The Dark Side of Pain Management: Handling Drug-Seeking Behavior
Prescription pain medication is central to most pain management plans, and most patients who ask for pain medication truly need it. But some patients who need pain relief may also be struggling with drug addiction. Others may only pretend to have pain or exaggerate in order to obtain a prescription for pain killers. How can you tell the difference?
You can find many clues in the patient’s behavior, according to Sandy Zuggi, RNC, CARN, CAC, program coordinator for the Methadone Program at Community Hospital. Signs of addiction include agitation and overall uncooperative and demanding behavior. Physical signs may include dilated or pinpoint pupils, track marks and tremors. Someone who is in withdrawal will probably be perspiring and have clammy skin, nausea and diarrhea.
Trust Your Instincts
One sign of drug-seeking behavior is a patient who asks for prescription medication out of proportion to their pain symptoms, or who seems to be exaggerating the problem. “One patient asked for a prescription for 30 Vicodin tablets for sunburn,” recalls Zuggi, a 32-year nursing veteran who spent 12 years in emergency nursing before moving into the methadone treatment arena. “In a case like that, it’s best to consult with the physician about offering a non-narcotic medication instead. However, a drug-seeking patient is likely to say, ‘I’ve tried that before and it didn’t work for me. Can’t you give me something stronger?’ It’s important to trust your instincts. If something seems amiss, ask more questions before acting on the request.”
If you suspect drug-seeking behavior, Zuggi recommends that a non-narcotic pain reliever such as ibuprofen be ordered and the patient be referred to his or her family physician for follow up. “If you feel that the pain may warrant a narcotic, the prescription should be limited to just a few doses so the patient will have to follow up with the family physician for more,” she says. “Also, be careful to keep all prescription pads secure!”
An inpatient with drug problems may ask for pain medication much sooner than it is scheduled. The patient may also complain about being anxious or unable to sleep in order to get anti-anxiety or sleep medication. “These patients usually have a sense of entitlement and want their demands met immediately,” says Zuggi. “In some cases, the patient may persuade friends or family to bring drugs when they visit. If you suspect a problem of this nature, keep an eye on visitors.”
It is also advisable to obtain routine urine drug screens from the patient to ensure that no drugs are present other than those ordered, according to Zuggi. Best practice calls for a baseline urine drug screen on all patients when they are first admitted.
Some patients who genuinely suffer from pain fear that they will become addicted to narcotic pain medication. The risk of addiction generally increases after a patient has been taking a significant amount of pain medications for 4 to 6 weeks, according to Zuggi. At that point, it is advisable to refer the patient to a pain management clinic where alternative interventions can be explored. A physician can help wean the patient off narcotic medications slowly and safely.
If a patient admits up front that he or she has been in a drug treatment program, contact the program immediately for guidance regarding acceptable pain management modalities.
For more information. . .
Use the links below to access articles about drug-seeking behavior via EBSCOhost. If you need a user name and password, contact Judy Ziegler at firstname.lastname@example.org or 15-2601 to request them.
Pavlovich-Danis S, Rush D. Continuing education: recognizing drug-seeking behavior. HT: The Magazine for Healthcare Travel Professionals [serial online]. September 2000;8(2):38-41. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 16, 2010.
Florea J. Cutting-edge discussions of management, policy, and program issues in emergency care. Managing drug-seeking behavior. JEN: Journal of Emergency Nursing [serial online]. August 2007;33(4):393. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 16, 2010.
McCaffery M, Pasero C. Pain control. Stigmatizing patients as addicts: 'drug-seeking behavior' may simply signify the need for more effective pain management. American Journal of Nursing [serial online]. May 2001;101(5):77. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 16, 2010.
Henderson S, Stacey C, Dohan D. Social stigma and the dilemmas of providing care to substance users in a safety-net emergency department. Journal of Healthcare for the Poor & Underserved [serial online]. November 2008;19(4):1336-1349. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 16, 2010.
Trafton J, Oliva E, Horst D, Minkel J, Humphreys K. Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment. Drug & Alcohol Dependence [serial online]. 2004 Jan 7 7, 2004;73(1):23-31. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 16, 2010.