Drug Seekers

[saintsfan180]

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Who doesn't hate dealing with these guys? I had a particularly persistent one tonight and I told the guy I was gonna give him Tramadol. Well he had that at home and blah blah blah 20 minutes later I just let him talk to my attending. Oh he name dropped a bunch of "big wigs" that he was going to complain to, all of which were made up and hold no position in our hospital. So my staff goes in there and agrees that we will give him a Lortab tonight and kick him out, after about 20 minutes of them having a yelling match also.

So yes, I think we should treat pain in the ED and fine, one Lortab, whatever. But what do you all do with these people? I try to reason with them that we do not treat chronic pain, and we will get them follow up and everything, but they are so frustrating and emotionally draining. Does anyone have a standard "go to" approach for these folks, or is it just an argument every time? I'm non confrontational and this exhausts the crap out of me, especially when I'm doing the fast track and this is all I deal with all day.

 

[dotcb]

Tell them no. Be polite, professional, and try to be nice. Then have them escorted out of the dept by security, if necessary

 

[Cynic]

http://www.craigslist.org/about/best/sfo/301345524.html

Bam.

 

[Birdstrike]

What dotcb said, and remember not to let your bias cloud your judgement and miss something acute that is masked by a chronic condition (ie "chronic" back pain doesn't mean you can't have a AAA, and chronic migraine doesn't prevent someone from getting an acute SAH, ie, classic set up for a missed diagnosis if you're too clouded by cynicism).

Do and read this, from ACEP (WA Chapter):

http://washingtonacep.org/Postings/edopioidabuseguidelinesfinal.pdf#page3

"Washington Emergency Department Opioid Prescribing Guidelines1. One medical provider should provide all opioids to treat a patient’s chronic pain.2. The administration of intravenous and intramuscular opioids in the ED for the relief of acute exacerbations of chronic pain is discouraged.3. Emergency medical providers should not provide replacement prescriptions for controlled substances that were lost, destroyed or stolen.4. Emergency medical providers should not provide replacement doses of methadone for patients in a methadone treatment program.5. Long-acting or controlled-release opioids (such as OxyContin®, fentanyl patches, and methadone) should not be prescribed from the ED.6. EDs are encouraged to share the ED visit history of patients with other emergency physicians who are treating the patient using an Emergency Department Information Exchange (EDIE) system.7. Physicians should send patient pain agreements to local EDs and work to include a plan for pain treatment in the ED.8. Prescriptions for controlled substances from the ED should state the patient is required to provide a government issued picture identification (ID) to the pharmacy filling the prescription.9. EDs are encouraged to photograph patients who present for pain related complaints without a government issued photo ID.10. EDs should coordinate the care of patients who frequently visit the ED using an ED care coordination program.11. EDs should maintain a list of clinics that provide primary care for patients of all payer types.12. EDs should perform screening, brief interventions and treatment referrals for patients with suspected prescription opiate abuse problems.13. The administration of Demerol® (Meperidine) in the ED is discouraged.14. For exacerbations of chronic pain, the emergency medical provider should contact the patient’s primary opioid prescriber or pharmacy. The emergency medical provider should only prescribe enough pills to last until the office of the patient’s primary opioid prescriber opens.15. Prescriptions for opioid pain medication from the ED for acute injuries, such as fractured bones, in most cases should not exceed 30 pills.16. ED patients should be screened for substance abuse prior to prescribing opioid medication for acute pain.17. The emergency physician is required by law to evaluate an ED patient who reports pain. The law allows the emergency physician to use their clinical judgment when treating pain and does not require the use of opioids."