasing intolerance for pain. Frequently patients are asked, "What is your pain goal?" The most frequent answer I have heard? "0."

Now this is completely anecdotal, but I imagine others in health care would offer similar statements. "0," in many cases is a very unrealistic expectation. We will try everything we can, more and more medications striving for a goal that may not be obtainable, or one that may be.. At too high a cost (over/inappropriate use). Unfortunately much of the time the cost of healing is pain, and it needs to be experienced, rather than attempted to be buried by escalation of meds.

I speak very generally here, I am not targeting those with certain unresponsive chronic pain issues that require meds to function (and usually have a level of function that does not include pain free).

 

[waggy]

Much of the debate had already been covered by waggy, HR, and TraumaRN, but I will say one small thing. I think a lot of the issues with prescription pain meds are societal; paramount of which is our increasing intolerance for pain. Frequently patients are asked, "What is your pain goal?" The most frequent answer I have heard? "0."

Now this is completely anecdotal, but I imagine others in health care would offer similar statements. "0," in many cases is a very unrealistic expectation. We will try everything we can, more and more medications striving for a goal that may not be obtainable, or one that may be.. At too high a cost (over/inappropriate use). Unfortunately much of the time the cost of healing is pain, and it needs to be experienced, rather than attempted to be buried by escalation of meds.

I speak very generally here, I am not targeting those with certain unresponsive chronic pain issues that require meds to function (and usually have a level of function that does not include pain free).

of course that's teh goal. rightfully so too. we aren't stupid and know 0 is damn impossible.

frankly the attitude of a few bitching that people with chronic pain want ZERO pain gone is insane. Those with chronic pain know we won't get that. We know we are only going to get the pain lowered not gone. But when you ask a person who is in pain 24/7 what he wants? of fucking course he wants teh pain FUCKING GONE. A ZERO.

its belittling to those with chronic pain to be told "Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain" WE KNOW. we live this. you don't need to tell us that you can't get rid of all pain or treat us like children.

I know i will rarely be without pain (but fuck deludid is nice). I would settle for being able to spend more then 15 minutes playing with my kids. Then after that not have to be in so much pain i'm damn near crying.


I have gone to the ER over pain 3 times. each time i was told to by my doctor (either PMC or Pain management) each time i was made to feel like i was a criminal. the initial nurse's treated me like shit and made remarks about abuse.

it wasn't until the doctor came in looked at my chart and talked to my pain management doctor that shit happened and i was treated with respect. So yeah not all nurse's are great at telling who is in real need and who is trying to get pills. This is number one complaint among a lot of people with chronic pain (btw there are fourms on it. you can yourself) and why they over medicate.

why would i really want to go in and be treated like a criminal?

 

[Dirigible]

Do you think there should be prescriptions for any drug, or should people be allowed to purchase and take whatever they want without limits?

I have very little respect for the medical profession and do not see them having a rightful claim to be the deciders. I used to be ok with it. But years of experiencing arrogance, stupidity, and indifference from them makes me object to the idea of them being in control of my body in any way.

So, yes. I so want to be able to use drugs how I see fit. A doctor would be used as a consultant.


It opens a can of worms though. One I haven't thought all the way through and it may not be the best for society.

 

[TraumaRN]

of course that's teh goal. rightfully so too. we aren't stupid and know 0 is damn impossible.

frankly the attitude of a few bitching that people with chronic pain want ZERO pain gone is insane. Those with chronic pain know we won't get that. We know we are only going to get the pain lowered not gone. But when you ask a person who is in pain 24/7 what he wants? of fucking course he wants teh pain FUCKING GONE. A ZERO.

its belittling to those with chronic pain to be told "Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain" WE KNOW. we live this. you don't need to tell us that you can't get rid of all pain or treat us like children.

I know i will rarely be without pain (but fuck deludid is nice). I would settle for being able to spend more then 15 minutes playing with my kids. Then after that not have to be in so much pain i'm damn near crying.


I have gone to the ER over pain 3 times. each time i was told to by my doctor (either PMC or Pain management) each time i was made to feel like i was a criminal. the initial nurse's treated me like shit and made remarks about abuse.

it wasn't until the doctor came in looked at my chart and talked to my pain management doctor that shit happened and i was treated with respect. So yeah not all nurse's are great at telling who is in real need and who is trying to get pills. This is number one complaint among a lot of people with chronic pain (btw there are fourms on it. you can yourself) and why they over medicate.

why would i really want to go in and be treated like a criminal?

Make no mistake I'm not trying to insult you with my statements. Rather my statements are for the people who DON'T know about the side effects of these meds. Same thing with pain control, most people again don't realize the initial goal is pain control. I realize everyone wants pain to be zero especially if you are in chronic pain, but for most acute pain we aren't going to rid you of it and those are the people who don't know these things.

I'm glad you are well educated in this because believe it or not many of the chronic pain patients aren't aware of these things which speaks to poor quality medical care and education.

And last I really hate that so many people in legit chronic pain get treated like shit by doctors and nurses and it is why I try and treat those with legit chronic pain with as much respect as possible because I know what they go through to even get some measure of pain control.

I just wish there was some better way but unfortunately I see no quick fixes or solutions at this point in time.

 

[Murloc]

most people who go in for those meds are addicts and the workers are stressed out humans who deal with people with problems and these exploiters all the time.
They did treat you nice after they saw the data, so you shouldn't take it personally, although it's understandable that it's hard.
It's difficult to strike a balance and the overwhelming quantity of addicts makes it worse.

As for other points expressed here:
1. DEA
They should enforce the drug laws, NOT make rules and definitely not decide on health issues or medications! That's not their job and is too heavily influenced by politics.
2. Prescription
Dirigible I think that if the system works this way it's because the other possibility is simply too dangerous. People will do stupid stuff with medication, even unintentionally. Not everyone is educated and knows that if the doctor says to take X it's for a reason, they will make stupid assumptions and self-diagnosis would go wild. Lots of people would be eating antidepressives every time they're sad and you end up with a serious problem. Kid bad in school? Give medication. It sometimes happens already even with the prescriptions, just think how bad it can get.
Plus doing that would legalize all drugs and make them easily available for abuse.
3. 80% of pain meds end up in the US

legally they are. i can go and get a bottle of whatever fairly easy but i would get arrrested if caught with them..

its those that need them that are having a hard time getting them. Those that abuse and want snort them can find them anywhere.

why does this happen in the US?
In the rest of the world painkillers are not as big as a drug since the US get 80% of the global supply.
So, you have a system full of holes, but at the same time it's difficult for patients to get them.
The DEA is going full retard I guess. Those pain clinics are really just fronts maybe.

 

[Londo_Jowo]

Seeing your doctor every 6 months if you have chronic pain doesn't sound that onerous to be honest.

Did I say there was an issue? I was describing what I have to do to get a non-opiate based pain killer. For years prior to that I was forced to take NSAIDS and other pain killers that death is one of the side effects.

Meloxicam was one of the NSAIDS I took before I was prescribed Tramadol.

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601242.html

NSAIDs such as meloxicam may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death.

I have osteo-arthritis (bone on bone in both knees), fibromyalgia, and Hashimoto's thyroiditis. All cause muscle and joint pain. I'm happy that Tramadol takes the edge of of my pain and allows me to have a somewhat normal life.

 

[TheVrolok]

of course that's teh goal. rightfully so too. we aren't stupid and know 0 is damn impossible.

frankly the attitude of a few bitching that people with chronic pain want ZERO pain gone is insane. Those with chronic pain know we won't get that. We know we are only going to get the pain lowered not gone. But when you ask a person who is in pain 24/7 what he wants? of fucking course he wants teh pain FUCKING GONE. A ZERO.

its belittling to those with chronic pain to be told "Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain" WE KNOW. we live this. you don't need to tell us that you can't get rid of all pain or treat us like children.

I know i will rarely be without pain (but fuck deludid is nice). I would settle for being able to spend more then 15 minutes playing with my kids. Then after that not have to be in so much pain i'm damn near crying.


I have gone to the ER over pain 3 times. each time i was told to by my doctor (either PMC or Pain management) each time i was made to feel like i was a criminal. the initial nurse's treated me like shit and made remarks about abuse.

it wasn't until the doctor came in looked at my chart and talked to my pain management doctor that shit happened and i was treated with respect. So yeah not all nurse's are great at telling who is in real need and who is trying to get pills. This is number one complaint among a lot of people with chronic pain (btw there are fourms on it. you can yourself) and why they over medicate.

why would i really want to go in and be treated like a criminal?

As I already said in the post you quoted. I'm not targeting those with chronic pain that understand. That said there are numerous chronic pain pts whose goal is 0, and unfortunately that goal may very well be out of reach and when striving for it problems do occur.

Also, it's not like opiates are only prescribed for chronic pain, they're often overused for acute pain which can be equally (moreso?) damaging.

 

[WoodButcher]

I quit drinking and recreational drug use in '95.

That said I'm 51 years old and have been in construction full time since I was 14 years old and have beaten my body for many years to feed my family. I've broken and sprained many bones over the years, I have carpal tunnel in both wrists, tendon issues in both shoulders and knees that are just plain worn out, not to mention breaking my back in a fall when I was 19. My chiropractor tells me I have also the beginnings of arthritis so it ain't getting better. Seldom do I wake pain free, advil is on my nightstand, averaged out I would guess 2 a day but I do have painkillers in my cabinet.
I need to work every day so my life is an adventure in pain management. As a recovering alcoholic I know better than anyone the dangers of my personality. I have tramadol and hydrocodone prescribed by my physician and oxycodone prescribed by a dentist, I'll use what I need to sleep and advil only when at work. I don't want to risk further injury when medicated and if I can sleep through the night I'll deal with pain when I'm working.
I'm offended by any one who thinks they know what is "best" for me, I've woken in the middle of the night screaming and gone to the hospital only to be given Tylenol. The opiates I keep are used when I need them and not when someone else tells me it's ok, I'm not looking forward to old age.

I say let those who abuse, use, give them all they want and more, let Darwin take them. Don't bust them and send them to rehab at my expense.

 

[Jaskalas]

Yeah, "accidental" doesn't preclude abuse. Think about all the famous people who have died from overdoses... it's not like they were trying to.

Is it our government's job to curtail these "accidents", or should society be willing to voluntarily shun and shame drug addicts and abusers? Especially in the case of celebrities I find it's the people around them helping facilitate abuse.

Due to our lack of personal action, can it be said that society does tolerate, or is even accepting of it? I find it interesting that we might propose for laws to do what we are not willing to do ourselves. In this case, tackle drug abuse.

If our government takes action against pain killers, as they already have, then I'm afraid there are many innocents suffering in pain who will be harmed by this action. When doctors are afraid of relieving pain, the cure is worse than the disease.

 

[Hayabusa Rider]

Is it our government's job to curtail these "accidents", or should society be willing to voluntarily shun and shame drug addicts and abusers? Especially in the case of celebrities I find it's the people around them helping facilitate abuse.

Due to our lack of personal action, can it be said that society does tolerate, or is even accepting of it? I find it interesting that we might propose for laws to do what we are not willing to do ourselves. In this case, tackle drug abuse.

If our government takes action against pain killers, as they already have, then I'm afraid there are many innocents suffering in pain who will be harmed by this action. When doctors are afraid of relieving pain, the cure is worse than the disease.

There are potential ways to address these issues, but it comes down to will and wit. I've not been encouraged thus far by those in power in this regard.

 

[Pray To Jesus]

Now onto my own opinion about the matter. Drug seeking patients are a massive waste of my time as an ER nurse every single day. I now work in a smaller ER and in an average 12 hour shift I personally see approximately 30 patients, of those I will average 2-5 drug seekers PER SHIFT.

The problem is that bad. So anyone who legit needs pain meds to function...that is why it is so hard for you to get drugs.

If you are drug seeking, except no sympathy/empathy from me. As far as I'm concerned you are wasting my time. To those who legit need pain meds, I'm sorry if I seem so overtly suspicious. You are simply a rare bird in my world. I might see someone who legit needs pain meds once every two weeks.

As far as what needs to be done, well honestly I'd like to see more public awareness to the problem more than anything else. Make people aware that tens of thousands are dying. Remind people that just because it is a prescription doesn't mean it's safe, or that you can get addicted quite easily to some of these drugs. Secondly, crack down on the pill pushing doctors/pill shops. I'd like to see a bit more monitoring/oversight of pain clinics, especially because more than a few of them are fronts for moving large quantities of pain meds. Third, we need to educate doctors on not prescribing these pain meds in the first place for conditions that don't need them. We have people ask all the time for vicodin or percocet for a sprained wrist or ankle. The answer is always no. Motrin and tylenol when taken at correct dosages will alleviate most of the pain. Last we need to educate patients about these medications, inform them that they can be very habit forming, AND that we are aiming for PAIN CONTROL not complete eradication of pain. Pain meds basically make things tolerable and most of the time don't take pain completely away. I try every day to educate patients about these things when I discharge because so many of them do not know.

2-5 drug seeker per day? LoL. Where are you at?


Why are these patients seeking drugs in the ER? I'm sure it's a lot cheaper to buy heroin on the street. The answer is because they want legal drugs that are thought to be safer than illegal drugs. Solution is decriminalization and legalization of drugs and proper drug education and control support.

I think the DEA is doing a disservice to doctors and patients.

 

[TraumaRN]

2-5 drug seeker per day? LoL. Where are you at?


Why are these patients seeking drugs in the ER? I'm sure it's a lot cheaper to buy heroin on the street. The answer is because they want legal drugs that are thought to be safer than illegal drugs. Solution is decriminalization and legalization of drugs and proper drug education and control support.

I think the DEA is doing a disservice to doctors and patients.

I'm not sure the context of your post, but considering I work only 12 hour shifts that is quite a few in a single 12 hour shift.

People come to the ER because it's easy to get meds, plain and simple. The solution is not to decriminalize these medications. They are extremely potent and extremely dangerous when not used correctly.

We should be looking to other countries to see what they do, further education of patients, especially regarding the risks of these medications and working with the DEA to bust doctors and clinics who are pill pushing.

 

[Brovane]

My wife suffers from chronic back pain with severe degeneration in several of her disks. She also suffers from chronic knee pain.

For over a year now my wife has being seeing a pain management doctor. The last 6 months she has been on a Fentanyl patch and has done a lot to reduce her constant pain to more tolerable levels. She can now semi -function. Take or children to school and pick them up. Do chores around the house and overall have somewhat of a life. Before the pain was so bad that she was becoming severely depressed. While things are not perfect at least the Fentanly has allowed her to function a lot better. It is frustrating sometimes because people that are not living with or experiencing constant pain themselves don't understand how much pain that sometimes someone can go through. For a while the pain level was so bad that my wife was almost suicidal in her depression. However ever thing is tightly controlled for her pain medication. For her their is no refills. She has to go in every 30-days to get a new script for a refill. The DR will evaluate her and see if any adjustments need to be made. Overall the pain management DR she works with is fairly good and they do a good job from what I can see of trying to weed out the people just wanting to get the pills. We are in CA but I have heard in other states that things are getting fairly bad for people trying to get the proper medication for their pain management.

 

[Pray To Jesus]

I'm not sure the context of your post, but considering I work only 12 hour shifts that is quite a few in a single 12 hour shift.

People come to the ER because it's easy to get meds, plain and simple. The solution is not to decriminalize these medications. They are extremely potent and extremely dangerous when not used correctly.

We should be looking to other countries to see what they do, further education of patients, especially regarding the risks of these medications and working with the DEA to bust doctors and clinics who are pill pushing.

I was curious what hospital you work at?

My wife worked as a nurse at Howard University Hospital ER. She told me there are a lot of drug seekers there. Many homeless people. Lots of her patients have HIV or AIDS.

I taught her that drug addiction is a disease. Therefore, as a medical professional she is obligated to help them effectively, at the medical and social level. As a nurse, it's still her job to inform the doctor what she thinks of the treatment plan.

I think you are biased against people struggling against drug addiction. This bias was developed because you work in a situation that has limited resources which are often taken up by drug seekers. In your mind, you think they are a detriment to others.

You should remember that everyone is human and need help. Therefore, you should pursue the optimal solution using best available evidence and practices.

 

[Pray To Jesus]

The problem with the DEA, and why most MDs dislike the DEA, is that the failed drug policy continues to harm innocent people.

Many MDs say that they don't want to be seen as a pill pusher. Most MDs don't break the law and only treat pain as good doctors. The fact that the culture of viewing patients as drug seekers creates bias and prevent good judgement. Therefore, in medical school, they teach us to initially view all pain as real, and go from there.

 

[TraumaRN]

I was curious what hospital you work at?

My wife worked as a nurse at Howard University Hospital ER. She told me there are a lot of drug seekers there. Many homeless people. Lots of her patients have HIV or AIDS.

I taught her that drug addiction is a disease. Therefore, as a medical professional she is obligated to help them effectively, at the medical and social level. As a nurse, it's still her job to inform the doctor what she thinks of the treatment plan.

I think you are biased against people struggling against drug addiction. This bias was developed because you work in a situation that has limited resources which are often taken up by drug seekers. In your mind, you think they are a detriment to others.

You should remember that everyone is human and need help. Therefore, you should pursue the optimal solution using best available evidence and practices.

I'm not biased against these people. I recognize that they have a problem, however as an ER nurse it is not up to me to attempt to correct their addiction. Fact of the matter is they ARE a detriment to others more often than not.

They waste the time of the nurse, doctor and support staff from taking care of people that are actually using the emergency room for the intended purpose. I also feel this way about people who use the ER as a glorified primary care doctor, and about primary care providers who advise patients to come to the ER because they overbooked for the day.

For example from my shift tonight, I had 6 patients, one was in acute renal failure, two were chest pain patients, one was a teenager who attempted suicide, one was a rule out testicular torsion, and the last was a known drug seeker. Guess which patient tied me up a combined period of almost 2 hours...the drug seeker. And the thing is this particular drug seeker is so well known to our ER that we know her little game, she deliberately fakes pain, will use a tongue depressor to make herself vomit, refuses to be discharged unless we give her opiates etc etc. We had to call her primary care doctor and explain to him what we did and then myself, our ER doctor and her primary care doctor on the phone explained that we would NOT be giving her opiate pain medications. And despite all that I still almost had to call security to escort her out. Taking it a little further this patient has over 125 visits in 2 years just to MY ER ALONE. Meanwhile I had 5 other patients that needed my attention that didn't get it. And 2 of those were particularly sick.

And let me be perfectly clear this is not an extreme example. This kind of thing happens daily 24/7/365 all hours of the day and night. I'm well aware that these people need some sort of intervention but they are not coming to the ER for intervention. They are coming for drugs and for the vast majority nothing else matters. It's narcotics or bust. End of story 99.99999% of the time. You can only help people who are willing to receive your help. I consider myself a humanist but I also know when my help isn't going to help so to speak.

Understand the optimal solution for most of these people is a sit down talk about how using the emergency room for narcotics isn't appropriate behavior and how we will NOT be giving them any narcotics today and referring them to a pain control MD/clinic, or to their PCP, or if they are willing to listen an addiction specialist/center.

The problem with the DEA, and why most MDs dislike the DEA, is that the failed drug policy continues to harm innocent people.

Many MDs say that they don't want to be seen as a pill pusher. Most MDs don't break the law and only treat pain as good doctors. The fact that the culture of viewing patients as drug seekers creates bias and prevent good judgement. Therefore, in medical school, they teach us to initially view all pain as real, and go from there.

I agree that their are some issues within the DEA regarding failed drug policies. However, that issue is somewhat separate.

Being a good doctor does not mean handing out potentially addicting meds to every joe or susie that walks in the door. My PCP is extremely careful prescribing ANY narcotics. In fact I've had discussions with him about it, and he understands that most acute pain can be treated WITHOUT narcotics of any kind. Drug seekers need to be treated differently than other patients, they have an addiction yes, but as far as I'm concerned if you continue to feed that addiction you are DOING HARM. Treat them as a human, shown empathy and try to help them in a way that does not involve giving them another narcotic prescription. If they are not agreeable to that then you as a provider can refuse to see them.

Personally I think we as a country need to have an honest discussion about the serious problem with have with prescription narcotics in this country and work towards honest and meaningful changes within the system. Especially one that involves directly people towards more helpful resources(addiction centers/clinics) and not towards feeding their addiction.

 

[Hayabusa Rider]

TramaRN-

I had an interesting conversation regarding the nonsense regulations and increasing problems in practice with an ER doc a few days ago. This is a young bright guy of 26 and our Emperor Cuomo in his wisdom created a nice looking ineffective suite of torture regarding Vicodin and a few other meds has been the last straw. He is working on his MBA, and plans to pay off his loans and become debt free. Then he's leaving medicine entirely. He tells me that he's surprised by the number of others who are bailing. The trend to leave once providers find out what the real world is like seems to be growing, and none of it has to do with medicine itself.

 

[TraumaRN]

TramaRN-

I had an interesting conversation regarding the nonsense regulations and increasing problems in practice with an ER doc a few days ago. This is a young bright guy of 26 and our Emperor Cuomo in his wisdom created a nice looking ineffective suite of torture regarding Vicodin and a few other meds has been the last straw. He is working on his MBA, and plans to pay off his loans and become debt free. Then he's leaving medicine entirely. He tells me that he's surprised by the number of others who are bailing. The trend to leave once providers find out what the real world is like seems to be growing, and none of it has to do with medicine itself.

Really doesn't shock me. This may sound cynical but you've really got to have an emotional shut off valve to work domes places in nursing and medicine nowadays. Especially the ER.

Not to mention you've got to be prepared as a person to put up with an enormous level of bullshit coming at you from every direction. My particular ER our manager focuses super intensely on patient satisfaction scores...but hardly at all on staff satisfaction. That alone can be maddening at times. And to BD clear I love my job and what I do. I have found how to extract maximum satisfaction of out it independent of anyone else.

I really wonder some days if people come into medicine and nursing because its the hot thing right now and its constantly glamourized on TV. People don't have any idea how difficult it is, both mentally, physically and emotionally, again especially in the ER.

 

[Charles Kozierok]

Taking it a little further this patient has over 125 visits in 2 years just to MY ER ALONE.

That is absolutely outrageous.

 

[TheVrolok]

I really wonder some days if people come into medicine and nursing because its the hot thing right now and its constantly glamourized on TV. People don't have any idea how difficult it is, both mentally, physically and emotionally, again especially in the ER.

It's the same in all the primary care disciplines, being on the front lines of medicine can really suck.

 

[TraumaRN]

It's the same in all the primary care disciplines, being on the front lines of medicine can really suck.

This is very true as well. Its why my primary care doctor runs a private office so he can screen his patients. He actually will refuse to see you if he has proof that you are a drug seeker. He told me he does it for his own sanity and the safety of his office staff.

 

[TheVrolok]

This is very true as well. Its why my primary care doctor runs a private office so he can screen his patients. He actually will refuse to see you if he has proof that you are a drug seeker. He told me he does it for his own sanity and the safety of his office staff.

I'm impressed that he's still in business as a private practice. Exceedingly difficult to do nowadays, especially as a solo practitioner - unless one enjoys working extremely long hours, always being on call, making little take home pay, and fighting bureaucracy daily, I suppose.