Seekers who are good actors!

[medicRob]

No need, this is the end of my posts in this thread. These posts were originally made to prove a point that all addicts aren't stupid, not to promote anything to do with drugs. I'm sure the members here know this.

 

[firetender]

You don't catch the smart ones.
The rest are obvious.

 

[usafmedic45]

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.

Yeah, read the rest of that paragraph. I said exactly that.

Wrong. Just look at some of the drug sites on the internet where..... 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.

Stupidity and a lack of intelligence are not necessarily the same thing. Even the most intelligent person can be very stupid at times. Besides, your average addict isn't cooking this crap otherwise EDs and docs in a box would have a lot fewer clients.

 

[Sandog]

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.

Your attitude is typical of most health care providers. The addict is seen as a screw up, a loser, one with no self control, one who is lacking intelligence. As a former addict and now a speaker at addict meetings, I can tell you, addicts are not those things mentioned above.

The AMA has determined that addiction is a disease, yet addiction still carries a stigma and the accompanying disdain. You have cancer and everyone supports you, your an addict and screw you, it is your fault.

This stigma will carry on for years to come, but health-care providers should educate themselves about this disease as it is at pandemic levels.

Addicts are not bad people, they are not losers as many of you think, they are people in turmoil, they suffer and they hurt.

Genetic research has unraveled many of the mysteries of the addict, as science and biology continues to progress this baffling disease may be eradicated in our lifetime. Until then, how about a little tolerance?

 

[samiam]

Psuedoseizures

Had a guy come into the ER via ems with an AMAZING seizure (he had LOTS of practice) the doc who had never seen him before gave ativan and after about thirty seconds it was over and he was complaining of back pain so the doc ordered 50 of fentanyl and the guy with out missing a beat said "doc 50 is not enough give me 100" the doc said ok give him 100 and continued charting. Once he got halfway thru his history he said "mr smith..are you sure it was a real seizure this time.. it says here you like to fake them" Patient: of course doc it was real.

 

[Veneficus]

Your attitude is typical of most health care providers. The addict is seen as a screw up, a loser, one with no self control, one who is lacking intelligence. As a former addict and now a speaker at addict meetings, I can tell you, addicts are not those things mentioned above.

The AMA has determined that addiction is a disease, yet addiction still carries a stigma and the accompanying disdain. You have cancer and everyone supports you, your an addict and screw you, it is your fault.

This stigma will carry on for years to come, but health-care providers should educate themselves about this disease as it is at pandemic levels.

Addicts are not bad people, they are not losers as many of you think, they are people in turmoil, they suffer and they hurt.

Genetic research has unraveled many of the mysteries of the addict, as science and biology continues to progress this baffling disease may be eradicated in our lifetime. Until then, how about a little tolerance?

While I am sure his opinion is he would like to give them narcan, he didn't say that he did.

He also likes to stir the pot so to speak.

 

[medicRob]

Had a guy come into the ER via ems with an AMAZING seizure (he had LOTS of practice) the doc who had never seen him before gave ativan and after about thirty seconds it was over and he was complaining of back pain so the doc ordered 50 of fentanyl and the guy with out missing a beat said "doc 50 is not enough give me 100" the doc said ok give him 100 and continued charting. Once he got halfway thru his history he said "mr smith..are you sure it was a real seizure this time.. it says here you like to fake them" Patient: of course doc it was real.

Nice. lol

 

[usafmedic45]

one with no self control

Technically isn't that the definition of addiction? Where the desire to use the substance overwhelms whatever self-control the addict has.

While I am sure his opinion is he would like to give them narcan, he didn't say that he did.

Only once, and only because the guy was technically meeting the requirements of the protocol that allowed me to have medical reasons (altered mental status) for doing so. He started checking the ambulance building parking lot to see who was working before coming to the door after that. It also dropped the frequency of his visits to our station by about 75% and he started riding his bicycle the 19 miles to the next town over for treatment for his "back pain".

As for the "show them the Narcan" trick. I've lost count of the number of times I've used that one. It's a good way of getting the really hardcore junkies to back down. Technically, it's not illegal and it's less unethical than feeding someone's habit.

The AMA has determined that addiction is a disease, yet addiction still carries a stigma and the accompanying disdain.

And you don't see a stigma associated with any of the following other diseases?:
-Syphilis
-AIDS
-Gonorrhea
-Chlamydia
-Herpes
-Leprosy
-Tuberculosis
-Scabies
-Lice
-Crabs

So please, get off the high horse and let's not act like addiction is any less deserving of a stigma than a disease like syphilis you pick up by making bad choices. It's not the addiction that attracts the stigma anyhow. It's the associated behavior that makes most people treat addicts the way they do. You'll notice that most of the diseases with an associated stigma have a connection or transmission associated with poor hygiene or risky behavior. The stigma is simply the natural response by a society to minimize and discourage persons from engaging in those activities. In the case of leprosy, it actually serves a pretty important public health role by encouraging quarantine.

Until then, how about a little tolerance?

You mean, how about I feed their addiction or feel sorry for them? No, not going to happen. Feeling sorry for them does no good for them. I offer to get them help, most of them tell me to do something anatomically impossible and the medical equivalent of a Mexican standoff ensues until they become someone elses' problem.

Addicts are not bad people, they are not losers as many of you think, they are people in turmoil, they suffer and they hurt.

You could have described about 90% of people in EMS. I know most addicts are not "bad" people but until they go into remission.

one who is lacking intelligence.

No, just the ones with intelligence have better ways of getting their fix than scamming paramedics and emergency physicians so we get sort of the bottom of the barrel.

 

[Sandog]

So please, get off the high horse and let's not act like addiction is any less deserving of a stigma than a disease like syphilis you pick up by making bad choices.

High horse? No, I am just attempting to clear up the misconceptions about addicts. My attempt here is that we are all worthy of redemption.

My drug of choice was alcohol, I had my first drink when I was in the Navy, I was 17 years old. Was this a bad choice, after all, how harmful could one drink be? For most, the one drink ended at that, one drink, for me it was just the beginning. At the time I had no idea that I had the propensity to abuse alcohol. Subsequently I went on a twenty year binge and a lot of regrets. At the time no one told me that I would become an addict so I did not think that first drink was a bad choice.

What I am trying to convey here is that most people do not make a decision to become an addict, one social smoke or drink and they will be done. For many that one social drink or smoke turns into a catastrophic outcome the likes of which the user never anticipated.

Have you ever taken a drink of alcohol, was that a bad choice? Most likely you have and that was that, you are fine, not a drunk. For some that is not the case, the release of dopamine overwhelms the judgment center and indeed one does lose self control, but I must iterate that this loss of control was not a choice.

There is light at the end of the tunnel for those that seek help as I did. Through medications and therapy addicts can overcome the disease that propels so many into the darkness.

As EMS providers I am sure many of you see the worst of the worst addicts. It is easy to understand that you develop a thick skin and intolerance to these people as they do not seem to want your help. Truth is they really do want your help, deep inside they do, they just do not know how to ask. Best thing you can do is talk to them, tell them about help programs, give them cards to help resources. If you can save just one, you have earned a pass to the afterlife...

 

[Phlipper]

I've seen far too many seekers in my short career already who are obviously trying to scam us. How can we be sure? Because we pick them up every week, or more, for some crazy ailment. One, a very overweight 30-ish lady, always has a new complaint and last time it was appendicitis. She evidently researches these various diseases to get the symptoms down. The ER has caught on and she gets nothing, but there we'll be ... dragging her fat butt off the porch next week cuz she won't give up.

I have sympathy for folks who are in pain or lonely or whatever. We've all had our moments, and I try to remember this when trying patients are trying my patience We're here to help, so I help, regardless of my personal feelings. Most all my pts get 110%. But if we've picked you up six times just this month for a different disease each time and you're a known junkie you only get 100%, not 110%. Our medics won't break out the fentanyl unless something's broken or bleeding or your bp is so high it's obvious you're really in pain. And I see myself following suit next year.

One last thing ... I'm sorry, and I don't mean this personally. I'm speaking of the general public "you", not the poster above: this "disease" excuse just doesn't add up. There is no disease I am aware if that takes over your muscles like Linda Blair being possessed by Satan and forces you to take drugs. It is a choice. A conscious choice. Telling yourself you have a "disease" releases you from responsibility when you ARE responsible for your actions. It's a cop out. Nothing more.

 

[the_negro_puppy]

Regardless of how much we are here 'try help' and how much 'addiction is disease' i still feel used and cheated when I transport someone to hospital w/pain relief only to find **alerts** for drug seeker etc at hospital

 

[medicRob]

Regardless of how much we are here 'try help' and how much 'addiction is disease' i still feel used and cheated when I transport someone to hospital w/pain relief only to find **alerts** for drug seeker etc at hospital

Just a question (Not picking or anything), but what is it that makes you and the others feel cheated when this happens? Is it the thought that someone pulled a fast one on you, is it a feeling that what you've done is unethical, or is it something else?


Every provider who has access to prescribe narcotics and administer them per their own discretion is going to end up scammed at one point or another. Here is the funny thing about it.. usually it is the little old lady coming in complaining of back pain that is seeking, because at her age docs have seen fit to pretty much prescribe her anything she wants, and even she wants more.

When I give a patient morphine, fent, or any other pain med only to find out that they are 'seeking', I just see it as a learning opportunity. I don't get mad, I don't feel guilty, and I don't take it personally. We are all going to get tricked.. If I see that patient again, I am certainly going to be skeptical.. However, I will do my best not to let my clinical judgement get clouded over a previous experience. Now, if I see your *** twice in the same day and you haven't just been in a serious car accident or something of the like, then I will more than likely ask you to explain yourself, lol.. or at least take you to the medical center of your choice so you can tell the doc yourself that you are allergic to X even though it is in the same class as Y that you say works well on you without prob.

 

[Veneficus]

Why make more work for yourself than you have to?

Since you cannot possibly help the seeker with their problem, give them the med and be done with it like every other EMS treatment.

I don't see many medics revascularizing an MI in the field. But you still do what you can for them right?

You don't have what it takes to treat an addict, so just give them what little you can.

One day I will figure out why any level of health provider who knows the resources don't exist to treat addiction except for the extremely wealthy somehow feel compelled to try and help by restricting access.

So now instead of calling 911 and scamming some narcs they can go hold up a pharmacy with a gun (or similar) or finally go into DT and get what they wanted at death's door.

I keep telling people. Addiction is not and can not be solved by medicine. It is a social issue and requires a social address.

 

[jjesusfreak01]

I don't see many medics revascularizing an MI in the field. But you still do what you can for them right?

I imagine if you could do cardiac caths in the field, medics would have more practice at that than intubation...just saying.

 

[mycrofft]

Drug seeking or Munchhuasen?

1983, young woman borrowed her absent roommate's work clothes (stewardess uniform) and nametag, driven to ER by taxi, said she was on layover and came down with horrible flank and back pain and had history of renal calcs. Left by herself to produce a UA specimen; of course it had a little occult blood. She actually underwent a KUB with contrast and received a Demerol shot, then eloped during a busy stretch before we could tell her the KUB was fine and hand her a pain medication Rx.

I worked with addicts for over twenty years, including six overseeing subacute housing detox, in a jail. Before you generalize, examine your mental picture of an "ADDICT". Firetender got it, the smart ones and the rich/managed ones are not the ones you see on Skid Row. The best con is the one you never know was pulled on you.

What makes all addicts poor people to be around is the preeminent role their addiction takes in their lives. For people without resources (mental, fiscal or other) or with cumulative brain damage, that means they will do anything to get their addiction met...and "anything" can get really "out-there" as your choices narrow.

Why people like entertainment like "Weeds" or "Breaking Bad" is beyond me.

 

[firetender]

Regardless of how much we are here 'try help' and how much 'addiction is disease' i still feel used and cheated when I transport someone to hospital w/pain relief only to find **alerts** for drug seeker etc at hospital

I will cop to having had this same experience in my time in the field. The system that formed me -- Florida in the 1970's -- was barely able to manage "true" emergencies. I didn't so much resent the drug usage, what bugged me was using an ambulance as a vehicle to get what they needed. Most could have walked to the ER on their own and pulled their scams there.

At times, the presence of passersby would prevent me from "discouraging" transport for someone very well known to the system, an obvious scammer and pitiful, yes, but, in my mind an obstruction. Stuff like this drove me nuts, and to be honest, at times I was less than kind!

 

[jjesusfreak01]

Had a patient rolling on the ground complaining of back pain. When told he was going to the hospital, promptly hopped up, walked into the ambulance without any apparent difficulty, and explained he was allergic to Toradol. He didn't get anything for the pain.

 

[DCAP-BLS-TIC]

I had a patient complaining of the "worst headache" he's "ever had". So bad that he was "seeing squiggly lines". We get there and he literally has a book bag full of prescription bottles for various drugs, probably about 30-40 bottles, all of them being full/unopened except for his Oxycontin. Pain scale a 13 out of 10, of course.

We get to the ER only to find out that he had been to that same ER just the day before for the exact same complaint.

 

[usafmedic45]

Have you ever taken a drink of alcohol, was that a bad choice? Most likely you have and that was that, you are fine, not a drunk. For some that is not the case, the release of dopamine overwhelms the judgment center and indeed one does lose self control, but I must iterate that this loss of control was not a choice.

Given the massive history of alcoholism in my family? Probably. However, I've learned to moderate my drinking by simply associating it with food (a glass of wine with dinner, a beer with a steak, etc.) and also by finding a lot of humor at parties in watching other people act stupid while blitzed out of their gourds.

BTW, I don't believe it's a "choice" to be come an addict, at least not in the case of alcohol. However, the choice to abuse narcotics and illegal substances is somewhat different. I know a lot of people who became addicted largely through no fault of their own to pain medication because of poor prescribing practices, but I know far more who simply seek them out as an "escape" because to quote the country song "the whiskey ain't working anymore". That is a conscious choice. Same with someone who becomes addicted to heroin, cocaine, meth, etc. You can't plead ignorance on the fact that these are massively and nearly universally addictive substances. Those folks are the ones I have little empathy for because of the bad choices in their life.

 

[mycrofft]

A little off line but contributive.

Some (not all or most) people feel that analgesia means absolutely no pain, and even a little euphoria. Coupled with adaptive tolerance and possibly a worsening condition (because getting some Rx is cheaper than surgery and less boring than therapy), of course their frequency and doseage increase, and soon, beyond their means to supply legally.