Seekers who are good actors!

[Tone]

What kind of detailed schemes have you seen drug seekers pull?

Fake allergy to acetaminophen so they get oxycontin and arthrotec instead of oxycocet?

Chronic pain that a cause can't be seen on any diagnostic imaging?

Lets hear stories of seekers who are actually GOOD at acting, and that would probably fool even the most experienced medics.

 

[Shishkabob]

"Ow"

"It hurts"

 

[medic417]

Not my job to decide who's faking. It's not your job either.

 

[Tone]

"Ow"

"It hurts"

yeah this is the majority!! but I'm talking about the patients who are GOOD at it.

 

[usafmedic45]

Fake allergy to acetaminophen so they get oxycontin and arthrotec instead of oxycocet?

If someone lists an allergy to a non-narcotic analgesic other than aspirin, I suspect a drug addict. If they list an allergy to ALL non-narcotic pain meds or to Toradol specifically, they are a drug seeker until proven otherwise.

A great way to separate the true drug addicts is to pull out a vial of naloxone, ask them if they know what it is. You'd be amazed how many of these low-lifes have experienced Narcan and will cut the crap if you "threaten" them with it.

What kind of detailed schemes have you seen drug seekers pull?

99.9% of drug addicts are not smart. The remaining 0.1% have better established sources of the pain meds than pulling fast ones on the paramedics and ED staff.

Chronic pain that a cause can't be seen on any diagnostic imaging?

"Drug addict" and "fibromyalgia" (read as "psychiatric diagnosis with psychosomatic symptoms" usually in a very tightly wound fat woman) jump to the top of my list if a patient gives me that "history".

Since when do we do diagnostic imaging in the field?

Lets hear stories of seekers who are actually GOOD at acting, and that would probably fool even the most experienced medics.

In 15+ years, I've never encountered one. Then again, unless someone is burned or obviously have something broken, they get nitrous or Toradol.

 

[Veneficus]

The best seeker act I ever saw was a guy with sickle cell who came into the ED complaining of priapism. He got several doses of hydromorphone before the doc handling him walked in and caught him masturbating to keep his erection going.

His narcotics were stopped and miraculously despite being brought in by EMS, he was well enough to sign out AMA and walk out.

I agree it is not the role of EMS to decide who is seeking nor to hold medication based on those suspicions. Unless you have the ability to provide the proper rehab both short and long term, moral convictions are of no value.

Narcotic withdrawel can be life threatening. Under what medical risk/benefit analysis can an EMS provider determine withholding the drug is more beneficial than giving it?

From the standpoint that pain is a subjective finding, if you suspect the patient is a seeker and you give the drug, so what?

What if you suspect the person is a seeker and you withhold the drug and you are wrong?

What if the person is a drug addict and having pain for an actual medical complaint? Does the fact the patient also has an addiction problem preclude him/her from having their pain treated?

Deciding who is worthy of what treatment is a very slippery slope to start down.

 

[MMiz]

This thread has been cleaned and members have been warned appropriately. As a reminder: While we promote debating and discussion, we will not tolerate rudeness, defamatory or insulting posts, personal attacks or purposeless inflammatory posts.

 

[firecoins]

I had a drug seeker recite Hamlet for me. Excellent actor! Got a standing ovation at the ER. When he said "to be or not to be" we really thought he was suicidal.

 

[MediMike]

Read a recent article (I'll try to dig it up) discussing how chronic opiate abusers actually have severely decreased px tolerances due to their unfamiliarity with "pain". I'm very loathe to withold drugs from anyone, I see no point in it. I'd rather give 10 "seekers" their fix than not provide some palliation from someone who needs it.

 

[medicRob]

Not my job to decide who's faking. It's not your job either.

Absolutely 100% correct. I feel the same way.

Which is worse, giving a junky a fix or withholding meds from someone in real pain because you thought they were a drug seeker?

 

[usafmedic45]

I'd rather give 10 "seekers" their fix than not provide some palliation from someone who needs it.

I'd rather give a junkie a dose of Narcan than a dose of morphine. As they say, mileage may vary.

 

[Tone]

If someone lists an allergy to a non-narcotic analgesic other than aspirin, I suspect a drug addict. If they list an allergy to ALL non-narcotic pain meds or to Toradol specifically, they are a drug seeker until proven otherwise.

A great way to separate the true drug addicts is to pull out a vial of naloxone, ask them if they know what it is. You'd be amazed how many of these low-lifes have experienced Narcan and will cut the crap if you "threaten" them with it.

99.9% of drug addicts are not smart. The remaining 0.1% have better established sources of the pain meds than pulling fast ones on the paramedics and ED staff.

"Drug addict" and "fibromyalgia" (read as "psychiatric diagnosis with psychosomatic symptoms" usually in a very tightly wound fat woman) jump to the top of my list if a patient gives me that "history".

Since when do we do diagnostic imaging in the field?

In 15+ years, I've never encountered one. Then again, unless someone is burned or obviously have something broken, they get nitrous or Toradol.

Good post, I agree with the exception that there are lots of smart addicts. Probably they have a source established at a family MD, and we don't see the smart seekers in ER? its more that we just see the desperate ones.

Is that pretty much what your saying too?

 

[Tone]

This thread has been cleaned and members have been warned appropriately. As a reminder: While we promote debating and discussion, we will not tolerate rudeness, defamatory or insulting posts, personal attacks or purposeless inflammatory posts.

My threads always get people excited!

did you all miss me?

 

[JPINFV]

Chronic pain that a cause can't be seen on any diagnostic imaging?

...because chronic pain will always show up in diagnostic imaging?

 

[JPINFV]

This thread has been cleaned and members have been warned appropriately. As a reminder: While we promote debating and discussion, we will not tolerate rudeness, defamatory or insulting posts, personal attacks or purposeless inflammatory posts.

Gorram! (for the record, this is my new favorite fracking pop-sci-fi exclamation).

I go and study outside for a significant part of the day and I miss a thread filled with fun? Grr!

 

[medicRob]

99.9% of drug addicts are not smart.

Wrong. Just look at some of the drug sites on the internet where individuals are speaking of complex means to convert Safrole and other pre-cursors to MDMA, or some of the sites outlining the use of entheogenical bioderivatives, or talks of individuals using column chromatography and other advanced procedures to separate an alkaloid from its other constituents, or the acid/base extractions of the Peruvian torch cactus by way of the solvent xylene to end in Mescaline Hydrochloride, or the extraction of the Alkaloid N,N-Dimethyltryptamine from the inner root bark of the mimosa hostillis by way of acid/base mechanisms using NaOH basified H20 to pull the alkaloid from the bark, adding VM&P Naptha to the mix to pull the N,N-DMT into the solvent, evaporating it, and performing CFC Precipitations to result in a crystalline solid of the product... or if that doesn't convince you, read on how some are growing their own Papaver Somniferum and extracting the various constituent alkaloids and carrying out patented chemical procedures to result in the alkaloid of their choice... My friend, most addicts are smarter than you give them credit for.

I will not link the sites openly here as I do not want to provide individuals with information that would promote the manufacture of scheduled substances, nor would I want anyone without a working knowledge of chemistry to attempt any of the procedures.. However, I will more than happily send them via PM to the individual who posted this skewed statistic.

Two of the most common books in the possession of addicts are PIHKAL (Phenythalamines I have known and loved), and TIHKAL (Tryptamines I have known and loved) by the famed biochemist Dr. Alex Shulgin, of MDMA fame. These are his chemical notebooks written after the time he was one of the top researchers with the DOW chemical company outlining the mechanisms and synthesis of hundreds of psychoactive compounds, along with an assay of their effects.

 

[JPINFV]

If I posted an equally skewed statistic, could I get the link via PM anyways?

 

[medicRob]

If I posted an equally skewed statistic, could I get the link via PM anyways?

Nope, you and me are cookin crystal meth in the kitchen later, buddy. Start scraping matches.

 

[ffemt8978]

Nope, you and me are cookin crystal meth in the kitchen later, buddy. Start scraping matches.

 

[JPINFV]

Well, if you're outside watching us, why don't you come in and join us?