Friday, September 14, 2007

More on Drug Seekers

In a recent post I talked about how certain online depictions of the "drug-seeker" have taken on the characteristics of an urban legend. While I stand by my remarks, I want to make it clear that I do recognize that drug seekers actually exist, and that they can cause a lot of headaches for doctors and nurses, particularly at times when there are real crises going on. But urban legends are not necessarily completely false; sometimes they are based on actual events or have a grain of truth to them, but they rise to the status of urban legend when that truth gets blown way out of proportion or becomes a self-fulfilling prophesy as confirmation bias sets in and people who are guilty of nothing but displaying one or more characteristics associated with drug-seekers find themselves branded and denied treatment. The reality of drug-seeking has clearly been grossly exaggerated, and due to the problem of confirmation bias, any evidence that a particular person or group of people may not be drug-seekers is discarded, and any "evidence," no matter how tenuous, that the same person or persons are drug-seekers gets reinforced and exaggerated. Confirmation bias is, of course, the basis of bigotry.

But like anything else, there are two sides to every story. We have doctors saying they are inundated with drug seekers, and cp'ers saying they are being falsely accused of drug-seeking and denied treatment as well as being blacklisted. I know without the slightest doubt which of these two events constitutes the greater crime, with denial of treatment being utterly barbaric and drug-seeking amounting to a nuisance, but my opinion on the validity of either viewpoint naturally tends to be biased towards the experience of cp'ers because that is what I know, and because I have experienced what they talk about myself.

But in a recent Usenet debate where I had posted my article "Drug Seekers: an Urban Legend?", a poster named Trisha provided what I thought were very balanced responses to some of my comments which I think are worth repeating here. Trisha has the unique perspective of having been a nurse for many years and experiencing drug seekers firsthand, as well as being a chronic pain patient and experiencing the problem of being falsely accused of drug-seeking and treated contemptuously by the medical profession. I feel her comments provide a much-needed perspective from the middle ground. The comments with the > thingies are mine:

"Even with a letter from my neurologist and approval from my pain management specialist, I've been refused care at an emergency room locally because they thought I was drug-seeking. Never mind that I have documented allergies to NSAID drugs, and that I'm already on Methadone for my pain....they offered me Toradol, an NSAID, or nothing. They said they'd call the neurologist and talk to him, but they weren't changing their minds. Then they had the balls to bill me for "services rendered." What services? The laughing and talking behind my back they didn't think I heard? The snide comments? The implication that I wanted to get stoned? The suggestion that even with a pulse of 136 and a blood pressure of 147/110 I wasn't in pain? Sure. Let me run right to the bank and get your money. Okay. NOT!

> Viewing so many people as drug
> seekers is really the result of ignorance and bigotry, and is
> unscientific. But to treat everyone contemptuously and to deny
> treatment to people on the basis of one's experiences with a handful of
> people is simply uncivilized.

I'm trying to think of how to put that it makes sense to someone but me...
If you go to a place, any place, and there are 586 people acting well, and behaving, and being civilized and such, and one creep is a blathering drunk, yammering at the top of his/her lungs, making inappropriate comments, falling over things, reeking like a brewery... At the end of it all, are you going to remember the 586 well-behaved people, or the jerk? What sticks out more in your memory? "Hey, remember the time we went to ------ and there was that one guy falling all over the place? What an idiot!"

It's not really ignorance. It is bigotry. I will agree with that. It's the cumulation of outstanding and memorable experiences. As an oncology nurse I witnessed the death of hundreds of people, but only a handful stand out in my mind 10 years after leaving that field. They were different. Mostly good different, but different nonetheless.

I agree it's uncivilized, but our society seems to be heading in that direction anyhow. Witness road rage. Where has traffic courtesy gone? How about the Visa commericals where people paying with cash are looked at as holding the line up? It's not so much about being kind or considerate any's each man/woman for themselves, and, yes, that has invaded healthcare just like everything else, and it sucks. I can't argue that point. It also sucks when I go to the grocery store and the cashier acts like she's doing me a favor by ringing up my groceries, forgetting that it's the shoppers that pay her wages. It stinks when someone in a big old nasty Navigator or Hummer thinks that because they are in that behemoth on wheels that screams, "I'm rich and you're not!" and I'm driving a (gasp!) used minivan that they have the right to cut me off, whip in front of me and slow down, or weave into my lane, all the while gabbing on the cell phone, reading the newspaper, and yelling at the kids watching a DVD or 3 in the back seat because they don't have enough time to spend with their kids and choose instead to pacify them with things.

> I suspect there are
> a helluva lot more crooks and creeps in the medical profession,
> percentage wise, then there are drug addicts among cp'ers.

Again, point taken. However, the loud obnoxious ones are the ones that make an impression, and they taint the memory and attitude, and it rolls over to the next person in chronic pain, and if you're already overstaffed and having a bad day, you get cranky and short and take it out on someone who doesn't deserve it. I'm not justifying it. There is no justification. None at all. We need to take each and every person at face value. But we don't. And it's not the good nurses and doctors that get the's the jerks and idiots and creeps that treat people like objects that make the news. I know lots of nurses, including myself when I was still able to work, who treat(ed) patients in pain with dignity and humanity and respect. There are many, many of them out there who truly care about a patient who is hurting and who do whatever they have to do to get the pain under control, even if it means fighting with an arrogant doctor at 3 in the morning until he gives the order for the medication the patient needs. And yes, I've done that. I've gotten docs so mad they got out of bed and came in to see for themselves that I was telling the truth. That doctor ate his words because he had nicked the patient's liver during surgery and I saved his life because he was bleeding to death. But do you hear about those nurses? Nope...not often enough. You hear about the ones who act like they never learned a social skill in their lives.

The whole thing sucks. I can't agree more. However, my original point stands...there are, indeed, drug-seeking patients, and they raise hell till they get what they want, and they hospital-hop, and the docs will eventually treat them to shut them up, and they are the ones that leave the impression on people and make them wary of dispensing pain medication to people who truly need it for relief and not for a buzz or a high. It's not right. I won't argue that. But that's how it goes.


Trisha, feeling crappy again (or is that still?)"


Legend said...

Hi. This seems to bring up a whole new issue; "pain-relief seeking etiquette". And, it seems that it applies in the ER, most of all!

I wonder how a person, coming in with a calm demeanor, a willingness to wait, and, even an attempt to hide the physical changes in appearance and attitude that pain gives, would be treated. Most likely, like another person in the room!

If certain behaviors are reinforced, it's only natural to go back to it. And avoid unsuccessful behaviors like the plague!

Oh, well...I guess it's best just to avoid ER's like the plague! said...

Before my doctor moved, I had not been in an ER in approximately ten years! The one time I went before finding my doc, they routinely phoned all of the pharmacies to see if you were getting drugs from several places. I was informed that I passed that test, but that they do not give shots, other than toradol etc for migraines. It was more important for me to wait 6 hours while they tried to catch a drug seeker before informing me of this policy. I had never been treated like that in the past, and
do my best to avoid their over priced, and inadequate treatment.

Tricia you've definately been one of the GOOD nurses! I see that you too have bad reactions to N-saids,
aspirin and other meds in that catagory. Imagine my surprise to learn that the documented TRUTH about that is one of the worst things you can tell a new doctor, or an ER staff! What are we to do,
LIE and say we can take them since this is apparently considered to be one of the absolute "drug seeker statements", which helps them thin us from the herd.
They're doing that nicely with lack of treatment already.
Thanks for the chance to rant.

Anonymous said...

I have seen a psychiatrist for the last year and was diagnosed by my physician with bipolar disorder. I was prescribed Risperdal, and a low dosage of Xanax. For a year, I have received 60 xanax (25 MG) pills in addition to 400 mg of Lamictal. My physician recently increased my dosage of Xanax (after having a house fire) to 90 25 mg (hopefully I am saying this correctly) pills. The prescription she wrote indicated no refills--refills require prior authorization. In my patient chart, she wrote that she had written a script for 3 refills. Yesterday, I called CVS Pharmacy to refill my prescription of xanax.....they contacted my Psychiatrist, who denied my request indicating that she had written the script for 3 refills. Sherry, the head pharmacist at CVS sent my psychiatrist a scanned copy of my prescription indicating that she had written "all refills require authorization:....but my psychiatrist still refused the refill. I recognize that Xanax is a controlled substance, but my doctor will not return my, nore my pharmacist's phone calls to refill my Xanax script again stating that she wrote a script for 3 refills. I have no "drug seeking" background and have always had a good rapport with the physician but communication has ceased with my psychiatrist and her staff. Does anyone have any ideas how to deal with this? The answer is so logical -- and CVS, where I dropped off the original script has confirmed what I said. I want to fire my doctor.....but I don't want to go to a new psychiatrist and be labeled, once he or she calls my existing psychiatrist as a "drug seeker".....does anyone have any advice on this or how to present this to a new psychiatrist? Kansas City has such a small mental health care provider community..this whole thing is silly....I have been without Xanax for ten days....I'm ok with it, but still I want my existing psychiatrist to acknowlege the mistake versus putting me in a database for "drug seeking behavior"......any thoughts and direction would be greatly appreciated. Thank you -- Lawrence

Anonymous said...

I've had to "hospital hop" to get even minimal treatment. It's humiliating enough to have to do that; getting caught is like a conviction with evidence that you're a "scumbag addict." Me, I've got - and taken with me into ERs - decades of CT scan films, MRIs in film and CDs, POUNDS of medical records of every test there is and clinic visits, drug tests, you name it.

Even so, to see a new doctor or, especially, an ER doc, is to stand trial. I have over a decade in the medical field, no police record of any sort, I was a professional level athlete (rock climber, tennis, a lifelong martial artist, etc.), a volunteer resource for mushroom poison cases from a state mycological society through the Poison Control Center, I've played piano for the local senior center and the nursing home...

None of it makes a difference. After all, everyone knows that anyone can be an addict. I'll leave going into an ER until I almost can't get there (and a few times I've miscalculated and WAS unable to get there), it's such a horrible experience. And I dread actually being hurt in an accident. My sixth and last back operation (so far), the neurosurgeon said I was already taking FAR more than he prescribed for post-op pain, so I got nothing for it. Two weeks of post-op recovery time with no pain meds for that added pain. A pain regimen works for the chronic pain. It does NOTHING for added pain. If I slam my hand in a car door I feel it just as much as anybody else.

America has become a savage, bigoted, ignorant place more interested in punishing than helping, and if that means punishing one "Bad Guy" AND a thousand innocents to "get" the one "Bad Guy", well, it's worth the price. Unless you're one of the innocents.


Payne Hertz said...

What many people who rationalize this kind of treatment of people in pain don't realize is that one day, it might just be you who is enduring this abuse. You are but one slip and fall away from realizing that no matter what were you were in your previous life, in your new chronic pain life, you are likely to be treated as a faker, a weakling or a "scumbag addict."

We have become a hostile and uncaring society, where compassion is frowned upon and any sign of human weakness or imperfection is swiftly judged and harshly punished. Sadly, the medical profession is particularly infected with this way of thinking.