[Separated] Give drugs to drug seekers

I think this conversation is pointless. Prudence should be used on a case by case situation to best assure a positive outcome. Principle based ethics has its limitations, and this is specifically true in medicine, because of its complexity. By saying everyone should or shouldn't get pain relievers is a slippery slope (if you believe the slippery slope argument is valid at all).
 
Sasha said:
Do you think by with holding the medication you are going to cure them of their habit?
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Do you think by giving them pain medicine you're curing them of their habit? Or are you supporting it?

Sasha said:
All you're doing is starting them through the whole withdrawal roller coaster which causes pain.
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And all you're doing is starting the cycle over again. They will come down and call 911 again when they need more paid meds, because they know you'll give it to them.

Sasha said:
Pain that you should be treating.

And please keep in mind, drug seekers CAN feel pain.
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I don't believe this is the proper treatment for these people. Do you honestly believe that? Do you give an alcoholic withdrawal patient more booze because he is in withdrawals? This is the worst logic I've ever heard. How about suggesting a proper treatment facility where they can get real help if they want it.



Maybe my view is different than many on those on this site because I live in an area where there is A LOT of drug users, but I am very surprised to see people advocating giving pain medicine to drug seekers. I work in a county hospital where we get A LOT of these people, and on the box you get those call pretty regularly too in this area. I literally have watched a guy walk down a set of stairs from his apartment carrying his backpack, get in the ambulance and sit on the stretcher (all the while in no pain), and then immediately once he sits down start having severe 10/10 abdominal pain that he can't stand, and starts flailing around like he's dying.

Fortunately we have the ability to look up these people's previous ambulance rides and many of them get marked as drug seekers. I don't think a lot of people on here understand the insane amount of abuse on 911 and the hospitals in some areas by drug seeking individuals. I have literally seen a homeless patient in the hospital here who claimed 10/10 chest pain that was relieved by nothing but Dilaudid. He went through every test (CE's, Cath lab, ect.) and all came back negative. Trust me he never appeared to be in any pain others than stating "My pain is 10/10, I need Dilaudid". After days of nothing coming back on him he was D/C'd and he refused to leave so he was arrested. We get people like this often.

If every paramedic here had the attitude of "Well if he says he has pain, I must give him pain meds", and every abuser got narcs, the system would be a nightmare.
 
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Sublime said:
Do you think by giving them pain medicine you're curing them of their habit? Or are you supporting it?



And all you're doing is starting the cycle over again. They will come down and call 911 again when they need more paid meds, because they know you'll give it to them.



I don't believe this is the proper treatment for these people. Do you honestly believe that? Do you give an alcoholic withdrawal patient more booze because he is in withdrawals? This is the worst logic I've ever heard. How about suggesting a proper treatment facility where they can get real help if they want it.



Maybe my view is different than many on those on this site because I live in an area where there is A LOT of drug users, but I am very surprised to see people advocating giving pain medicine to drug seekers. I work in a county hospital where we get A LOT of these people, and on the box you get those call pretty regularly too in this area. I literally have watched a guy walk down a set of stairs from his apartment carrying his backpack, get in the ambulance and sit on the stretcher (all the while in no pain), and then immediately once he sits down start having severe 10/10 abdominal pain that he can't stand, and starts flailing around like he's dying.

Fortunately we have the ability to look up these people's previous ambulance rides and many of them get marked as drug seekers. I don't think a lot of people on here understand the insane amount of abuse on 911 and the hospitals in some areas by drug seeking individuals. I have literally seen a homeless patient in the hospital here who claimed 10/10 chest pain that was relieved by nothing but Dilaudid. He went through every test (CE's, Cath lab, ect.) and all came back negative. Trust me he never appeared to be in any pain others than stating "My pain is 10/10, I need Dilaudid". After days of nothing coming back on him he was D/C'd and he refused to leave so he was arrested. We get people like this often.

If every paramedic here had the attitude of "Well if he says he has pain, I must give him pain meds", and every abuser got narcs, the system would be a nightmare.
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This isn't what we are saying. We don't freely hand out pain meds to all that ask with no indication. It is best practice and of expert opinion to treat pain based on the patients description and complaint. We don't treat pain based on our own perception of what the patient is feeling.

Yes, there are overt signs of drug seeking behavior of which we can pick up on when its very clear. But outside of the very obvious I don't recommend playing judge.
 
I don't believe this is the proper treatment for these people. Do you honestly believe that? Do you give an alcoholic withdrawal patient more booze because he is in withdrawals? This is the worst logic I've ever heard. How about suggesting a proper treatment facility where they can get real help if they want it.



Maybe my view is different than many on those on this site because I live in an area where there is A LOT of drug users, but I am very surprised to see people advocating giving pain medicine to drug seekers. I work in a county hospital where we get A LOT of these people, and on the box you get those call pretty regularly too in this area. I literally have watched a guy walk down a set of stairs from his apartment carrying his backpack, get in the ambulance and sit on the stretcher (all the while in no pain), and then immediately once he sits down start having severe 10/10 abdominal pain that he can't stand, and starts flailing around like he's dying.

Fortunately we have the ability to look up these people's previous ambulance rides and many of them get marked as drug seekers. I don't think a lot of people on here understand the insane amount of abuse on 911 and the hospitals in some areas by drug seeking individuals. I have literally seen a homeless patient in the hospital here who claimed 10/10 chest pain that was relieved by nothing but Dilaudid. He went through every test (CE's, Cath lab, ect.) and all came back negative. Trust me he never appeared to be in any pain others than stating "My pain is 10/10, I need Dilaudid". After days of nothing coming back on him he was D/C'd and he refused to leave so he was arrested. We get people like this often.

I see this frequently see this issue both in Pre-hospital and in the Emergency Room. My issue is typically not an issue of giving the narc's but the behavior of the PT while they are waiting.


If every paramedic here had the attitude of "Well if he says he has pain, I must give him pain meds", and every abuser got narcs, the system would be a nightmare.

I agree here as well.
 
Do y'all really think your withholding narcotics makes a hill of beans?

Is it your job to be "system defender"?
 
18G said:
Yes, there are overt signs of drug seeking behavior of which we can pick up on when its very clear. But outside of the very obvious I don't recommend playing judge.
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Very, very good advice.

We have a frequent patient who causes a painful orthopedic insult to himself, likely to obtain narcotics. Are you not going to treat him?
 
I don't see what the big fuss is all about.

When they're clearly drug seeking (which is reasonably rare in my limited experience), then I'll say, "Oi, Frank you've called us seven times this week mate, and I keep telling you, I don't have any pain killers for you". And if they say, "Oh hey, hey bro! Give us some morphine, eh", I'll tell them I don't hand out drugs of dependence to New Zealanders.

Otherwise, if they say they've got pain, they've got pain. Its not my morphine and they're addicted whether or not I give it to them so I may as well make sure I never withhold from someone who is actually in pain.

Its a no brainer in my opinion.
 
Sublime said:
Do you think by giving them pain medicine you're curing them of their habit? Or are you supporting it?



And all you're doing is starting the cycle over again. They will come down and call 911 again when they need more paid meds, because they know you'll give it to them.



I don't believe this is the proper treatment for these people. Do you honestly believe that? Do you give an alcoholic withdrawal patient more booze because he is in withdrawals? This is the worst logic I've ever heard. How about suggesting a proper treatment facility where they can get real help if they want it.



Maybe my view is different than many on those on this site because I live in an area where there is A LOT of drug users, but I am very surprised to see people advocating giving pain medicine to drug seekers. I work in a county hospital where we get A LOT of these people, and on the box you get those call pretty regularly too in this area. I literally have watched a guy walk down a set of stairs from his apartment carrying his backpack, get in the ambulance and sit on the stretcher (all the while in no pain), and then immediately once he sits down start having severe 10/10 abdominal pain that he can't stand, and starts flailing around like he's dying.

Fortunately we have the ability to look up these people's previous ambulance rides and many of them get marked as drug seekers. I don't think a lot of people on here understand the insane amount of abuse on 911 and the hospitals in some areas by drug seeking individuals. I have literally seen a homeless patient in the hospital here who claimed 10/10 chest pain that was relieved by nothing but Dilaudid. He went through every test (CE's, Cath lab, ect.) and all came back negative. Trust me he never appeared to be in any pain others than stating "My pain is 10/10, I need Dilaudid". After days of nothing coming back on him he was D/C'd and he refused to leave so he was arrested. We get people like this often.

If every paramedic here had the attitude of "Well if he says he has pain, I must give him pain meds", and every abuser got narcs, the system would be a nightmare.
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Wow you work somewhere people have a lot of drug problems? Wow I guess the rest of us just work in some bizarre part of the world where drug addiction is a non issue.

We don't give a patient in severe alcohol detox alcohol we give them benzos, lots and lots if benzos, at least that's the accepted treatment. Just like we don't give someone in severe heroin withdrawal heroin, we give them morphine for the pain and methadone to manage their other symptoms.

So the hospital allowed a homeless guy to stay in the hospital for days, receive every expensive test they could run on him probably ran up a 50000 dollar hospital bill and then got sent to jail where he will cost the state another 50000 thousand and this was all to avoid giving him a 300 dollar shot of dilaudid? Wow I guess the hospital really showed him.
 
Medic419 said:
Do you give an alcoholic withdrawal patient more booze because he is in withdrawals?
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Actually, I have seen first hand where doctors prescribe alcohol to patients admitted in the hospital. And yes, the nurse hands the patient a can of beer or dispenses the prescribed amount of liqueur. This is to prevent withdrawal.

Pain and nausea are two of the worst feelings human beings can experience! Why are we so bent on neglecting effective treatment of these two conditions when it can be done cheaply, safely, quickly, effectively, and yield great results and improvement in the patient!!!!!!

I don't understand the whole taboo surrounding narcotics within healthcare circles. I really don't.
 
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And a patient should only addiction their drugs under care of a doctor to monitor and treat their condition accordingly. Withdrawals can kill.

You're not a doctor so stop trying to fix their addiction.

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Medic419 said:
Maybe my view is different than many on those on this site because I live in an area where there is A LOT of drug users, but I am very surprised to see people advocating giving pain medicine to drug seekers.
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I don't think anyone is advocating intentionally giving analgesics to drug seekers. I think what is being advocated is that it is impossible to distinguish drug-seekers with a 0% false-positive rate, and that it's better to bias towards treating pain to avoid accidentally labelling a patient in acute pain as a drug seeker. This will follow them around through the healthcare system, and may result in their symptoms not being treated appropriately in the ER, or even worse, them being undertriaged as a malingerer while there's serious underlying pathology going on.

This is being presented as an acceptable risk of giving narcotic analgesia. Some people will try and trick you, and some of them will do a very good job of it. I think we have all probably given morphine (or fentanyl or demerol or....) to someone, and then had a nagging doubt afterwards as to whether they were genuine. It's being suggested that it's best not to make these sort of decisions, because if we do, we're going to eventually withhold pain medication from someone in need.

And let's look at this realistically here. How much morphine / whatever are we realistically giving? If someone is an injection heroin user, and I give them 5mg MS IV, it is barely barely going to touch them. I mean, think about that dose -- is that even remotely appropriate for a cancer patient with chronic pain? I've got orders of 30mg morphine IVP as a single dose for these patients.

We are not getting these people high and euphoric. At the best (or worst), we're taking the edge off their withdrawal. And I'll freely admit that people will call us for that. I'm sure we've all done the abdo pain at the rehab clinic. There's no doubt these people are abusing the system, but all we're doing is providing a very temporary relief -- they're hoping for a script for something they can crush and inject at the ER. We're not the main source of anyone's narcotics.
 
This is why Nitronox needs to be on every ambulance. I love that stuff.
 
firefite said:
I think you misread what I wrote. The 10ml of Saline is NOT used in anyway as a pain medication. It is used as a flush (what a 10ml preload of saline is for...). The patient is just told if at all that it is saline (nothing more, nothing less). Ive had a couple of patients get instant pain relieve with the saline flush. If they say their pain when away with the flush then why would you give pain medications to a patient who no longer has any pain?

Once again so everyone understands what I am saying: the 10ml saline preload is used as a saline flush, nothing more and nothing less. It is NOT used as any kind of pain medication.
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How is this documented?

How is it communicated to hospital staff?

It's bad practice to put anything in anyone that's A&O and not tell them what it is, even if only a flush. One day it will come back to bite whoever may or may not be telling the pt what is going on. Pt says they were given pain medicine by the medic and feel a little bit better yet none of the tests they had done are showing opioids? Sounds like a diversion investigation although not true.
 
BF2BC EMT said:
How is this documented?

How is it communicated to hospital staff?

It's bad practice to put anything in anyone that's A&O and not tell them what it is, even if only a flush. One day it will come back to bite whoever may or may not be telling the pt what is going on. Pt says they were given pain medicine by the medic and feel a little bit better yet none of the tests they had done are showing opioids? Sounds like a diversion investigation although not true.
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Very good point!
 
BF2BC EMT said:
How is this documented?

How is it communicated to hospital staff?

It's bad practice to put anything in anyone that's A&O and not tell them what it is, even if only a flush. One day it will come back to bite whoever may or may not be telling the pt what is going on. Pt says they were given pain medicine by the medic and feel a little bit better yet none of the tests they had done are showing opioids? Sounds like a diversion investigation although not true.
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"a saline lock was attached to the cath. The cath was then flushed with a 10ml preload of saline. After the cath was flushed the IV tubing was connected and the patient stated 'my pain is alot better now', even tho no pain medication was given."

Patient may state whatever he/she wants. But the medic states only the flush was given and not any pain medication.

I hate how my posts got separated from the other thread and placed in this one. My posts have nothing to do with giving drug seekers pain medications. If they are in pain then give them the medication.
 
firefite said:
"a saline lock was attached to the cath. The cath was then flushed with a 10ml preload of saline. After the cath was flushed the IV tubing was connected and the patient stated 'my pain is alot better now', even tho no pain medication was given."

Patient may state whatever he/she wants. But the medic states only the flush was given and not any pain medication.

I hate how my posts got separated from the other thread and placed in this one. My posts have nothing to do with giving drug seekers pain medications. If they are in pain then give them the medication.
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This isn't the practice you were coming across with initially.
 
I find the FLACC scale the most objective measure.
 
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