[Separated] Give drugs to drug seekers

[DrankTheKoolaid]

"2mgs of morphine is enough"

Amazing how much of a struggle it has been to get people to treat pain at my service, thankfully all but 1 or 2 have come around. "But they looked fine"
or "I could live with that pain" or "He got better while enroute" is the typical excuse while still noting 8/7/6 - 10 pain in the VS .......

But in time they will leave the darkside and join the force! Or find employment elsewhere... whichever comes first.

 

[DesertMedic66]

Patient rates pain at a 10 out of 10 but yet are still smiling and no issues moving. Then you follow that with the wonderful 10ml preload of the "pain medication" saline. Their pain magically drops to a 1 or 2.

 

[usalsfyre]

^^^Horribly unethical...

I've never understood WHY people care about giving meds to drug seekers. Your withholding them makes no difference at the end of the day.

 

[Remeber343]

^^^Horribly unethical...

I've never understood WHY people care about giving meds to drug seekers. Your withholding them makes no difference at the end of the day.

I was discussing this the other day actually. Who are we to judge someone's pain level. We can't see it, we have to go off of what they tell us. We can observe their behavior. For example "10/10 chest pain" but the pt is laying there, legs cross, arms behind head relaxing. But who are we to say no he isn't in pain, he's just seeking meds.

On the other hand, I kind of think that drug seekers should get the 10ml NS. Just to show the ER that the pt is full of crap and is just using the system. But as I said before,who are we to judge.

 

[Sasha]

I was discussing this the other day actually. Who are we to judge someone's pain level. We can't see it, we have to go off of what they tell us. We can observe their behavior. For example "10/10 chest pain" but the pt is laying there, legs cross, arms behind head relaxing. But who are we to say no he isn't in pain, he's just seeking meds.

On the other hand, I kind of think that drug seekers should get the 10ml NS. Just to show the ER that the pt is full of crap and is just using the system. But as I said before,who are we to judge.

How does it affect you? Give them drugs. I would rather give drugs to ten drug seekers than withhold from someone truly in pain.

Don't ever lie to your patient about what you are giving them.

Sent from LuLu using Tapatalk

 

[Remeber343]

Who said anything about lying?

 

[Remeber343]

And if you read what I said, who are we to judge.

 

[DesertMedic66]

^^^Horribly unethical...

I've never understood WHY people care about giving meds to drug seekers. Your withholding them makes no difference at the end of the day.

How is it unethical? I never said that we withheld the pain meds. After the 10ml flush their pain goes away so there is no need for pain medication. If they want pain medication then they are going to get pain meds. If they say they are in pain they are more then likely going to get pain meds (up to the medics).

 

[DrankTheKoolaid]

re

Back in the days of working as an ER tech I once asked the head of the ED MD group why he gave obvious drug seekers medications.

His answer that has stuck to this day and always will was "I would rather give 9 drug seekers drugs they didn't need, then withhold pain drugs from someone who truly needed them".

Who are we to be real judges of pain? Cant rely on VS, as someone with chronic pain may actually decrease there BP and HR instead of the opposite that we expect. And don't even get me started on nationalities and the way they express their pain... that's a whole can of worms there.

 

[Sasha]

And if you read what I said, who are we to judge.

And then you said they should give them the saline to prove what a liar they are.

It's lying to mislead a patient into believing that you are giving them pain meds when you aren't.

Sent from LuLu using Tapatalk

 

[Remeber343]

And who said its lying. You can tell them. They aren't going to know why the difference is. What I'd like to happen and what I do are two different things.

 

[usalsfyre]

How is it unethical? I never said that we withheld the pain meds. After the 10ml flush their pain goes away so there is no need for pain medication. If they want pain medication then they are going to get pain meds. If they say they are in pain they are more then likely going to get pain meds (up to the medics).

Your administering a placebo in place of real medication. Look up the Tuskegee Syphilis experiment to see the slope this can lead down.

 

[DesertMedic66]

Your administering a placebo in place of real medication. Look up the Tuskegee Syphilis experiment to see the slope this can lead down.

I say it's 10ml of saline. That's all I say. If it makes their pain go away then that's all them. I don't tell the patient it's any sort of pain med.

 

[Shishkabob]

While I'm an outspoken proponent of anagesia and am happy to be called "Candyman" by the amount of Fentanyl I give out... let's be honest here.


10/10 (or more) pain will manifest itself in some outward way. If someone says they're 10/10 (or my pet peave, 11+/10) and there is no other possible way to show (even as little as a small facial grimace) aside from them just saying "10", I'm going to doubt they understood my directions, or failed kindergarten math. 10 is the wrost you've ever been in, EVER. I've yet to see someone in true 10/10 pain that weren't on the verge of crying/screaming out, if not already there. I don't care how much 'tolerance' for pain you have, 10/10 will do SOMETHING to you.

If you say 12/10 abd pain, cramping, and you jump up and walk to me with a smile on your face... yeah, I'm calling a spade a spade. I won't ever doubt someone is in pain... doesn't mean I can question the number they give me to myself.




But just because I don't believe them, I never said a word about withholding. ($10 says someone is going to ignore that last tidbit and jump in with a "It's not your job to believe" or some crap of that nature)

 

[the_negro_puppy]

^^^Horribly unethical...

I've never understood WHY people care about giving meds to drug seekers. Your withholding them makes no difference at the end of the day.

How does it affect you? Give them drugs. I would rather give drugs to ten drug seekers than withhold from someone truly in pain.

Don't ever lie to your patient about what you are giving them.

Sent from LuLu using Tapatalk

I never withold pain meds, but I can't help but think that if drug seekers weren't given opioid analgesia by EMS and ED staff, then they would stop calling 911?

There has to be a way of stopping the repeating cycle. Why would anyone in my state try to buy drugs on the street / commit crimes to pay for them, when they can call 000 (911) get an ambulance straight away, lie to receive opioids, lie to the hospital and not get charged a single penny.

 

[Shishkabob]

At some point, the hospitals, and potentially the EMS agency, will put the patient on a no-treat list. (If the hospitals and agency are progressive enough)



I know of several patients in my service area who some hospitals refuse to see, and several more who have no choice in which hospital they get taken to. If they don't want to go to the one they're being taken to, they get refused by the agency.


I also knew of one patient at my last agency who I ran on constantly who a big hospital absolutely refused to see the patient any longer.

 

[BandageBrigade]

They may refuse to give pain medication or any non lifesaving treatment, but they cannot refuse to examine a patient.

 

[medicsb]

Comparing the administration of saline to the Tuskegee experiment is a bit hyperbolic... sayin'.

But, what should be pointed out (if it already has, then I apologize) is that one is NOT necessarily "proving" that someone if "faking" (or whatever) by administering saline/placebo for pain. It raises the potential that they are a placebo responder, as are many people here (statistically speaking). Something like 1/3 of people will respond to placebo for treatment of pain. It does not mean that they were not experiencing pain.

Anyhow I don't think it is wrong to withhold IV narcotic analgesia if your H&P tells you it may be inappropriate. If someone tells me 10/10 and is able to hold a conversation, laugh, etc., then I do not think that they are experiencing the worst pain ever (not saying that I don't think they are experiencing some degree of pain). The problem with EMS analgesia is that it is "all or nothing". Many pain complaints could be managed just fine with PO narcs, NSAID, an ice pack, or, god forbid, placing them in a position of comfort. I've had patients rate their pain 5 or 6 and obviously in distress due to pain, and I've treated them. And conversely I've had a few tell me 9,086,987/10, who, if I had no way of getting a number from them, I would assign a "wong-baker" faces score of 1 or 2, and yes, in the prehospital setting, I triaged some of them to BLS. So, put me in the group that uses the pain rating as just one component of the H&P that is integrated with any other findings to determine a treatment disposition. Just because they say 10, or anything else, doesn't mean they NEED (or do not need) IV analgesia.

 

[adamjh3]

While I'm an outspoken proponent of anagesia and am happy to be called "Candyman" by the amount of Fentanyl I give out... let's be honest here.


10/10 (or more) pain will manifest itself in some outward way. If someone says they're 10/10 (or my pet peave, 11+/10) and there is no other possible way to show (even as little as a small facial grimace) aside from them just saying "10", I'm going to doubt they understood my directions, or failed kindergarten math. 10 is the wrost you've ever been in, EVER. I've yet to see someone in true 10/10 pain that weren't on the verge of crying/screaming out, if not already there. I don't care how much 'tolerance' for pain you have, 10/10 will do SOMETHING to you.

If you say 12/10 abd pain, cramping, and you jump up and walk to me with a smile on your face... yeah, I'm calling a spade a spade. I won't ever doubt someone is in pain... doesn't mean I can question the number they give me to myself.




But just because I don't believe them, I never said a word about withholding. ($10 says someone is going to ignore that last tidbit and jump in with a "It's not your job to believe" or some crap of that nature)

Going off of this, how do y'all document the pain scale? I don't really like using the 1-10 scale as that is very subjective and is often not accurate at all.

With the kids I see at my stand by job I generally don't even ask for a scale and document it as I see it and how they react to my assessment. Palpate an injury and they scream: "severe pain." They wince with a little groan: "moderate." They say "it hurts" but show no outward signs of discomfort? "Mild/minor"

 

[medicsb]

Going off of this, how do y'all document the pain scale? I don't really like using the 1-10 scale as that is very subjective and is often not accurate at all.

With the kids I see at my stand by job I generally don't even ask for a scale and document it as I see it and how they react to my assessment. Palpate an injury and they scream: "severe pain." They wince with a little groan: "moderate." They say "it hurts" but show no outward signs of discomfort? "Mild/minor"

I will document the the patient's rating and then document a Wong-Baker faces scale (applicable for all ages) and qualify it with a description of the patient at the time of assessment and their vital signs.