How Do You Handle Patients Addicted to Prescription Pain Killers?

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First Do No Harm: the bedrock of quality health care.

Have you seen this great, very useful piece from Nurse Eye Roll on prescription pain medication abuse? Prescription medications kill more Americans each year than only illegal drugs combined.

It’s well worth your time:

How Do You Handle Patients Addicted to Prescription Pain Killers?

Of course, there are also people in serious pain who don’t get the relief they deserve sometimes, out of concern for abuse. It happens. Pain is invisible, and we have no particularly reliable ways to assess it. There are no easy answers in this area, clearly, and the stakes are quite high. Yet most nurses have no choice: we have to deal with it as best we can.

I’m seeking for other links on this topic to add here:

Beth Hawkes offers: How To Cope with Patients Who Have a Substance Abuse Disorder

I’d appreciate any thoughts or experiences – Greg


  1. I have a chronic disease that causes me severe pain. My illness also makes it difficult to absorb oral medication. I have just about 3 feet of small bowel, no large or colon. I go to pain management and chose one who’s in my “group” of doctors so they’re all on the same page. Pain management prescribed me fentanyl patches and I’m given dilaudid (2mg, 3 per day–as needed) for breakthrough pain. I often go to an infusion clinic for “rescue” hydration and I’m given nausea and pain meds IV. I ask the nurses to dilute the pain med (2 mg Dilaudid) and they also give it slowly–they even keep their eye on their watch as they push the med. I have excellent relief from the pain and no high.
    However, when I’ve been hospitalized and get the same IV pain med, the nurses push it so fast, it really messes with my head. I don’t enjoy that feeling. I bet those who are “drug seekers” or addicts love those nurses who push the med too fast. Maybe the nurses in the hospital are too busy to sit and push the med slowly. I don’t know. It’s something I constantly have to ask them to do (“Push the med slowly, please.) and I thought pushing those pain meds slowly was some kind of protocol. I’ve had a few who seem a little annoyed by my request. I have other nurses who have no problem doing that at all–and even seem in disbelief. And they always take a liking to me because I guess they can tell I’m not seeking drugs for a high. I want to relieve my pain! Once they take the time to talk with me and learn my medical condition and history, they’re the ones who come to me when it’s med time and ask if I need it yet. They tell me it’s not good to wait until the pain is extremely bad because I may not get the same relief. I tend to wait because I always have this feeling I’m bothering the nurses. Something I’m working on! 🙂
    I once had a roommate who I could hear on the phone saying how she was “only” allowed 1 mg of dilaudid and she was asking this person to bring her some pills from home. I couldn’t believe it! What’s even worse is when one of her doc’s came in to talk with her, they argued about the pain med and her dose and that’s when I learned she was pregnant!!! I was beside myself.
    I’m so thankful for those nurses who show me compassion and empathy. They truly care for me and when needed, advocate for me.
    I have a great respect for nurses. It seems like it can sometimes be a thankless job yet those times when something happens where you’re able to help a patient through a tough time, I hope those rewards outweigh the more trying times.

    Liked by 1 person

    1. As medical and other sciences produce more new data daily that anyone could hope to absorb in 24 hours, let b al I NE in their spare time, we providers face a new era. Increasingly often, a patient will know know more about their condition they we do: they can specialize more than most providers ever could. Given the very mixed quality of information available to the public, and highly variable abilities to understand and sort it, we also see patients with much confidence but very poor knowledge. In either case, this rapid shift in an age old balance of power threatens and irritates many providers, especially those who have done the least work to keep up with the literature. I’ve noticed two kinds of people : those who reject and attack surprises and novelty , and those who appreciate all opportunities to learn and grow. Many nurses, especially those older and less educated and those overworked and with punitive managers, are extremely conservative : no changes allowed unless mandated from above. You’ve met a few. I’ve met many. Such thinking is common and often a strong majority in many walks of life. Fortunately not universal : otherwise humanity would remain a small fringe species in Africa alone, or extinct.

      As for pain and addiction, I see no easy answers. We have no reliable way to assess pain. Unless there is immediate harm, I’m willing to risk some abuse to avoid risking undertreatment. Others prioritize eliminating abuse. So it goes. I do enjoy my work, more than most seem to, perhaps because I don’t approach patients as problems or enemies but as people.

      Good luck to you & thanks for your thoughtful comment.


  2. That would be challenging. I think there are quite a few doctors who prescribe narcotics for things that don’t really need narcotics because they make shortcuts. I have lupus and degenerative disk disease, but I also was addicted to benzos in my 20s. My neurologist/pain management doctor kept trying to prescribe me vicoden. I told him that I don’t want to go on that and I want do do something that addresses the cause of the pain rather than covering it up. He said “Well then suffer!” I quit going to him.

    I think that what needs to be done is addressing the cause of the pain rather than covering it up with narcotics. =( And if you have a drug seeking patient, maybe refer them to a psychiatrist that specializes in addictions.

    Liked by 1 person

    1. Part of the problem seems to be the expected brevity of office visits. Not easy or likely possible to sort out what’s actually going how, let alone how to address. Simply writing a pleasing script seems a popular way to move things along.


  3. Hi Greg, I appreciate this post because I constantly run into opioid addicted patients in my practice up in Vermont. As you may or may not know, VT is more progressive with addressing treatment of narcotic addiction and has some (although limited for our current needs) treatment programs that include medication replacement (subutex or methadone) along with required therapy. Although these programs are wonderful, and I am proud of my small state for making big leaps with this nationally, it is still hard for practitioners to deal with opioid abuse and addiction. There is certainly still a stigma, not just by the general public, but also from their providers.

    I work in OB/GYN and up here in VT it can be challenging because if a woman becomes pregnant while she is taking opioids/narcotics/heroin, she can get immediate entry into a subutex/methadone treatment program in order to protect the growing fetus. I then see this women during their pregnancy and afterwards while their babies are born and it is part of my responsibility to help monitor the baby’s withdrawal symptoms and treat adequately. It is challenging and at first I was really like “wow, how can this happen”, but I understand now that addiction is a real medical condition that needs treatment just like diabetes or hypertension. Unfortunately, it gets messy when you add a newborn into the mix. I actually commend my mothers I take care of that have taken the big leap to seek treatment or who have been in treatment for years so that they can help their babies be born as comfortably as possible. Part of the issue is admitting the problem and seeking help. I find the mothers that have been in treatment for awhile, although they experience stigma from the outside community, have strong ties to the medical community and are willing to do whatever it takes for their baby. Of course, I see all ends of this spectrum, and it can be very sad.

    I recently took care of a woman who was on something like 20mg oxycodone every four hours around the clock during the last three months of her pregnancy due to some postop-pain. She had the baby and requested /required to be on the same dose PLUS a 10mg dose for breakthrough pain. At this point, I was really curious why her provider continued to prescribe this during her pregnancy at such high doses and at what point does someone have the discussion with her about the consequences of physical dependance and addiction? I ended up having to send her baby up to the neonatal intensive care unit because it was scoring high on the withdrawal scoring protocol due to the fact it was used to such high levels of opioids in its blood stream while in utero , which was suddenly halted once he was born. It was sad and it was really hard to deal with and the family was in denial. The mother and father didn’t want anyone in their family to know about the pain meds or the neonatal abstinence scoring so the nursing and medical staff felt we had to tiptoe around the issue. The parents asked me if they could use a “white lie” to tell their family why the baby was in the NICU… It was hard for me. I told them that they have the right to keep their medical information confidential and can just say the baby needs extra monitoring up there that we cannot provide in the normal newborn nursery, but ultimately it was their choice what they said and the medical staff cannot give any information to them without consent.

    At the end of that shift I was really in a somber mood. I see some really good outcomes with patients working hard to get treatment and turn their lives around to provide the best possible life for their children, and then I see patients like the one I just described who are either in denial, or just don’t understand the severity of the issue.

    Its challenging. Opioid addiction is a very scary and real thing. I couldn’t NOT medicate her because pain is subjective and she probably was in pain… but at the same time I felt like I was feeding into her addiction and contributing to the problem at hand.

    Liked by 1 person

    1. It’s tough, very tough! As I have read, we tend to trade guns from VT for opiates from urban areas, but that doesn’t account fo rthe largest source of opiates, all legal. It’ sso tough, isn’t it, when you inherit the poor decisions of prior providers who just wanted to move things along regardless of consequences? I blame fee for service on that one. Providers get paid far better to do the wrong thing than to slow down the assempbly line a bit. Money talks, many providers do whatever money says. Too bad! When temptation is a problem, it seems clear to me the answer is to eliminate the temptation, but what do I know? Thanks for your very thoughtful response – Greg

      Liked by 1 person

  4. I was on narcotics for years. It started at my induction and I didn’t come off it until a couple months ago. Only ever got physically addicted though, because I never used recreationally. Physical addiction is just a matter of getting through withdrawals. If people don’t use recreationally, then their pain needs should be met without question. Especially in a controlled seeing like a hospital.

    Liked by 1 person

    1. The problem is that providers don’t have that kind of information in many cases. Abuse (by patients) and neglect (by providers) can both be problems. I have no answers, just concern. I work inpatient, we don’t often start opiates but often continue them, try to taper them when we can. It’s a conundrum! Especially when MOST of the deaths and other harm comes form legal prescriptions, not drug dealers. Perhaps a change in priorities is in order. Thanks – Greg

      Liked by 1 person

  5. Opiate based painkillers are among some of the most dangerous drugs out there, legal or illegal. Physiologically speaking, you are addicted to them within a couple of weeks, which is well within the normal standards of prescribing them after surgeries. I’ve known plenty of people professionally and personally that made the switch from heroin to painkillers because they were so much easier to find and the quality was consistent. I just try to remain empathetic – none of us know if there is something out there that we have the potential to become hopelessly addicted to. The unfortunate part about opiates is that pretty much everyone is prescribed them at some point or another, so you are screwed if that’s the thing that flips the switch…

    Liked by 1 person

    1. You’re right about the switch. I took opiates for a broken clavicle years ago that cause INCREDIBLE pain. Hard to breathe. The meds were essential, and I hated every dose: no euphoria, just feeling wierd and sweaty and constipated. My luck! Others have different luck. Some people, though, I know from experience, tell the story that they were innocent victims of prescribers when actually, they were abusing from the forst dose. No easy answers.

      Liked by 1 person

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