Drug seeking patient signs?

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Ahertens21

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I have a question for some of the more seasoned EMTs and medics out there. How can you tell someone is drug seeking?

For example: patient has been vomiting and says they pulled their back whilst vomiting. Immediately upon getting into the rig, they ask for pain meds. Same thing the minute they hit the hospital bed: pain meds.
 
Every patient is different and everyone's pain tolerance is different. Sometimes you aren't going to be able to tell.

We have some frequent flyer that every time they call as soon as we make patient contact they ask for an IV and pain meds.

If they state 10/10 pain but are resting comfortably on the gurney and are talking on their cell phone will no distress then I am probably not going to give any meds.

In the case where you can not tell I would rather give pain meds to a seeker than withhold pain meds from a patient who is in true pain.
 
"For example: patient has been vomiting and says they pulled their back whilst vomiting. Immediately upon getting into the rig, they ask for pain meds. Same thing the minute they hit the hospital bed: pain meds."

LOL. That would be one sign.

You shouldn't really be trying too hard to figure out who is faking and who isn't. That said, you shouldn't give narcotics inappropriately, and giving narcotics to someone who is very obviously drug seeking is inappropriate.

Do you carry non-narcotic pain meds? Hot packs? If it is appropriate (i.e., lower back pain, not a bone sticking out), consider giving those and telling the patient that you are going to give them something nonnarcotic because that is the safer choice.
 
How I know:

"I'm seeking drugs."- drug seeking patient.

Seriously though, OP. I look at the bigger picture. Are they tachycardic, hypertensive, tearing (applies to sedated, and intubated patients as well) for reasons not matching their chief? Does it hurt me to look at them, or their injury? Are my spidey senses saying "this poor schlub needs pain relief?"

Those are some of my big ones, but if all else fails if they're in pain and I can treat it, I do. I could care less what Nurse Ratchet tells me at the ED. They had pain, I provided relief, done.

Times are changing, and the almighty judgmental paragod is going the way of the dino (thankfully). The more you do it, the easier it gets, that's all:).
 
It comes with experience. I consider myself to be fairly liberal with pain meds. That said I've been burned. If you truly listen to the patients story, you'll learn to pick up on the subtle BS.

If you are not 100% sure they are seeking, give the meds. No matter how experienced you are, you will get burned again.





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Visual signs of distress and vital signs are a really good start. People in real pain don't hide it well for the most part. Grimacing, grunting, labored breathing, perspiration, elevated bp, hr and so on are all good indicators of real pain.

Calm, minimal or no distress, flat vitals and directly asking for pain management for a vague, chronic pain complaint are all indicators of a bs call. Not absolutely bs of course. I took a guy yesterday who slipped on the ice and broke his ankle. His foot flopped around like a wet lasagna noodle. Multiple fractures confirmed on X-ray later at the hospital. He was the chillest dude ever. A bit hypertensive but nothing crazy. All other signs unremarkable. So there are people out there who are undercover sick.

All that being said, when I wrecked my motorcycle and wound up in an ambulance, i was grossly undermedicated. It was ultimatley hours of ineffective small doses of pain medicine before one of the trauma surgeons at the hospital decided to nut up and get to it. Consequently, having lived through the side of the patient who's pain is being under treated or worse, ignored, i will give drugs to almost anybody. I truly believe a patient experiencing real pain deserves relief from that pain regardless of whether or not their injury or pain impresses me.

The only people I dont medicate are the obvious drug seekers. Beyond them, if I believe your pain is real and you want relief, I'm on it. I too have been burned. We cant put peoples pictures on the station house wall labeled "med seeker", so inevitably we're each going to encounter these people without knowing their game. I dont care. I'd rather unwittingly give a hundred junkies a free pop than let one patient with real pain slip past me. This causes me some grief when I'm working with a VOMIT medic, but I'm past caring about what lazy hacks think about my practice.
 
Thanks for all the input guys. As a BLS agent, we can't do any lines or anything for a patient. But I am going into medic school so I really wanted to know. I guess, as always, air on the side of safety.

Hospitals in my area are cracking down hard on opiates. The one big hospital in my area will no longer be giving anyone any type of pain relief besides NSAIDs, unless necessary patients. Times are changing.
 
Ahertens21 said:
Thanks for all the input guys. As a BLS agent, we can't do any lines or anything for a patient. But I am going into medic school so I really wanted to know. I guess, as always, air on the side of safety.

Hospitals in my area are cracking down hard on opiates. The one big hospital in my area will no longer be giving anyone any type of pain relief besides NSAIDs, unless necessary patients. Times are changing.
Click to expand...
No problem, OP. I find this interesting, and it appears quite the opposite in my neck of the woods, good luck going from B to P.
 
Ahertens21 said:
Thanks for all the input guys. As a BLS agent, we can't do any lines or anything for a patient. But I am going into medic school so I really wanted to know. I guess, as always, air on the side of safety.
Click to expand...

I'd disagree - we can do more than nothing:
1) distraction (plus, in some places, a little sugar water for infants)
2) positioning, splinting, and padding
3) cryotherapy (good old ice packs!)
4) call for an ALS intercept



Sent from my iPhone using Tapatalk
 
Ahertens21 said:
Thanks for all the input guys. As a BLS agent, we can't do any lines or anything for a patient. But I am going into medic school so I really wanted to know. I guess, as always, air on the side of safety.

Hospitals in my area are cracking down hard on opiates. The one big hospital in my area will no longer be giving anyone any type of pain relief besides NSAIDs, unless necessary patients. Times are changing.
Click to expand...


Good for them. I'm glad their taking this stance. As a corollary, I'm I'm ever a patient there, and require analgesia, they will be intubating me as I am deathly allergic to all NSAIDS(or at least the few that have landed me in the hospital so far).
 
hometownmedic5 said:
Visual signs of distress and vital signs are a really good start. People in real pain don't hide it well for the most part. Grimacing, grunting, labored breathing, perspiration, elevated bp, hr and so on are all good indicators of real pain.

Calm, minimal or no distress, flat vitals and directly asking for pain management for a vague, chronic pain complaint are all indicators of a bs call. Not absolutely bs of course. I took a guy yesterday who slipped on the ice and broke his ankle. His foot flopped around like a wet lasagna noodle. Multiple fractures confirmed on X-ray later at the hospital. He was the chillest dude ever. A bit hypertensive but nothing crazy. All other signs unremarkable. So there are people out there who are undercover sick.

All that being said, when I wrecked my motorcycle and wound up in an ambulance, i was grossly undermedicated. It was ultimatley hours of ineffective small doses of pain medicine before one of the trauma surgeons at the hospital decided to nut up and get to it. Consequently, having lived through the side of the patient who's pain is being under treated or worse, ignored, i will give drugs to almost anybody. I truly believe a patient experiencing real pain deserves relief from that pain regardless of whether or not their injury or pain impresses me.

The only people I dont medicate are the obvious drug seekers. Beyond them, if I believe your pain is real and you want relief, I'm on it. I too have been burned. We cant put peoples pictures on the station house wall labeled "med seeker", so inevitably we're each going to encounter these people without knowing their game. I dont care. I'd rather unwittingly give a hundred junkies a free pop than let one patient with real pain slip past me. This causes me some grief when I'm working with a VOMIT medic, but I'm past caring about what lazy hacks think about my practice.
Click to expand...


I agree 100% with this. I previously while not unwilling, was more hesitant to give meds to abdominal pain patients of unknown etiology. However, after going through the pain of a very large gallstone back in November and being originally undertreated, I've become a much more willing medic. We (generally) aren't the ones causing the addictions to opiates. Like you, I'd much rather give a small dose of meds to a seeker than let someone in actual pain slip by.
 
EpiEMS said:
I'd disagree - we can do more than nothing:
1) distraction (plus, in some places, a little sugar water for infants)
2) positioning, splinting, and padding
3) cryotherapy (good old ice packs!)
4) call for an ALS intercept



Sent from my iPhone using Tapatalk
Click to expand...
When was a BLS provider, i had a woman who broke her femur in her basement. Getting her our was going to require a carry up narrow basement stairs and a turn that put her at almost vertical to negotiate. I requested an ALS intercept to give her pain meds prior to this move.

The ALS providers laughed at me when they arrived and gave report, left, then filed a formal complaint that i was "wasting ALS resources"
 
I would have filed right back at them for abandonment, negligence, malpractice, and being an AH.

Most likely none of it would have gone anywhere, but I really would like to have seen them squirm in the chair trying to explain how pain management in a long bone fracture with extrication is a waste of ALS.
 
Bullets said:
When was a BLS provider, i had a woman who broke her femur in her basement. Getting her our was going to require a carry up narrow basement stairs and a turn that put her at almost vertical to negotiate. I requested an ALS intercept to give her pain meds prior to this move.

The ALS providers laughed at me when they arrived and gave report, left, then filed a formal complaint that i was "wasting ALS resources"
Click to expand...

That's really substandard care on their part.

hometownmedic5 said:
I would have filed right back at them for abandonment, negligence, malpractice, and being an AH.

Most likely none of it would have gone anywhere, but I really would like to have seen them squirm in the chair trying to explain how pain management in a long bone fracture with extrication is a waste of ALS.
Click to expand...

Agreed.

ALS pain management is so totally indicated for long-bone fractures that are acutely painful or may become so due to movement. I'd go as far as to say that anything where we might cause pain, ALS should be at least considered. I've never hesitated to call ALS for pain management - and I wouldn't want anybody taking care of me to demean my pain.
 
@EpiEMS @hometownmedic5 This was a few years ago, they claimed that they would never get orders for this. In the ensuing investigation it did turn around on them once they read my chart and the hospitals follow up. They both faced internal discipline
 
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